bluuebunny/crossref_metadata_2025 huggingface dataset:
ABDOMINAL WALL PSEUDOHERNIA
Authors: Chamzin A , Theodoropoulos C , Galyfos G , Triantafyllou A , Saliaris K , Michalopoulos N V , Toutouzas K G , Theodorou D
Published: May 2024

Background

Latrogenic, traumatic, infectious or any other pathologic reason causing temporary or permanent denervation of a segment of the muscle of the abdominal wall may result in a protrusion of a group of muscles clinically evident as a hernia, but if there is no muscle or fascial defect, then it is categorized as pseudo hernia.

Aim

To report a case of a 53-year-old man with a history of Multiple Sclerosis (MS) and scoliosis who presented for evaluation of a painless protrusion of his left abdominal wall flank with exacerbation on upright position. Abdominal computed tomography did not reveal any herniation of abdominal contents, but magnetic resonance imaging of chest and abdomen showed a protrusion of a herniated soft disc at the T11–T12 neural foramen. Rest and non-steroidal anti-inflammatory drugs were prescribed, and the patient was followed for six months with resolution of his pseudohernia.

Conclusion

This case presents a rare instance of abdominal pseudohernia due to T11–T12 radiculopathy. Though MS is characterized by central nervous system, there are some references for peripheral nerve damage. In our case, due to the temporary feature of denervation and the complete restoration of function, there is no doubt that radiculopathy was the cause.
MANAGEMENT OF ACUTE PRESENTATION OF LEFT PARADUODENAL HERNIA WITH SPONTANEOUS REDUCTION
Authors: Chamzin A , Theodoropoulos C , Galyfos G , Triantafyllou A , Ioannou T , Michalopoulos N V , Toutouzas K G , Theodorou D
Published: May 2024

Background

Left paraduodenal hernia is an internal hernia developed due to the prolapsed small bowel through the fossa of Landzert and is usually presented as acute abdomen or bowel obstruction. This abstract is about a case report of a patient with signs of strangulated left paraduodenal hernia.

Methods

A 32-year-old female presented with acute reccurent abdominal pain. Investigations with an enhanced CT scan showed crowding of small bowel loops in the left paraduodenal area, twisting of mesenteric vessels and mild dilatation of small bowel loops, signs suggesting possible internal herniation.

Results

The CT scan is showing the initial presentation with signs of internal herniation and the subsequent MRI shows spontaneous resolution. Due to mild symptoms of the patient we proceeded to an exploratory laparoscopy to exclude sings of intestinal ischemia. Exploratory laparoscopy did not reveal any signs of ischemia and confirmed the prevalence of the fossa of Landzert, that was managed by widening the orifice of the herniation site.

Conclusions

Strangulation and incarceration can occur in up to 64% in paraduodenal hernia, so exploratory laparoscopy could be an adjunctive tool in excluding intestinal ischemia, verifying the site of herniation even in cases of spontaneous reduction and repairing the orifice to prevent recurrence.
LAPAROSCOPIC SOLUTION FOR AN UNEXPECTED FINDING IN AN INCARCERATED FEMORAL HERNIA, FIRST CASE PUBLISHED
Authors: Díaz Pérez D , Serrano González J , Reyna-Villasmil E , Hernández Bartolomé M A , Colao García L , Esteban Agustí E , García Val T , Chavarrías Torija N , Galindo Jara P
Published: May 2024

Aim

Femoral hernias (FH) are relatively uncommon, comprising <2% of all hernias and 2–8% of all inguinal hernias. More common in women and frequently associated with incarceration/strangulation. Different contents in the hernial sac have been described in the literature, but the ileum accompanied by the adnexa (fallopian tube+ovary, FT/O) has never been described before.

Material and Method

Case and literature review.

Results

62-year-old woman with 48 hours of vomiting and non-reducible right inguinal hernia. Normal blood test and obstruction-patternt x-ray. Exploratory laparoscopy was decided, finding FH with an ischemic intestine in the crural orifice and, unexpectedly, herniated FT/O as well. The elements were reduced – they were viable – and repaired using TAPP with tetanized-low-density-PLP mesh. The course was uneventful and asymptomatic.

Conclusions

The FH appears inferior to the inguinal ligament, between the Gimbernat and the femoral vessels. Its size and ligamentous-anatomy facilitate incarceration. That they contain the adnexa represent <3% and always in pediatric age associated with genital-anomalies. There are <15 published reports of adult FH with incarcerated FT/O. The concomitance of intestine+adnex has not been previously published. Traditional treatment considers the anterior inguinocrural way, but we prefer the laparoscopic-approach to verify intestinal viability and, in this case, discover infrequently herniated organs. Avoids double incisions (Gregoire+laparotomy) in case of resection and accidental reductions without visualizing the hernia content. The posterior approach is an excellent tool that every emergency-surgeon must control, and in this case, it allowed us to describe – and resolve – the first published case of an atypical hernia.
LUMBAR HERNIA, A BIG UNKNOWN. CASE SERIES ON AN EXPERIENCED ABDOMINAL WALL UNIT
Authors: Dominguez Bastante M , Fernandez Baeza M , Santidrian Zurbano M , Mansilla Rosello A
Published: May 2024

Aim

Primary lumbar hernia or lumbar incisional hernia (LIH) is a rare pathology. It can cause serious quality of life problems or complications such as intestinal obstruction. Its management is complex, conservative treatment is being recommended in many centers. The objective is to describe our series of lumbar hernias/LIH.

Material and Methods

LIH and primary lumbar hernias operated by during 2019–2023. We have analyzed demographic and intervention-related data. The minimum follow-up has been 8 and the maximum 50 months. Morbimortality (Clavien Dindo classification), reinterventions and recurrences have been analyzed.

Results

100% of primary lumbar hernias and LHI seen in the out patient clinic were operated (8 patients). Demographic and intervention-related characteristics are described in Table 1.Aetiology Primary1 (12.5%) LHI7 (87.5%)Medium BMI (kg/m2)33.1 +/- 7.1Medium CeDAR (%)29.8 +/- 19Gender Male5 (62.5%) Female3 (37.5%)Medium age (years)54.6 +/- 17.6Prehabilitation Botulinum toxina3 (37.5%) Progressive pneumoperitoneum1 (12.5%)Clasification L47 (87.5%) M1M2M3L41 (12.5%) W26 (75%) W32 (25%)Surgical technique Preperitoneal5 (62.5%) HemiTAR2 (25%) Carbonell1 (12.5%)Medium stage (days)6.3 +/-4.3Complications  I (haematoma)1 (12.5%)  II (superficial surgical site infection)2 (25%)

Polypropylene meshes were used in all patients, 3 cases a long-term resorbable biosynthetic mesh was added. No reinterventions or recurrences have been recorded.

Conclusions

According to our results, repair with large meshes has a low rate of complications and no recurrences, which is why we recommend the intervention in experienced units.
A NEW ETIOLOGY SEMILUNAR LINE DIASTASIS AND POSSIBLE RELATION TO RECTUS DIASTASIS
Authors: Dudai M , Ganiem M
Published: May 2024

The guidelines for Rectus Diastasis (RD) of the European Hernia Association published in 2019, created the clinical basis for the diagnosis and treatment. There is no reference in the guidelines or in the medical literature to the situation of Semilunar Line Diastasis (SLD). We want to bring our experience with this new phenomenon and raise the discussion.

We have seen that after SCOLA for repair of Hernias with RD, some swelling of the lower abdomen can remain. A review of the CT scans showed that preoperatively the patients also had SLD on both sides, which widened postoperatively. From an examination of 8 cases that we located; we can see several things in common: 1. SLD is always accompanied by RD, but smaller 2. SLD is always bilateral 3. SLD is not symmetrical and is wider on one side 4. There is asymmetry of the lower abdomen probably due to SLD separations in different sizes 5. Patients always have CORE INSTABILITY, and probably it is aggravated by the addition of the SLD. From a systematic examination of the CT images of patients with RD, it was found that a small part also has BSLD.

There are no data in the medical literature regarding diagnosis or treatment of SLD. We present our report on SLD phenomenon and raise the need to check the situation with its implications on RD, CORE INSTABILITY and the possible need for surgical repair together with RD.
INCIDENCE OF HERNIA DEVELOPMENT IN A SURGICAL SCAR (POIH), IN THE PRESENCE OF UNTREATED RECTUS MUSCLE DIASTASIS TREATED BY SCOLA REPAIR
Authors: Dudai M , Ganiem M
Published: May 2024

In the last decade, many works have been published demonstrating the recurrence of Umbilical or Epigastric Hernia that are repaired without a combined repair of an existing Rectus Diastasis (RD). Guidelines recently published including the European Hernia Society recommend combined repair and use of the Mesh. These are mostly small Hernias, but we would like to report on the development of Post Operative Incisional Hernias (POIH) sometimes big in the midline, following even small incision of Laparoscopic and Robotic procedures, in the presence of undiagnosed and uncorrected RD. We will bring our experience to the repair of these POIH and RD by Subcutaneous Onlay Laparoendoscopic Approach-SCOLA with the Release of the Anterior Rectus Fascia (RFR).

Since 2016, we perform a combined repair of Hernias together with an existing RD using a SCOLA with RFR. All patients are discharged home the day after surgery. We analyzed 123 patients, 34 of whom had POIH combined with RD, while 17 of them had the POIH in a Laparoscopic or Robotic scar. Hernia width was 2–10 cm. The repaired Hernia recurred in only 2 of them, 10 of them developed a Seroma that was treated by aspiration.

Any surgical operation performed on the ventral abdominal line should ensure the presence of RD. Also, ventral penetration in Laparoscopic or Robotic approach in the presence of undiagnosed and uncorrected RD, will lead to the development of POIH. Even big POIH combined with present for RD, are successfully repaired with low trauma by SCOLA approach with RFR.
EMERGENCY TAPP FOR STRANGULATED HERNIA. SAFE OPTION OR ROAD TO DISASTER? CASE REPORT
Authors: Đurica N , Stojanović M , Stojanović N , Ardeljan D P
Published: May 2024

Background

Laparoscopic approach to strangulated hernia is controversial and there are only few papers on this topic. We present a case of emergency TAPP and complications that occurred during and after surgery.

Case presentation

A 68-year-old female came to the emergency department with complaints of right inguinal bulging, abdominal pain and vomiting. Abdominal ultrasound and X-ray confirmed small bowel strangulation.

Manual reduction was unsuccessful, so we proceeded to emergency laparoscopic surgery which showed femoral hernia with strangulation of small bowel and omental adhesions in the right iliac fossa. After adhesiolysis, reduction of herniated small bowel was achieved. Bowel was congested but peristalsis was present. We continued to repair hernia by TAPP approach. After completion, bowel was inspected and it was concluded that there were no signs of ischemia.

4 hours after the surgery patient became hypotensive and tachycardic. Abdominal CT scan showed hematoma with active bleeding.

We proceeded to emergency laparotomy and saw hematoma spreading from liver to the right inguinal region. Hemostasis was achieved by suturing the bleeding vessel on omentum. Because of the suspected bowel ischemia we decided to do resection. During procedure attempts of placing central venous catheter failed. After the surgery chest X-ray showed complete right sided pneumothorax, which was drained.

Patient was discharged with full recovery. There were no signs of mesh infection or recurrence.

Conclusion

Emergency TAPP for strangulated hernia should be done by an experienced surgeon. In the postoperative course one should expect complications which are uncommon in elective setting.
LAPAROSCOPIC INGUINAL HERNIA REPAIR IN A LOCAL HOSPITAL. 2 YEARS’ EXPERIENCE AND CHALLENGES
Authors: Đurica N , Stojanović M , Stojanović N , Morišan B
Published: May 2024

Although 3 decades have passed since the first laparoscopic inguinal hernioplasty, only small number of patients in Serbia is currently operated by laparoscopic approach. Around 260 hernia repairs per year is done in our hospital, and only 10% is operated by laparoscopic approach.

Aim

The purpose of this study is to present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our hospital and highlight the challenges we faced.

Material and Methods

It is a retrospective observational study including all patients who underwent a laparoscopic hernia repair (TAPP and TEP) in our hospital between January 2022 and July 2023.

Results

From a total of 49 patients, 46 (94%) were male and 3 (6%) were female. Mean age was 56,8 ± 11,9 years.

There were 24 patients with right sided hernia, 16 with left sided hernia and 9 with bilateral hernia.

45 patients (91,8%) had primary hernia and 4 patients (8,2%) had recurrent hernia.

44 patients were operated using TAPP technique and 5 using TEP.

ASA 2 was the most frequent score (69,4%).

All patients received flat polypropylene mesh and absorbable tackers were used for fixation. The mean time of postoperative hospital stay was 2,02 days ± 0,38.

Seroma was observed in 7 patients, and urinary retention in 2 patients. There was one recurrence (2,04%) and 2 patients acquired incisional hernia on the umbilical port site.

Conclusions

Laparoscopic hernioplasty can be performed safely and effectively, without increasing the rate of intraoperative or postoperative complications, with short operative times and successful results.
QUALITY OF LIFE IN PATIENTS, WHO UNDERWENT INGUINAL HERNIOPLASTY
Authors: Fedorkiv M , Pylypiuk B , Galipchak I , Omelchuk N , Filipenko A , Khrunyk A
Published: May 2024

Background

20 million people with inguinal hernias are operated annually throughout the world. Severe chronic pain after hernia repair effects social life, daily activity and overall quality of life (QL). In medicine, QL is assessed by the level of well-being and satisfaction with those aspects of life that are affected by the disease and its treatment. The Short Form-36 is (SF-36) a validated indicator of overall health status.

Method

this study was to evaluate QL by SF-36 questionnaire in patients, who underwent inguinal hernioplasty (open surgery – Lichtenstein tension-free mesh inguinal hernia repair or laparoscopic surgery – transabdominal preperitoneal (TAPP)). Results: State the main findings, including important numerical values.

Results

The majority had unilateral hernias 89.0% and the most common surgical technique was Lichtenstein’s repair (82.4%). The postoperative QL was significantly better after surgery. Comparing two groups of patients after surgery, only the pain domain of the questionnaire was worse in patients operated by Lichtenstein repair: 46.5%/39.8% experienced mild pain, 38.6%/42.0% experience moderate pain and only 14.9%/18.2% experienced severe pain.

Conclusion

Results showed that 213 (86.9%) patients felt that their QL was satisfactory after the hernia repair, with most of them being from the age group of 19–39 years (93.2%).
TAPP (TRANSABDOMINAL PREPERITONEAL) APPROACH IN A RARE CASE OF SPIGELIAN HERNIA INCARCERATED WITH OVARY
Authors: Florea I , Chiru B , Dutu C
Published: May 2024

Aim

Spigelian hernia, a very rare form of anterior parietal defect (incidence reaching maximum 0.12–2% of abdominal wall hernias), occurs at the semilunar line or Spigelian line. In most cases, it is a small hernia defect, measuring <2 cm in diameter. With ambiguous symptoms and often no clinical findings, this hernia is diagnosed usually in the complication stages (the incarceration rate reaches up to 27%). This is why no “watchful waiting” approach is recommended and it should be operated upon even if the patient is asymptomatic.

Material and Methods

A 32-year-old female patient with incarcerated Spigelian hernia, presented to our clinic with pain in the left iliac fossa. The clinical examination revealed a small, irreducible swelling at the level of the left semilunar line. CT (computed tomography) examination described a 5 mm parietal defect – compatible with a left infraumbilical Spigelian hernia, in which the left adnexa was incarcerated.

Results

A laparoscopic TAPP approach was chosen, practicing the reduction of the herniated content (left adnexa of normal macroscopic appearance) and the placement of an 11/8 cm synthetic mesh at the preperitoneal level. After surgery, the patient was discharged safety on the second postoperative day, with favorable evolution, quick post-operative recovery, no surgical site infection, no postoperative complications and a good aesthetic outcome.

Conclusion

In conclusion, we want to highlight the importance of knowing rare pathologies such as Spigelian hernia and their high complication rate, as well as the benefits of minimally invasive treatment.
CASE PRESENTATION: INTERNAL HERNIATION CAUSES DOUBLE OBSTRUCTION, SMALL BOWEL AND URINARY TRACT
Authors: Fotiadis P , Gemousakaki E , Permekerlis A , Tepelidis C , Papalos C , Fentas A , Mallioris A , Kouridakis P
Published: May 2024

Aim

The presentation of a rare case of small bowel obstruction accompanied by obstruction of the urinary tract, due to an internal hernia caused by the ureter, as a secondary complication of ureteroplasty.

Material and Methods

A 58-year-old female, who underwent hysterectomy-right ureter injury-ureteroplasty ten years ago, presented to the Emergency Department with acute abdominal and right lumbar region pain accompanied by nausea. Clinical examination showed tenderness in the lower abdomen, positive Giordano's sign on the right, and metallic bowel sounds. A Computer Tomography scan revealed right- sided hydronephrosis with perinephric stranding, and absence of excretion in the right urinary tract. In the pelvic cavity, dilated loops of the small intestine were observed, and at the same level, a point of luminal narrowing of the right distal ureter.

Results

The patient underwent an investigative laparoscopy-laparotomy-resection of a segment of the ileum and oblique anastomosis-reimplantation of the right ureter, and placement of a ureteral catheter. The postoperative course was uneventful, and the patient was discharged 8 days postoperatively, with the ureteral catheter removed 30 days later.

Conclusions

The literature contains very few cases of internal herniation beneath the ureter, with retro-ureteral small bowel incarceration and simultaneous urinary tract obstruction. These cases typically involve patients who have undergone either gynecological surgeries or kidney transplant procedures. Surgical history should be strongly considered in the diagnostic approach, in order to recognize even rarer causes of small bowel obstruction.
REPAIR OF RECURRENT INGUINAL HERNIA AFTER ENDOSCOPIC TEP HERNIOPLASTY THROUGH TAPP APPROACH
Authors: Friedova P , Acosta Rodríguez A , Rodríguez Valenzuela N , Sánchez González J , Pérez Saborido B
Published: May 2024

Objective

To demonstrate the feasibility of repairing recurrent inguinal hernias following endoscopic TEP hernioplasty using a laparoscopic TAPP approach.

Materials and Methods

A 71-year-old male patient with no significant personal history underwent bilateral TEP hernioplasty in 2021. He presented with a right inguinal hernia on consultation. Abdominopelvic CT was requested, confirming a recurrent indirect right inguinal hernia. A TAPP approach was chosen, revealing a recurrent indirect inguinal hernia due to medial displacement of the mesh, classified as L3r according to the EHS classification. Repair was performed through the TAPP approach without removal of the previous mesh, with traumatic fixation of the new mesh to the pubis.

Results

Postoperative period was uneventful, with discharge 24 hours after surgery. The first follow-up at 10 days post-intervention showed that the patient only required continuous analgesia in the first 24 hours. Three months after surgery, the patient reported no pain, physical examination showed no recurrence (complications), and excellent aesthetic results.

Conclusions

Minimally invasive repair of inguinal hernias is not only advisable for primary hernias but should also be the treatment of choice for recurrent hernias through laparo-endoscopic approaches. Although repair may be more challenging due to fibrosis from previous surgery, in expert hands, it can be performed with the utmost safety for the patient.
THE IMPACT OF THE CREATION OF AN ABDOMINAL WALL UNIT
Authors: Gaspar B , Ribas S , Oliveira F
Published: May 2024

Background

Abdominal wall units in surgery departments are becoming more and more necessary due to the increasing complexity of hernias and the ongoing development of new surgical techniques and resources. This study aims to understand the impact of an abdominal wall unit in a medium-sized hospital's surgery department.

Method

A retrospective study was conducted involving all patients who underwent elective hernia repair between October 2021 and March 2023 and the outcomes were compared before and after the creation of the abdominal wall unit (July 2022).

Results

700 patients were included with median age of 59 and median BMI of 27.5 kg/m2. Of these, 388 underwent surgery from July 2022.

Was identified a reduction in complications after unit creation, from 7.7% to 7.2% (p = 0.811) and a decrease in recurrence from 3.8% to 2.1% (p = 0.159), diagnosed 8 months after surgery, on average. With the creation of the unit, an increase in the usage of minimally invasive techniques was observed, from 10.6% to 13.9% (p = 0.271). For example, the use of TAPP technique for inguinal and femoral hernias increased from 9% to 14,5%. New techniques and adjuvant procedures have also been introduced, such as LIRA technique, Fasciotens abdominal device and botulinum toxin A application.

Conclusion

Our study supports the existing literature, confirming the positive impact of an organized abdominal wall unit. We highlight the reduction in post-operative complications and recurrence after the unit creation and the introduction of new and innovative surgical techniques in the treatment of abdominal wall hernias.
COMPARATIVE ANALYSIS OF ANATOMICAL SHAPED AND STANDARD FLAT MESH IN TRANSABDOMINAL PREPERITONEAL (TAPP) INGUINAL HERNIA REPAIR: EARLY OUTCOMES
Authors: Gianluca B , Sartori A , Bagolini F , Simone T , Sanna A
Published: May 2024

Background

Mechanical fixation in transabdominal preperitoneal inguinal hernia mesh repair (TAPP) is associated with pain syndrome and mesh migration may occur without flat protheses fixation. An anatomical shaped mesh (4DTM Cousin Biotech) using no fixation would improve the pain syndrome.

Method

A retrospective case study, that included 100 patients and 200 TAPP performed from 2019 to 2023. This study was conducted to compare laparoscopic inguinal hernia repair with (group A) or without mesh fixation (group B) regarding outcomes using two different mesh technologies: well-established flat macroporous partially absorbable mesh and the anatomical shaped partially absorbable lightweight mesh (4DTM Cousin Biotech).

Results

Recurrence rates, postoperative outcomes, and complication rate and type were analyzed to provide insights into the performance of each mesh in TAPP. There was statistically significant difference in postoperative early pain, assessed via VAS score, 3 days after surgery (group A versus group B; 3,4 ± 1.46 vs. 4 ± 1.6, P <0.001) and a week after surgery (group A versus group B; 1.5 ± 0.9 vs. 2.5 ± 0.6, P <0.001). Operative time, on average, was longer in group B (92 ± 12. vs. 79 ± 20 min, P <0.001).

Conclusion

The study results revealed that laparoscopic TAPP inguinal hernia repair with anatomical shaped mesh without fixation is safe and feasible with no increase in recurrence rate. In addition, it offers an improvement of operation time than TAPP mesh fixation. However, further study with a longer follow-up will be needed to confirm the results.
HERNIA REPAIR SURGERY IN INTERNATIONAL COOPERATION PROGRAMMES IN AFRICA
Authors: González-Valverde F M , Rodríguez-Lucas J M , Medina-Manuel E , Hernández Agüero Q , Torregrosa Pérez N M , Jimenez-Moreno I M , Hurtado Vázquez A M , Del Valle-Ruiz S R , Rodríguez González J M
Published: May 2024

Introduction

Hernia pathology is particularly prevalent in underdeveloped countries. The population is often forced to perform physically demanding work in order to survive. In many cases, hernia repair can be a vital part of survival.

Materials and Methods

Retrospective study of a consecutive series of patients who underwent inguinal hernia repair between 2005 and 2023 in Cameroon, Mali, Algeria, Kenya and Senegal as part of an international cooperation programme of the Spanish NGO "Cirugía Solidaria".

Results

1634 patients were operated on, with a total of 1823 surgical procedures. The mean age was 52.21 years. A total of 83.2% were male. More than 90% of the patients had comorbidities. 23% of patients had had the hernia for more than 10 years and 25.2% of patients were unable to work. Of the hernias repaired, 9.8% were recurrent and 13.2% were bilateral.

The rate of use of local anaesthesia with sedation was 16.36%. Antibiotic prophylaxis was 100%, but DVT prophylaxis was never used. The use of mesh was 82.8% and the number of procedures performed by residents was 20.42%. There was no mortality. The haematoma rate was 4.66% and the wound infection rate was 1.16%. The hernia recurrence rate was 3.3%, although only 20.97% were followed up. The mean length of stay was 18.8 hours.

Conclusions

Hernia surgery in underdeveloped countries with scarce instrumentation and suboptimal operating conditions can be performed with quality standards similar to those in developed countries.
OBTURATOR HERNIAS
Authors: González Valverde F M , Rodríguez-Lucas J M , Medina-Manuel E , Navarro-Duarte J C , Jimenez-Moreno I M , Sandoval Marin J , Moreno García C , Hurtado Vázquez A M , Del Valle-Ruiz S R
Published: May 2024

Introduction

Obturator hernias are an extremely rare cause of bowel obstruction. This type of hernia accounts for 0.5% to 1.4% of all hernias. In addition to the rarity of this type of hernia, there is no standard approach to its management.

Case Presentation

The case of an 88-year-old woman with a 24-hour history of intestinal obstruction is presented. A CT scan showed a strangulated obturator hernia of the right ileum. Laparotomy confirmed the presence of a right obturator hernia with ileal strangulation. A segmental enterectomy with primary anastomosis and reduction of the hernia sac with mesh was performed to close the obturator foramen.

Discussion

Due to the non-specific symptoms, the diagnosis of this type of hernia is usually challenging and its treatment is only surgical. It often occurs in older, multiparous and emaciated women. Risk factors include weight loss, chronic lung disease and ascites, which increases abdominal pressure. A rare presenting sign is a palpable mass or the Howship-Romberg sign (pain radiating from the inner thigh and knee). Computed tomography has a higher sensitivity and accuracy than other radiological investigations for assessing the presence of an obturator hernia.

Conclusion

Obturator hernia is a rare type of hernia due to its often unclear diagnosis; a rapid suspicion based on non-specific symptoms is crucial for diagnosis. Surgical management is the only possible treatment for this pathology and depends on early diagnosis.
WHEN THE GOING GETS TOUGH THE EXPANDERS START PLAYING
Authors: Grimaldi S , Morini L , Alampi B D , Nicastro V , Marin J N , Ferrari G
Published: May 2024

Background

Complex incisional hernias pose challenges for abdominal wall surgeons, often requiring invasive procedures like Transversus abdominis release (TAR). However, these approaches may not always be sufficient or may be overly invasive for patients. Tissue expanders provide a viable solution. This report presents a clinical case demonstrating the feasibility and safety of an abdominal wall expansion system, enabling the Rives technique in patients with large incisional hernias previously recommended for TAR.

Method

We treated a 77-year-old woman with ASA 3, BMI 33.69, affected by type II diabetes mellitus, arterial hypertension, hypothyroidism, dyslipidemia, chronic anemia, and multiple previous laparotomies. The patient presented to our department for recurrent and symptomatic incisional hernia (EHS classification M 2-3-4 W13L12) with a CeDAR score of 53% without TAR and 69% with TAR, and an RDR score of 1.35.

Once the retromuscular space was prepared, we positioned 6 stitches on each side, placed 2 cm from the medial margin. U-shaped stitches were used to encompass both the anterior and posterior fascia and were spaced 2 cm apart. The threads intersected the midline and were fixed to the device, which allowed for progressively increasing traction from 14 kg to 18 kg. We achieved an elongation of 8 cm toward the midline, enabling a downgrade of the procedure from TAR to Rives. A 30 × 45 cm polyvinylidenefluoride mesh was used in a sublay position.

Results

The patient was discharged on the fourth post-operative day without complications. Negative one-year follow-up.

Conclusion

When the going gets tough we should consider tissue expanders which can not only help us when we are unable to repair a complex hernia, but also offer the patient a less invasive surgery to reduce morbidity in high-risk patients.
REMOVAL OF GIANT ABDOMINAL PSEUDOCYST PRIOR TO LAPAROSCOPIC BARIATRIC SURGERY
Authors: Gutiérrez C , Serrano A , Nieto M , Carreño-Sáez O , Carbó J , Palassi R , Pous-Serrano S
Published: May 2024

Background

To present a case of an abdominal wall pseudocyst as a complication of hernia repair.

Material and Methods

We present a 35-year-old men with a body mass index of 62,2 and a surgical history of two urgent surgeries for incarcerated umbilical hernia. In both cases, hernioplasty was performed using a supraaponeurotic polypropylene mesh. During the follow up, there is evidence of a large mass in the central abdominal region. The tomography scan reveals a subcutaneous tumor in the anterior abdominal wall, measuring 22 (transverse) × 18 (anteroposterior) × 21 (craniocaudal) cm, that suggest a chronic post-surgical collection.

Surgical treatment is decided. It includes complete excision of the pseudocyst, laparoscopic vertical gastrectomy with trocar placement on the musculoaponeurotic layer, and abdominal wall repair with partially resorbable composite intraperitoneal mesh. Dermolipectomy is associated with the use of indocyanine green (ICG) to verify adequate cutaneous perfusion.

Results

The histopathological analysis reveals the presence of a pseudocyst, with no signs of malignancy and no epithelial cells. The patient shows a favorable progression and is discharged on the fifth postoperative day. Subsequent follow-ups confirm the resolution of the lesion, no hernia recurrence and a weight lost percentage of 51%.

Conclusions

Abdominal wall pseudocyst is a rare complication that can occur after hernia repair. It is characterized by a fluid collection lacking epithelium and a diameter greater than 10 cm. Obesity and prosthetic material are commonly identified as primary risk factors. Radical surgical excision is considered the definitive treatment and can be performed simultaneously with bariatric surgery. Fluorescence with ICG is as a valuable tool to evaluate skin perfusion.
IS THERE A NEED FOR DATA-DRIVEN APPROACHES TO REDUCE VARIABILITY IN VENTRAL HERNIA REPAIR?
Authors: Hall S K , Connaghan R , Haikka P , Luke Y
Published: May 2024

Background

The surgical community diverges on optimal technique to repair ventral hernias. New techniques are disseminated regularly, and there is a lack of evidence-based consensus on best practices. Diversity in technique leads to variability in patient outcomes, with up to 20% of patients experiencing an adverse event postoperatively. This paper demonstrates the extent of subjectivity in ventral hernia repair by examining differences in opinions of 14 hernia surgeons.

Method

Fourteen surgeons, all involved in training, were recruited from teaching hospitals distributed globally. A survey was issued, asking them to rank the phases of robotic-assisted ventral hernia repair by importance and teaching order. Kendall’s W was used to quantify correlation between their rankings.

Results

Kendall’s coefficient was nonsignificant for importance of surgical phases (W = 0.3) and for order of trainee contribution (W = 0.3). Preference for techniques (e.g. eTEP, TAPP), as estimated by self-reported case volumes, had a similarly low concordance of 0.1, with no single technique receiving majority consensus as the most preferred. All surgeons recorded their cases, 64% (N = 9) recording every case.

Conclusion

These results evidence significant divergence in how ventral hernia repairs are performed. Disparity is likely to increase rather than decrease among the next generation of surgeons, due to differences in training regimens. The authors conclude there is a need for a data-driven approach to quantify the variability in this procedure. With most surgeons already recording their cases, digital technologies offer powerful tools, like AI-supported automatic video analysis, to transform video data into valuable insights for driving standardization.
TRANS-ABDOMINAL PRE-PERITONEAL LAPAROSCOPIC HERNIA REPAIR: A SINGLE CENTER EXPERIENCE
Authors: Havlova K , Husarova T , Schutz S O , Murín M , Pohnan R
Published: May 2024

Introduction

Lichtenstein procedure and laparoscopic repair are the most recommended techniques for inguinal hernia repair. Laparoscopic techniques should be generally preferred for its benefits in faster recovery and lower rate of complications. Trans-abdominal preperitoneal (TAPP) laparoscopic repair is one of the common procedures. According to the European Hernia Society (EHS) the learning curve for laparoscopic technique of hernia repair is estimated at 50–100 procedures. There are several studies which resulted in lower numbers, mostly due to prior experience in laparoscopic techniques.

Method

We analyzed TAPP procedures for primary unilateral inguinal hernias between 2019 and 2023. In 2019 only the most senior residents performed their first TAPP surgeries, while by 2023, second year residents performed their first TAPP procedures.

Results

The residents had statistically significantly longer operating time, which is in line with the expected learning curve. They did not achieve enough surgeries to complete the learning curve. However, there was no statistically significant difference in perioperative complication rate. From 2019 to 2023 we raised the mini-invasive primary inguinal hernia repair from 24.7% to 52.57%. The percentage of TAPP surgeries performed by residents went from 16.13% to 36.95%, respectively.

Conclusion

While surgery in the Czech Republic has an excellent tradition and level of expertise, it is not a rule that all residents have enough experience leading the surgeries, especially laparoscopic, under the guidance of senior surgeons. Thus, local experience showing safety and feasibility of early experience as a leading surgeon in procedures like laparoscopic hernioplasty is valuable.
HERNIA SURGERY TRENDS AND LANDSCAPE IN LATVIA: A COMPREHENSIVE ANALYSIS
Authors: Ivanovs I , Berzina A A
Published: May 2024

Background

This study analyzes hernia surgeries in Latvia across years and healthcare facilities, aiming to discern trends and methodologies amid budgetary constraints and healthcare disparities.

Method

Analyzing hernia surgeries from 2016 to 2022, this study evaluated total repairs, elective surgeries, laparoscopic techniques, and specific methodologies at Riga East University Hospital and Latvian healthcare institutions.

Results

Hernia repairs fluctuated annually: 4516 (2016), 4285 (2017), 4315 (2018), 4639 (2019), 4169 (2020), 4527 (2021), reaching 5488 in 2022. In 2022, laparoscopic incisional hernia surgeries accounted for 19% (67 cases) of 226 total incisional hernia surgeries. Elective hernia surgeries ranged from 86.4% to 93.3% from 2017 to 2019, slightly declining in subsequent years (probably effect of COVID-19). Laparoscopic abdominal wall hernia surgeries varied from 15.3% to 20.2%. There was a notable surge in laparoscopic groin surgeries, and a shift towards TAPP (437 cases) over TEP (65 cases) in 2022. Emerging minimally invasive procedures – E-TEP (130), SCOLA (60), TARM (20) became apparent since 2019. At Riga East University Hospital, hernia surgeries significantly increased from 527 (2020) to 633 (2022). Laparoscopic techniques in groin hernias rose from 16% (2019) to 26% (2022), while laparoscopic incisional hernia surgeries declined from 11% (2019) to 8% (2022).

Conclusion

This study sheds light on the dynamic landscape of hernia surgeries in Latvia, highlighting trends in procedures, preferences, and adoption of innovative techniques. Understanding these trends is crucial for healthcare professionals to enhance hernia care strategies and adapt to the constraints and disparities within Latvia's healthcare system.
POSITIVE SCRATCH COLLAPSE TEST IN ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME (ACNES): EVIDENCE FOR A PERIPHERAL NEUROPATHY?
Authors: Jacobs M L Y E , ten Have T , Schaap L , Scheltinga M R M , Roumen R M H
Published: May 2024

Background

Chronic abdominal pain is occasionally caused by an abdominal wall entity such as Anterior Cutaneous Nerve Entrapment Syndrome (ACNES). This syndrome is thought to occur due to entrapped intercostal nerve branches (Th7-12) within the rectus abdominis muscles. This clinical diagnosis is based on subjective clues in patient history and physical examination. In contrast, in carpal tunnel syndrome an additional diagnostic test is used, which is referred to as the scratch collapse test (SCT). The SCT has shown positive results not only in other peripheral entrapment neuropathies involving the ulnar, peroneal, and long thoracic nerve, but also in three recently described ACNES patients. We investigated whether the SCT is of diagnostic use in patients suspected of having ACNES.

Method

A prospective, case-control study was performed among patients with ACNES (n = 20) and two control groups without ACNES (acute abdomen n = 20; healthy n = 20), all were consecutively included. ACNES was diagnosed based on previously published criteria. The SCT test was executed at the painful abdominal area in both patient groups and at a corresponding area in healthy controls. Predictive values, sensitivity, and specificity were calculated. Videos of tests were evaluated by blinded observers.

Results

SCT was judged positive in 19 of 20 ACNES patients, but not in any of the 40 controls. A 95% sensitivity (CI:75–99) and 100% specificity (CI: 83–100) were calculated.

Conclusion

This study provides strong evidence that ACNES should be considered as an entrapment neuropathy, while a positive SCT should be considered as a major diagnostic criterion.
ANALYSIS OF THE USE OF POLY-4-HYDROXYBUTYRATE MESH FOR INGUINAL HERNIA REPAIR: OUR FIRST 200 CASES
Authors: Kaufman J P
Published: May 2024

Introduction

Inguinal hernia repair remains one the most common operation that general surgeons perform on an annual basis. Selection of a tissue based repair versus permanent or bio-rebsorbable biomaterials still remains an issue for both patients and surgeons when faced with options for inguinal hernia repair. Other studies have demonstrated the long-term strength profile associated with a resorbable mesh comprised of poly-4-hydroxybutyrate, in Ventral Hernia Repair. We however looked at the application of this type of bioprosthetic for use in inguinal hernia repair (IHR)

Methods

We retrospectively reviewed the continuous application of poly-4-hydroxybutyrate for open inguinal hernia repair at one center in the US.

The study involves IHR with poly-4-hydroxybutyrate mesh in subjects across all types of open inguinal hernia to yield a larger overall, all-comers dataset at a minimum of 12-month postoperative timeframe follow-up. The trial includes a review comprised of 201 consecutive subjects. Poly-4-hydroxybutyrate plug and patch mesh was utilized in the groin for all primary and reccurent indirect, direct and femoral defects. Hernia complication rates including: recurrence rates, surgical site occurrences (SSO) requiring intervention, surgical site infection (SSI), seroma, wound dehiscence, skin necrosis, hematoma, were reviewed and will be reported.

Results

When the data for the subjects were reviewed it revealed that the distribution of the hernias were 24.4% direct, 68.1% indirect, 6.5% pantaloon, 1% femoral. 43% were left sided and 54% were right sided hernias; 90.55% were performed open and 9.45% were done MIS/Laparoscopically. Duration of follow-up was a minimum of 12 months. Overall complication rate was 2.99% inclusive of recurrence and when looked at independently the recurrence rate was 0.5% representing one laparoscopic recurrence.

Conclusions

Intermediate-term outcomes following inguinal hernia repair with poly-4-hydroxybutrate mesh in subjects with a minimum of one year of follow-up demonstrate low rates of recurrence and reasonable rates of SSO at the 12-month postoperative timeframe. Longer term follow-up will also be presented for 2 years and is also ongoing: Both 3 and 5-year (36,60-month) in the US at the same center and will be reported when results are available at a later date. Further study is needed to understand where and how this technology can be applied for IHR.
INTERPARIETAL POSTOPERATIVE HERNIA. PRESENTATION OF TWO CASES
Authors: Kochylas N , Papaeleftheriou S , Magganas D
Published: May 2024

Aim

Interparietal postoperative hernias are rare cases where the content herniates through layers of the abdominal wall, without reaching the skin and the subcutaneous fat. They are difficult to diagnose, since they cannot be palpated from the outside. They usually present acutely with small bowel obstruction.

Case 1

69-year-old female with a history of gastrectomy 8 years before, Rives-Stoppa for incisional hernia 4 years before and multiple episodes of partial small bowel obstruction. CT scan showed small bowel loops between the posterior rectus sheath and the mesh. Surgery confirmed the diagnosis of interparietal hernia, the small bowel was reduced and the posterior sheath was sutured. The previous mesh was not removed and a new mesh was placed underneath it.

Case 2

38-year-old female with a history of caesarean section 1 year before, presented to the emergency room with acute lower abdominal pain. No mass was palpated. CT scan showed incisional hernia with small bowel loops between the rectus muscle and the anterior sheath. Intraoperatively, the small bowel was reduced and the abdominal wall was sutured by layers.

Conclusion

Interparietal hernia is rare, with only case reports in the literature. It will usually present as an emergency and the CT scan is invaluable for the diagnosis. The difference in our cases, compared to others published, is that in our cases the interparietal hernia presented itself, long after the index operation.
OPEN PREPERITONEAL APPROACH FOR RIGHT SUBCOSTAL HERNIA: FIRST EXPERIENCE
Authors: Laskou S , Sapalidis K
Published: May 2024

Aim

The right subcostal incision, also known as Kocher, represents a transverse incision, which is most commonly utilized in hepatobiliary procedures. Although it offers good exposure of the upper abdomen, it is associated with high morbidity in terms of an incisional hernia since it bears the drawback of sectioning muscle fibers. Such incision are difficult to correct due to the close proximity to the costal margin.

Material and Methods

We present the case of a 50 year-old male with an LIW2 right subcostal incisional hernia. After routine preoperarative investigations the patient underwent an open preperitoneal repair with polypropylene mesh.

Results

Operative time was 150 minutes with minimal intraoperative blood loss. Postoperative period was uneventful and he was discharged on postoperative day 5th. He was followed-up on 7 days, 2 and 6 months postoperatively with no signs of recurrence.

Conclusions

The presence of subcostal hernia requires adequate surgical treatment. Its surgical correction requires rebuilding the muscle-aponeurotic acquired defect with fixation of the appropriate mesh.
ROBOTIC APPROACH TO ABDOMINAL WALL RECONSTRUCTION DECREASES TOTAL POST-OPERATIVE OPIOID EXPOSURE, BUT NOT DAILY OPIOID USE, COMPARED TO OPEN APPROACH: THE RETROSPECTIVE VENTRAL HERNIA REPAIR AND POST-OPERATIVE OPIOID USE (RETRO-HERO) STUDY
Authors: Liu Hennessey R Q , Yang Y , Guan R , Zhang Y , Meneghetti A T , Chiu C
Published: May 2024

Background

Many surgical specialties have shown a significant reduction in post-operative opioid use with adoption of the robotic platform. This has not been shown in General Surgery or in ventral hernia repairs. We compared post-operative opioid usage after open and robotic-assisted abdominal wall reconstruction (oAWR, rAWR).

Method

This is a retrospective cohort analysis of all patients with ventral hernias ranging between 5 to 15 cm who underwent either oAWR or rAWR between 01/2020 to 11/2022. Patient characteristics, surgery and length of hospital stay (LOS) information, post-operative opioid usage, and patient-reported pain scores were reviewed.

Results

74 patients undergoing oAWR and 27 after rAWR in the study period met inclusion criteria. There was no difference in age, sex distribution, BMI, comorbidities, size, and hernia characteristic between the two groups. Median LOS was significantly longer for open repairs (5 (4–6) days vs. 2 (2–3) days, p <0.05). Median total in-hospital opioid use measured in mg Oral Morphine Equivalent (OME) and was significantly higher for open repairs (71.25(15–159) vs. 7.5 (0–60), p <0.05). However, there was no difference in daily opioid use, multimodal pain control, or total discharge opioid prescription. Multivariable logistic regression analysis indicates lower age is a significant contributor to high opioid use (OR = 0.95 (0.9–0.99), p =0.02) but the use of the robot platform was not (OR = 1.7 (0.56–4.95), p = 0.88).

Conclusion

oAWR patients had higher total post-operative opioid exposure but there is no difference in daily opioid use. Future studies should explore the potential of the robotic approach at minimizing opioids by way of standardized multimodal pain management protocols.