bluuebunny/crossref_metadata_2025 huggingface dataset:
INTRAOPERATIVE FASCIAL TRACTION FOR TREATMENT OF W2 AND W3 VENTRAL HERNIAS
Authors: Marques-Antunes J , Correia P , Osorio C , Magalhães J , Guimarães M , Nora M , Pereira A
Published: May 2024

Background

Component separation techniques are increasingly employed in abdominal wall reconstruction surgery. The use of adjuvant techniques, such as intraoperative vertical dynamic fascial traction, enhances the compliance of the abdominal wall. This facilitates closure of the abdominal wall using less disruptive techniques without compromising effective treatment. Our aim is to retrospective review our results regarding the effectiveness and complication rate of intraoperative fascial traction for the treatment of complex ventral hernias.

Method

Conducted a retrospective analysis of 10 patients who underwent surgery using intraoperative fascial traction for W2 and W3 ventral hernias.

Results

Preoperatively, fascial distances measured ranged from 55 cm to 145 cm, with the majority of patients (70%) having a fascial distance greater than 10 cm. Most patients received other adjuvant treatments (nine cases with botulinum toxin injection and one with pre-operative progressive pneumoperitoneum). Posterior component techniques were employed in 40% of patients (half with W2 hernias and the other half with W3 hernias). The complication rate was 10%, with one case of hemorrhage requiring percutaneous embolization. During the average 6-month follow-up period (ranging from 1 to 17 months), one recurrence was observed.

Conclusion

Intraoperative fascial traction is a feasible and safe adjuvant technique for abdominal wall reconstruction. The use of adjuvants in complex abdominal wall hernia surgery may, in some patients, downstage the hernia, thereby avoiding the need for component separation techniques. This approach enables tension-free closure of the abdominal wall in a less invasive manner.
RECURRENCE AFTER MINIMALLY INVASIVE REPAIR OF INGUINAL HERNIA: INCIDENCE AND ASSOCIATED FACTORS
Authors: Marques-Antunes J , Rodrigues E , Magalhães J , Guimarães M , Nora M , Pereira A
Published: May 2024

Background

Minimally invasive laparoscopic surgery for inguinal hernia allows an approach to the entire myopectineal orifice, leading to an expected lower recurrence rate and/or incidence of occult hernias. Nevertheless, the literature reports recurrence rates of up to 12%, depending on the reported follow-up time.

Methods

Retrospective analysis of laparoscopic surgical corrections of inguinal hernias between January 2018 and March 2023. Evaluation of recurrence rate and factors associated with its development.

Results

During the analyzed period, 388 patients underwent laparoscopic surgical correction of inguinal hernia. In 183 patients, the surgical correction was bilateral, corresponding to 571 operated hernias (82% via TAPP and 18% via TEP). During an average follow-up of 22 months (6–65), the recurrence rate was 2.1%, diagnosed on average 14 months after surgery. The presence of postoperative wound complications and chronic pain were the only factors significantly associated with recurrence (p = 0.026, p <0.001, respectively). Factors such as gender (p = 0.155), age (p = 0.13), BMI (p = 0.3), smoking (p = 0.52), technique used (p = 0.391), recurrent hernia (p = 0.42) did not show an association with hernia recurrence. In multivariate analysis, the presence of postoperative complications was the only independent risk factor for recurrence (p = 0.04, OR 4).

Conclusion

In our study, the recurrence rate aligns with what is described in the literature. Limitations include the fact that only patients who returned to our hospital were diagnosed, and the short follow-up time in some cases. The learning curve of surgeons, both residents and specialists, during the implementation of the technique in our service may also impact these results.
ANALYSIS OF `ENHANCED-VIEW TOTALLY EXTRAPERITONEAL (eTEP) RIVES STOPPA (RS)` APPROACH FOR VENTRAL HERNIA: QUALITY OF LIFE AND EARLY RESULTS
Authors: Marrero Marrero P , Fernández Hernández L , Mon Martín F , González de Vera O , Lorenzo Rocha N , Delgado Plasencia L J
Published: May 2024

Background

Primary and incisional ventral hernias (PVH and IVH) are a common pathology which substantially impact patient’s quality of life (QoL). The first and only study addressing QoL following eTEP-RS to date was pubished by Rayman et al. in 2023. The purpose of this study was to evaluate the QoL, early postoperative complications and hernia recurrence rate following laparoscopic enhanced-view Totally Extra-Peritoneal (eTEP) Rives Stoppa (RS) for PVH and IVH repair.

Method

A retrospective review of a prospectively maintained database of all patients undergoing eTEP- RS from December 2022 to November 2023. Data retrieved included demographics, clinical and operative variables. Computed tomography scan was performed before and six months after surgery. QoL was assessed using the EuraHS-QoL scale prior to-and following eTEP-RS.

Results

During the study period, 29 patients met the inclusion criteria. PVH was the most common pathology (86.2%). Median follow-up time: 9 months. 8 patients (27%) had at least 13 months of follow-up. There were not hernia recurrence. Pre-operative and post-operative EURAHS-QoL questionnaire scores were available for 100% of patients enrolled in this study and showed significant improvement in pain (11.24 vs. 2.6, p <0.001), restrictions (median of 16 vs. 9.04, p <0.001) and cosmetic appearance (15.2 vs. 2.1, p <0.001).

Conclusion

Abdominal wall repair using the eTEP-RS approach improves subjective QoL variables with and aceptable post-operative complications and without hernia recurrence in a short-term follow-up. So far, these are the second published results where QoL is evaluated in patients undergoing eTEP-RS.
RETRORECTAL ABSCESS AFTER ABDOMINAL BLUNT TRAUMA
Authors: Martínez-López M , Verdaguer-Tremolosa M , Rodrígues-Gonçalves V , Martínez-López P , López-Cano M
Published: May 2024

Aim

To discuss an extended retrorectal abscess secondary to blunt abdominal trauma as a cause of abdominal wall (AW) infection and impairment.

Methods

We describe a case of blunt abdominal trauma with late diagnosis of jejunal perforation with an abscess that extensively dissected the retrorectus space.

Results

A 65 years-old female patient suffered multiple trauma after traffic collision. Ten days after admission, she presented fever and right abdominal swelling and induration. CT scan showed pneumoperitoneum and an extensive collection affecting the right retrorectal space until the ribs with preperitoneum.

Urgent laparotomy was performed and found a jejunal perforation with fecal peritonitis and extraperitoneal extension with dissection of the whole right retromuscular space.

Intestinal resection with anastomosis was performed. Exhaustive lavage of the cavity and retromuscular space with debridement of the necrotic posterior rectal lamina was required and a retrorectal drainage was placed. Primary closure of the aponeurosis was achieved with small bites technique and absorbable monofilament. Due to the weakness of the abdominal wall, an absorbable biosynthetic mesh impregnated with gentamicine was placed onlay. Negative pressure therapy was applied on the wound. Patient received antibiotics and CTs showed favourable evolution. No infectious complications or incisional hernia have been reported after more than 10 months of follow-up.

Conclusion

Literature does not report cases of blunt trauma causing extensive AW infection. Whilst rare, it should be considered in traumatic patients. Our experience shows they can be managed with surgical drainage and in case of fascial loss and AW weakness, absorbable meshes could be considered.
PARTIAL CYSTECTOMY DUE TO MESH MIGRATION FOLLOWING LAPAROSCOPIC INGUINAL HERNIOPLASTY. CASE REPORT
Authors: Martin-Ramos M , Bravo-Salva A , Fumadó Ciutat L , Pereira-Rodriguez J A
Published: May 2024

Aim

This case report aims to document and analyze a rare complication of mesh migration following laparoscopic inguinal hernioplasty.

Methods

We present the case of a 77-year-old male with a history of recurrent bilateral inguinal hernioplasty, the most recent procedure performed 17 years ago via laparoscopy. The patient presented with years of suprapubic pain, prompting investigation through abdominopelvic CT, revealing a metallic density image in the painful region and right inguinal hernia recurrence. Cystoscopy was performed observing mesh erosion into the urinary bladder. Surgical intervention was indicated.

Results

Open partial cystectomy, small bowel resection and anastomosis and recurrence herniorraphy was performed. The intraoperative findings confirmed the migration of the mesh into the bladder and its adherence to the intestine. Postoperative complication was intestinal ileus. Patient's symptoms were attributed to this rare complication, highlighting the importance of thorough evaluation in cases of persistent urinary symptoms or chronic pelvic pain post-hernioplasty.

Conclusions

Mesh migration following hernioplasty is an infrequent but significant complication. Persistent urinary symptoms or chronic pelvic pain should prompt suspicion of this pathology. The multidisciplinary approach is crucial for the effective management of such cases, emphasizing the need for thorough clinical evaluation and surgical intervention when necessary. This case underscores the importance of ongoing vigilance in post-hernioplasty patients, particularly those with atypical symptoms, to ensure timely diagnosis and appropriate intervention.
COMPARISON OF ANTERIOR COMPONENT SEPARATION (ACS) VERSUS POSTERIOR COMPONENT SEPARATION WITH TRANSVERSUS ABDOMINIS MUSCLE RELEASE (PCSTAR) FOR HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Mohamedahmed A Y , Talaat Issa M , Ramasamy S , Zaman S
Published: May 2024

Background

Component Separation (CST) typically involves the dissection of one or more fascial planes to generate myofascial advancement flaps to assist with fascial closure in incisional hernia repair. The aim of this systematic review and meta-analysis is to compare outcomes between anterior component separation (ACS) versus posterior component separation (PCS) with transversus abdominus release (TAR) for incisional and ventral hernias.

Methods

A systematic search of electronic data sources was conducted, and all studies comparing ACS versus PCSTAR for ventral hernia repair were included. The evaluated parameters were evaluated for overall wound-related complications, surgical site infection (SSI), hematoma, seroma formation, operative time, length of hospital stays (LOS), and recurrence rate. Revman 5.4 software was used for analysis, and the odds ratio (OR) and mean difference were calculated.

Results

Six observational studies reported that 2076 patients with ventral hernias in total were divided between the ACS group (n = 1436) and PCSTAR (n = 640). PCSTAR group showed a significantly lower rate of overall wound complications [OR 2.21, P = 0.03] and SSI [OR 1.86, P = 0.0007] compared to ACS. (Figure1) The two groups showed comparable outcomes regarding operative time [MD -3.01, P = 0.90], Haematoma [OR 0.80, P = 0.26], seroma [OR 1.28, P = 0.45], Hernia recurrence [OR 2.82, P = 0.24] and LOS [MD 0.56, P = 0.29]. Included studies showed moderate to low risk of bias.

Conclusion

Both techniques of component separation have comparable postoperative complications, operative time and LOS. PCSTAR is superior in terms of wound-related complications and SSI. Well-designed randomized controlled trials are needed to investigate this comparison.Figure 1:Forest plot of overall wound-related complications between ACS versus PCSTAR.
THE LONG-TERM OUTCOME OF SURGICAL TREATMENT IN PATIENTS WITH CHRONIC POSTOPERATIVE INGUINAL PAIN
Authors: Narita M , Yamaoka R , Hata H
Published: May 2024

Background

Surgical treatment for patients with chronic postoperative inguinal pain (CPIP) remains very challenging since there has been no consensus which procedure would be appropriate. The aim of the present study is to verify the effectiveness of surgical procedures for patients with CPIP by the patient-reported outcome measures.

Methods

Between February 2017 and May 2023, 50 patients who underwent surgery for CPIP in our institution were evaluated. A questionnaire survey was performed by post or at the outpatient clinic between January 2023 and December 2023. Surgical procedure was decided individually considering sort of pain and a previous surgical procedure. Outcome measures were complications, satisfaction (excellent/good/moderate/poor), and hernia recurrence rate.

Results

Among the study period, 50 patients underwent 53 surgeries for CPIP. Median age was 60 years old. There were 41 males and 9 females. Median duration from the primary hernia repair to surgery for CPIP was 28.8 months. A previous surgical procedure was Lichtenstein (n = 4), Bilayer (n = 5), mesh and plug repair (n = 11) Kugel repair (n = 2), TIPP (n = 10), laparoscopic repair (n = 16), and tissue repair (n = 2). Surgery for CPIP was performed via laparoscopy (n = 22), open anterior (n = 6), and both approaches (n = 25). Postoperative severe complications occurred in 3 patients (reoperation, abscess, and postoperative hemorrhage). A questionnaire was returned by 48 of 50 patients (96%). An 88% excellent/good long-term result was achieved (median 24.6 months). Two hernia recurrence was observed (4%).

Conclusions

An 88% of Patients suffering from CPIP that was refractory to alternative pain treatment benefited from surgery for CPIP.
VERY LONG-TERM QUALITY OF LIFE AFTER FOLLOWING MADRID'S MODIFICATION OF TAR FOR COMPLETE BILATERAL ABDOMINAL WALL SECTION AFTER A HIGH-ENERGY TRAUMA. HOW CAN WE FIX IT?
Authors: Nieto Martos R , Blázquez Hernando L , Divina Juez Sáez L , Manuel Molina Villar J , Martos Meléndez S , Andrés Andrade Yagual A , María Fernández Cebrián J
Published: May 2024

Introduction

We present the case of a young male transferred to our center after a high-speed car accident with multiple abdominal contusions. An urgent Angio CT scan revealed a grade 2 aortic laceration, colonic perforation with an expansive hematoma in the mesentery, and a complete bilateral section of the entire abdominal musculature.

Material and Methods

Initially, an aorto-aortic bypass treated the laceration, and a right hemicolectomy with manual anastomosis addressed the colonic perforation. Due to a complete bilateral abdominal wall section with significant active bleeding, packing was done, followed by transfer to the Intensive Care Unit.

48 hours later, a surgical review was performed. A complete left rectus abdominis and anterior aponeurosis section with an intact posterior rectus layer led to a retro-muscular space dissection (Rives Technique). On the right, there was a transverse section of the right rectus muscle, both oblique muscles, and disruption of the anterior aponeurosis and posterior layer, with integrity only of the peritoneum. A transversus abdominal release was done to place a mesh covering the defect. A slow-resorption biosynthetic mesh covered the space created with right TAR and left Rives, with a non-absorbable polypropylene mesh on top.

Conclusions

Abdominal wall injuries affect approximately one in ten patients presenting to the emergency department following nonpenetrating trauma. These injuries are frequently missed during clinical examination due to the focus on more severe associated injuries. Failure to promptly diagnose these injuries can lead to delayed complications such as giant abdominal wall hernias.

Complete muscle section on the right side of the abdominal wall

Right TAR

MESH placement

Before & After the abdominal wall reconstruction
50 × 50CM MESH IN THE TREATMENT OF COMPLEX ABDOMINAL HERNIAS: OUR HOSPITAL EXPERIENCE
Authors: Oliveira A , Barbosa E , Fonseca T , Barbosa E
Published: May 2024

Background

Repair for giant and/or complex hernias is a challenge that often needs complex abdominal wall reconstruction techniques and big size meshes to achieve a functional reconstruction with low recurrence. The outcomes of using one big size mesh instead of two meshes is poorly described in the literature and therefore the aim of this retrospective study.

Methods

Retrospective analysis of all patients with complex hernia treated at our hospital between May 2021 and December 2023 in which a polypropylene 50 × 50 cm mesh was used.

Results

There were a total of 32 patients. The median age, BMI and Cedar’s calculation were 67 years, 29,1 kg/m2 and 32%. 28% of the cases were recurrences. The hernias were mostly (81%) on the middle line, there were 2 lateral hernias and 4 cases with both. The average CT imaging measurement of the transverse defect and hernia volume was 11,6 cm and 875 cc3. In 22 cases Botulinum Toxin was used preoperatively and in 5 cases progressive pneumoperitoneum was added. 22 patients needed a bilateral TAR but in 9 patients an unilateral TAR was sufficient for adequate abdominal reconstruction. There was only 1 major complication that needed re-intervention (hemorrhage), 2 seromas and 1 wound infection. No recurrences were observed with a median follow-up of 11,2 months.

Conclusion

There is limited information regarding big size meshes in the treatment of incisional hernias. At our hospital, their use has a low percentage of complications and no recurrences. However, prospective multicenter studies are required for further validation and a longer follow-up.
ABDOMINAL WALL RECONSTRUCTION AFTER ILIAC CREST FREE GRAFT
Authors: Olona C , Rodrigo M , Díaz A , Rodríguez J , Caro A , Jorba R
Published: May 2024

Background

The iliac crest free graft with internal oblique muscle (IOM) is used for the reconstruction of composite head and neck defects. This graft can cause a muscular defect in the abdominal wall that requires complex reconstruction.

We present the case of a 43-year-old male patient who underwent left mandibulectomy with left iliac crest flap (LICF).

Methods

Pacient diagnosed with squamous cell carcinoma of bucal mucosa. He received adjuvant chemotherapy, and had a mandibular recurrence, so a left mandibulectomy was decided, and in collaboration with abdominal wall surgeon, a LICF was extracted.

The iliac crest free flap was harvested simultaneously with the resection and recipient site preparation with 2 teams of maxilofacial and abdominal wall surgeons. Internal oblique muscle and an island of subcutaneous tissue and skin were included.

A reconstruction by plans is necessary for the donor site. The TAM is sutured to the iliac muscle. The 10 × 5 cm defect created in the oblique muscles was reconstructed by approximating its margins and placing an onlay 15 × 15 cm PVDF prosthesis.

In the following days, bleeding at the level of the ileolumbar artery was observed and selective embolization was performed. The patient was discharged 50 days after without any other abdominal complication.

Conclusion

The closure of the abdominal wall defect is a challenging step and could be meticulously performed jointly maxillofacial and abdominal wall surgeons. The use of a synthetic mesh might help to the correct closure of abdominal wall.
HERNIA REPAIR WITH LOSS OF DOMAIN AT HOME ASSOCIATED WITH UROSTOMY PARASTOMAL HERNIA WITH SUBCUTANEOUS EXPANDER PLACEMENT
Authors: Plazas D , Gutierrez C , Serrano A , Carreño-Sáez O , Pous-Serrano S , García-Moreno M A , Bueno-Lledó J
Published: May 2024

Objectives

To showcase our experience in the surgical treatment of a complex parastomal hernia case. As a secondary objective, we aim to emphasize the importance of managing these cases in Reference Units and employing a multidisciplinary approach to ensure an optimal surgical outcome.

Materials and Methods

We present a 71-year-old patient diagnosed with a complex hernia secondary to radical cystectomy. The patient was evaluated using Valsalva-computed tomography (CT).

The hernia was classified as L2 M2 M3 M4 W3 according to the EHS classification, with a diameter of 16 × 17 cm and a Tanaka index of 45%. Significant cutaneous atrophy at the midline was noted, anticipating the need for a cutaneous flap for coverage.

Five months before the reparative surgery, a subcutaneous pocket was created for the placement of a subcutaneous expander with progressive inflation. Botulinum toxin infiltration was performed 5 weeks prior, and progressive pneumoperitoneum was created 10 days before the intervention. A follow-up CT scan was conducted 1 day before the procedure.

Results

An eventroplasty was performed using the Anterior Component Separation Type I technique with a 30 × 30 cm polypropylene mesh with silver ions, preceded by urostomy transposition. Finally, a cutaneous flap was designed for coverage. The patient progressed without complications.

Conclusions

Optimizing the surgical treatment outcome for complex hernias requires management by high-volume Reference Units and a multidisciplinary approach.
IMPLANTATION OF A BRIDGING MESH CAN BE AN IMPORTANT EXTENSION OF SOLE TRANSVERSUS ABDOMINAL RELEASE IN OPEN VENTRAL HERNIA REPAIR
Authors: Riediger H , Gröger C , Kundel L , Adam U , Köckerling F
Published: May 2024

Background

Transversus abdominis release (TAR) permits placement of large meshes (TAR-Mesh) between the posterior (PL) and anterior layer (AL). Additional bridging mesh (BM) can be necessary for the PL and less frequent for the AL. (retrospective review of clinical data)

Methods

In 2023, we performed open TAR in 22 patients without BM (n = 15) and with BM (n = 7). Surgical steps: laparotomy, leaving the hernia sac (HS) in place (!), ventral adhesiolysis, Retrorectus access, TAR dissection, PL reconstruction and optional bridging with long-term absorbable BM, placement of TAR-Mesh, linea alba reconstruction with optional skin/HS resection or AL bridging.

Results

The median defect width was 15 cm (without BM) and 24 cm (with BM). Without bridging, the TAR-Mesh had a median size of 1200 cm2. With posterior bridging (median bridging mesh size at PL: 600 cm2), the median size of the TAR-Mesh was increased approximately by this (1750 cm2). The duration of surgery was 139 and 222 min and the hospital stay 6 and 10 days, respectively. The morbidity (8/22, 36%, Clavien-Dindo 1 and 2: 6/8) was without bridging 3/15 and with bridging 5/7; p = 0.02.

Conclusion

Using the TAR technique with additional bridging, even large hernias can be safely repaired without further preoperative preparation of the hernia defect. Additional posterior bridging provides for reliable separation of the posterior plane from the intestines. Hence, the hernia sac is always available for anterior reconstruction of the linea alba. The bridging technique can be applied when tension free closure is not possible.
THE EFFECT OF ROBOTICS IN THE PERIOPERATIVE OUTCOMES OF HERNIA REPAIR IN MORBIDLY OBESE PATIENTS
Authors: Ruotsalainen A , Husu H , Harju J , Vironen J
Published: May 2024

Aim

To show that robotic hernia surgery in morbidly obese patients is feasible. Surgery is often denied in the fear of complications associated with obesity. Consequently, obese patients are over-represented in those requiring emergent repair.

Methods

From a prospective database, all patients with body mass index (BMI) ≥40 kg/m2 operated during 1.3.2022–25.1.2024 were analyzed. Robotic repair is our standard procedure for ventral hernias since 1.3.2022. Open surgery is still common in emergency cases.

Results

62 patients with BMI ≥40 (median 44.7, range 40–67) were operated for primary (n = 44, robotic 23) or incisional (n = 18, robotic 8) hernia. 32/62 (52%) were emergency/urgent operations (robotic 10, open 22).

There was no difference between robotic and open repairs in average defect width (4 cm primary, 9 cm incisional) or defect area (16,8 vs. 16,0 cm2 primary, 120 vs. 105 cm2 incisional). In primary hernias larger meshes were used in robotic procedures (291 vs. 197 cm2). In incisional hernias there was no difference (489 vs. 509 cm2).

Median operation time for primary hernias was 114 vs. 99 minutes and hospital stay 1 vs.2 days after robotic vs. open procedure. In incisional hernia operation time was 205 vs. 184 minutes and hospital stay 2 vs. 3 days.

After robotics complications (n = 9, 29%) were mild, mainly seromas. After open procedures (n = 10, 32%) complications were more severe leading to return to hospital (wound infections, mesh removal).

Conclusion

Robotic surgery should be offered to morbidly obese patients. More severe complications and prolonged hospital stay were seen after open procedures.
ABDOMINAL WALL PSEUDOHERNIA AFTER SHOCK WAVE LITHOTRIPSY: A RARE CAUSE OF ABDOMINAL WALL BULGING
Authors: Santana Valenciano Á , del Carmen Ortega Ferrete A , Zaborras Buill J , López Monclús J , Porrero Guerrero B , Valle de Lersundi A R , Muñoz Rodriguez J , Molina Villar J M , Garcia de León L R , Fernández Cebrian J M , Garcia Ureña M Á , Blazquez Hernando L
Published: May 2024

Introduction

Abdominal wall pseudohernia (AWP) is a marked protrusion of the abdominal wall due to neuropathy or denervation. It is a well-known complication of abdominal surgery, herpes zoster infection, diabetes and iatrogenic trauma. Here we present the first case of AWP after shock wave lithotripsy (SWL).

Case report

A 59 years old male presented with symptomatic left flank bulging. He had undergone SWL in 2003 due to a left kidney stone. He had no previous history of abdominal surgery or blunt abdominal trauma. He presented with pain and weightlifting impairment. CT-scan showed muscular atrophy on the left side of the abdominal wall, but no hernia defect (Figure 1).

A lateral incision on the bulging area was performed. Muscular atrophy and fatty infiltration were observed. The preperitoneal space was dissected from the retrodiaphragmatic space down to Retzius space, laterally to quadratus lumborum and psoas muscle and medially until linea alba. For reconstruction double preperitoneal mesh technique was used: a biosynthetic resorbable mesh of polyglycolide:trimethylene carbonate copolymer (PGA:TMC) (20 × 30 cm) and a polypropylene mesh (45 × 40 cm). He was discharged after 5 days, without complications. Pathology exam showed myofibers’ atrophy and mature adipose tissue with isolated skeletal muscle. He presented no pain and no clinical relapse after 6 months follow-up.

Discussion and Conclusion

There are cases of AWP reported after percutaneous nephrolithotomy, videoassisted thoracoscopy or spine surgery, but no case of AWP after SWL was ever reported. CT-scan shows muscular atrophy without hernia defect. Given AWP’s low incidence the optimal approach is controversial, leaving surgery mainly for symptomatic cases.
INITIAL EXPERIENCE WITH AN INTRAOPERATIVE FASCIAL STRETCHING DEVICE TO REPAIR COMPLEX INCISIONAL HERNIAS
Authors: Santidrián Zurbano M , Fernández Baeza M , Domínguez Bastante M , Mansilla Roselló A
Published: May 2024

Aim

Midline closure is a target of incisional hernia (IH) repair and poses a surgical challenge, especially in W3 IH. Therefore, measures such as surgical prehabilitation (Botulinum Toxin -BT- or progressive pneumoperitoneum -PN-) have been adopted.

We present our initial results with a fascial traction (FT) device for treating large IH.

Material and Methods

Single-centre, observational, retrospective study (April 2022–December 2023), including patients treated with FT (transverse defect greater or equal to 15 cm).

Epidemiological characteristics, comorbidity, prehabilitation, type of IH, bridging, surgical time, hospital stay, morbidity, mortality and recurrence were studied.

Results

Patients characteristics (N = 5) Male/Female 3/2 Age 57(43-63) Diabetes mellitus 2(40%) Arterial hypertension 4(80%) Body mass index 34,4 (30,7–41,5) CeDAR 32,6% (17-47)

IH classification (EHS): 3 M2-3-4-5 (60%), 1 M2-3-4 (20%), 1 bilateral L1 (20%), all W3 (15–27 cm). 2 cases R0 (40%), 2 R1 (40%), 1 R2 (20%). All received preoperatively TB and 4 PP, mean insufflated volume 8150 cc (4000–14400).Surgery related parameters (N = 5)TechniqueRives-StoppaBilateral TAR3(60%)2(40%)MeshesPVDF2(40%)Biosynthetic +PPL3(60%)Primary fascial closure4(80%)Bridging(size)1(15 × 5 cm)Surgical time(minutes)278(210–330)IFSD use30 minutesHospital stay(days)12,8 (6–29)Related postoperative painLow2Medium2High1ComplicationsWound-related (N = 4,80%)Infection3 (60%)Seroma2 (40%)Haematoma2 (20%)General (N = 0)Mortality0Recurrences0

Conclusions

FTD are useful to treat IH, but a rational use must be made through proper preselection of candidates (W3 defects wider than 15 cm), due to economic cost, increased surgical time and the possible complications they entail.
CYSTIC INGUINAL LYNFHANGIOMA IN ADULT FEMALE
Authors: Serrano A , Gutiérrez C , Álvarez A , Carreño O , García P , Bueno J , Pous S
Published: May 2024

Background

To present a clinical case of cystic inguinal lymphangioma in an adult female, an atypical site and age of presentation.

Method

A 42-year-old woman was referred for consultation due to persistent pain and swelling in the right inguinal region, with initial suspicion of inguinal hernia. A mobile, irreducible mass without protrusion during the Valsalva maneuver was identified. Faced with diagnostic uncertainty, inguinal ultrasound and magnetic resonance imaging were requested, revealing a cystic lesion indicative of cystic inguinal lymphangioma.

Results

Elective surgery was decided. A right inguinal incision revealed a cystic tumor extending along the inguinal canal from the labium majus to the preperitoneal space. Complete excision was performed, requiring section of the round ligament. Subsequently, closure of the deep inguinal ring was conducted, with the conjoint tendon approximated to the inguinal ligament using a continuous suture of slowly absorbable monofilament. Hernioplasty with self-adhesive polypropylene mesh was employed to repair the inguinal defect. The procedure was carried out in the ambulatory major surgery program. At the one-month post-surgery follow-up, the patient exhibited satisfactory recovery with no signs of clinical recurrence. Histopathological examination of the surgical specimen confirmed the diagnosis of cystic inguinal lymphangioma, with no additional pathological findings.

Conclusion

Cystic lymphangioma is a benign and uncommon malformation of the lymphatic system. It should be considered in cases of inguinal masses with progressive growth whose examination is not consistent with an inguinal hernia. Ultrasound is the imaging test of choice, with definitive diagnosis confirmed by histopathology. Surgery with complete resection is recommended due to the risk of recurrence.
COMPLICATIONS AND THEIR TROUBLE-SHOOTING IN LAPAROSCOPIC eTEP INGUINAL HERNIA REPAIR
Authors: Shaik N , Shrivastava R
Published: May 2024

Introduction and Aim

The field of hernia repair has been revolutionized since the advent of totally extraperitoneal (TEP) repairs. The concept of eTEP (extended view TEP) repairs have further expanded horizons by overcoming the challenges faced in TEP repairs. Although laparoscopic eTEP hernia repairs offer a myriad of advantages, these procedures pose a steep learning curve and may pose complications which maybe difficult to manage.

This study aims to highlight the complications faced during laparoscopic eTEP inguinal hernia repairs at our centre and provide possible trouble-shooting solutions for the same.

Materials and Methods

This is a high volume single-centre, single team prospective observational data of patients undergoing laparoscopic eTEP inguinal hernia repairs from January 2020 to October 2023. We reviewed a total of 252 such patients and collected demographic details, co-morbidities, intra-operative complications and post-operative recovery of the patients.

Results

We have highlighted the possible complications and recommended trouble-shooting approaches to tackle them. The incidence of intra-operative and early complications like early pneumoperitoneum, injury to brick’s artery, injury to inferior epigastric artery, peritoneal rents, urinary retention in our study was 5.15%, 0.02%, 0.003%, 10.3%, 1.9% respectively. Late complications like seroma, hematoma, recurrence showed an incidence of 1.58%, 0.003%, 0.003% respectively. Our cohort did not have any cases of visceral injury (bowel/bladder) or surgical site infection.

Conclusion

It is essential to identify and address complications faced during laparoscopic eTEP repairs to ensure patient safety, improved outcomes and reduced recurrences and surgical site infections. Implementing the suggested troubleshooting strategies may help improve the surgical outcome and in turn postoperative patient well-being and quality of life in patients undergoing eTEP repairs.
PEDIATRIC INGUINAL HERNIA: OCCULT BILATERALITY – AN INDICATION FOR LAPAROSCOPIC REPAIR
Authors: Sinha A , Kamesh S , Rathod K , Pathak M , Jadhav A , Saxena R , Nayak S
Published: May 2024

Aim

The study aimed to ascertain the incidence of contralateral patent processus vaginalis in patients undergoing laparoscopic inguinal hernia repair.

Settings and Design

A retrospective review of our cases of Inguinal Hernia operated by Laparoscopic herniotomy in the Department of Pediatric Surgery was done.

Subjects and Methods

All children who underwent laparoscopic inguinal hernia repair at AIIMS Jodhpur, India, during the period of Sept 2016–2023 were retrospectively studied. Parameters studied included age, gender, side of the hernia, incidence of contralateral patent processus vaginalis and recurrence rates. As per departmental protocol, all patients who had occult bilaterality were repaired in the same sitting after the repair of the presenting side.

Results

A total of 255 patients were included in the study. The mean age was 44.4 months and varied from 0 months of age to 192 months. Ligation of the sac was performed after or without division, depending on the operating surgeon's preference. The follow-up varied from 3 months to 7 years, with a mean of 3.8 years. 10 patients had a bilateral inguinal hernia at diagnosis, with left-side inguinal hernia in 95 and right-sided hernia in 150 patients. Out of the 245 patients with unilateral inguinal hernia, a contralateral patent processus vaginalis was found in 48 patients (19.5%). We had 7 recurrences in the cohort (2.7%). No recurrence was seen on the contralateral side, which was closed during the primary procedure. All recurrences occurred in patients between 1 and 3 years of age. Two patients had large inguinoscrotal swellings at presentation and 2 patients had spinal dysraphism along with inguinal hernia.

Conclusion

Bilateral inguinal hernia is universally accepted as an indication to repair a pediatric inguinal hernia through laproscopic route. However, there is often a debate regarding whether laproscopic inguinal hernia repair has a role in managing unilateral inguinal hernia. Our results show that out of our cohort of 244 patients with unilateral inguinal hernia, approximately one fifth of the patients have patent processus vaginalis on the contralateral side. This can be easily repaired in the same setting via laparoscopy without increasing the morbidity and preventing future recurrences to the contralateral side. Take home message Laparoscopic repair of Pediatric inguinal hernia has very acceptable success rates and should be the preferred way to tackle inguinal hernias in children, especially since around a fifth of the patients have contralateral patent processus vaginalis.
A SYSTEMATIC REVIEW AND META-REGRESSION OF FACTORS AFFECTING INCISIONAL HERNIA RATES IN MIDLINE INCISIONS OVER A 10-YEAR PERIOD
Authors: Smith L , Coxon-Meggy A , Gwilym B , Lukaszewicz A , Mckenna M , Osinkolu I , Bosanquet D , Torkington J
Published: May 2024

Aims

The Incisional hernia (IH) rate after midline incisions was reported to be 12.8% in a systematic review of literature published in 2015. With updated guidance on abdominal wall closure techniques, the landscape of abdominal wall closure has changed. We aimed to update this literature to assess any change in the rates and any new identifiable risk factors for IH in midline incisions.

Methods

We undertook a systematic review of literature according to PRISMA guidelines and registered on PROSPERO. All papers reporting IH rates in midline incisions with primary suture closure between April 2013 — October 2022 were included. Papers with two or more arms suitable for inclusion were extracted independently.

Results

Sixty three papers (21 RCTs, 36 cohort studies and 6 case-control studies), comprising 18,126 patients were included. The mean IH rate was 16.8% at a weighted mean follow up of 31.3 months. Meta-regression identified two study level variables that correlated with an increase in IH rates (Use of radiology for diagnosis of IH and inclusion of patients undergoing a contaminated procedure) and one operative variable that corresponded with a decrease in rates (Small bites closure technique).

Conclusions

The Incisional hernia rate in midline incisions reported in the literature have increased over the last decade. A change in detection method and an increase in patient complexity may account for the majority of risk, suggesting standardisation of trial technique is essential in IH prevention trials. Small bites technique is associated with a significant reduction in IH rates, and future work should focus on strengthening the evidence base around this technique.
EXTENDED TOTALLY EXTRAPERITONEAL (eTEP) VENTRAL HERNIA REPAIR: INITIAL RESULTS
Authors: Souto R , Barreira A , Carracha M , Figueiredo J , Branco A , Costa P , Cabeleira A
Published: May 2024

Background

Extended totally extraperitoneal ventral hernia repair (eTEP-VHR) is gaining increasing popularity due to its improved postoperative outcomes. Recent evidence suggests that minimally invasive retromuscular dissection and mesh placement has better outcomes than other mesh positions, lowering the rates of hernia recurrence and surgical site occurrences. We present the initial results from eTEP-VHR implementation at two non-robotic surgical departments.

Method

Retrospective analysis of all consecutive patients submitted to eTEP-VHR between June 2022 and November 2023 in two centers by the same surgical team. Data were analyzed for operative details and perioperative complications.

Results

15 patients underwent eTEP-VHR. 3 cases required a transversus abdominis release. No intraoperative complications were recorded. Median length of stay was 1,5 days. After a median follow-up of 9 months, there were 0 recurrences, 2 cases of uncomplicated seroma, 0 mesh infections and 0 cases of chronic pain.

Conclusion

Implementation of eTEP seems to be safe and a good alternative to ventral hernia repair in selected cases, allowing for excellent postoperative outcomes, even in non-robotic centers.
LIDOCAINE PLASTERS AS A NON-INVASIVE ALTERNATIVE TREATMENT OPTION IN CHILDREN WITH ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME (ACNES)
Authors: ten Have T , Zwaans W A R , Scheltinga M R M , Roumen R M H
Published: May 2024

Background

Chronic abdominal pain in children can sometimes be attributed to Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), a typical abdominal wall neuropathic pain entity. Not only the diagnosis but also the treatment poses various challenges. Usually, treatment starts with tender point injections, which are considered minimally invasive. Nevertheless, these injections can be quite burdensome for children, who might even refuse them. However, the alternative, surgical neurectomy, is far more invasive. The use of Lidocaine 5% medicated plasters, used successfully in various neuropathic pain conditions, might offer a non-invasive alternative for children with ACNES. This retrospective case series aims to evaluate the effectiveness and tolerability of lidocaine plasters in children with ACNES.

Method

Children under 18 diagnosed with ACNES, and treated with lidocaine medicated plasters from December 2021 to December 2022, were included. Treatment outcomes, including pain reduction and complications, were extracted from electronic patient records.

Results

Twelve of the sixteen children diagnosed with ACNES started the lidocaine plaster treatment. Mean age was 13 years (F:M ratio 3:1). The lidocaine plaster treatment resulted in lasting pain reduction in three patients, with two achieving a pain free status. Temporary pain reduction was noted in five patients. The last four patients experienced no pain relief during plaster treatment. One patient reported a skin rash, which disappeared a few days after not applying the plaster.

Conclusion

Lidocaine plasters might be considered as a non-invasive treatment option for children with ACNES, providing significant pain relief in a substantial portion of them.
LAPAROSCOPIC eTEP APPROACH TO VENTRAL HERNIAS: SHORT-TERM OUTCOMES
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 our series of patients with ventral hernias treated by laparoscopic eTEP approach.

Material and Methods

Prospective study where we analyzed our database of patients with ventral hernias (primary and secondary) undergoing abdominal wall surgery using laparoscopic eTEP approach, during the period August-2021 to December-2023. We present our short-term outcomes.

Results

A total of 65 patients underwent laparoscopic eTEP surgery (men: 54.8%, age: 64 (RIQ: 43–73years)). LOS: 1.48 ± 0.62 days. Pathological history: diabetes mellitus (19.4%), arterial hypertension (45.2%), dyslipidemia (51.6%), smoking (25.8%), alcohol consumption (13.3%), cardiovascular disease (12.9%). ASA Classification: I (32.3%), II (45.2%), III (22.6%). BMI: 30.6 ± 4.68 kg/m2. Overweight: 11 (35.5%) and obesity: 17 (54.8%).

Primary hernias: 26.7% and incisional hernias: 61.3%. Location: midline: 87%, lateral: 13%, supraumbilical: 58.1%, umbilical: 87.1% and infraumbilical: 25.8%. Hernia width (EHS classification): W1:12.9%, W2:80.6% and W3:6.5%, transverse hernia diameter: 6.5 ± 2.1 cm, hernia length size: 6.1 ± 4.4 cm. Associated with diastasis:77.4%, diastasis width: 4.9 ± 1.7 cm. Associated with inguinal hernia:19.4%.

Type of laparoscopic surgical technique performed: Rives-Stoppa: 77.4%, unilateral TAR: 16.1%, bilateral TAR: 6.5%. Number of trocars used by procedure: 4(RIQ:4-5). Preoperative botulinum toxin: 22.6%. Posterior sheath closure: 74.2%. Mesh fixation type: Glutack 16.1%, Tisseel 61.3%, no fixation 22.6%. Mesh type used: Low density wide-pore polypropylene 35.5%, PVDF-Mesh 58.1%, PVDF-IPOM mesh 6.5%. Mesh size: width 18(RIQ:16–22 cm) and length 28(RIQ:25–30 cm). Drainage: 4,8%. Surgical time: 165(RIQ:120–185 min).

Global and serious complications (CD≥III): 12.9% and 1.6%, Re-IQ due to incarcerated hernia due to posterior sheath dehiscence: 1.6%. No intraoperative complications. Clinical seroma: 9.7% and ultrasound seroma: 41.6% that resolved completely spontaneously during the first and second postoperative months. No cases of hematoma or surgical wound infection. Until the current follow-up we have not had any recurrence.

Conclusions

The laparoscopic eTEP approach of ventral hernias has a low rate of global complications, despite being our first cases performed. It also has low rates of postoperative pain and shorter LOS. We can conclude that in our Hospital the laparoscopic eTEP approach is a safe, efficient and effective technique.
LONG TERM QUALITY OF LIFE FOLLOWING LAPAROSCOPIC INGUINAL HERNIA REPAIR WITH MESH. A TEN-YEAR, SINGLE SURGEON SERIES FROM NEW ZEALAND
Authors: Wehipeihana E , Moss D
Published: May 2024

Aim

To provide objective analysis of quality of life for patients after laparoscopic inguinal hernia surgery (LIHS) with mesh from 2013 to 2022.

Material and Methods

This study is a retrospective audit of outcomes from ten years of LIHS by a specialist hernia surgeon working in public and private practice in South Auckland, New Zealand. Data were collected by screening digital clinical notes and surgeon records, with a representative sample of patients contacted to provide feedback on quality of life indicators using the Carolinas Comfort Scale (CCS).

The first five years of this data have been previously published. This study completed the ten year data set with analysis of the subsequent five years of patient outcomes, including revisiting a representative sample of previously contacted patients to update their quality of life outcomes. Statistical analysis was performed in Microsoft Excel.

Results

More than 500 patients met our inclusion criteria. Recurrence rate in this cohort was <1%, with no conversions to open surgery, no adhesion related admissions or mesh explant procedures. The essential CCS criteria showed fewer than 6% of patients experienced sensation of mesh presence, pain or movement limitation, with no severe or disabling symptoms reported.

Conclusions

This homogenous series describing outcomes from a single surgeon shows that LIHS with self-adhesive mesh is a minimally morbid procedure with high patient satisfaction in this cohort with long follow up.
PFANNENSTIEL HERNIA – AN UNDER DIAGNOSED PATHOLOGY OFTEN OVERLOOKED AND POTENTIALLY PREVENTABLE
Authors: Zanellato A , Sunny A , Tulloh B
Published: May 2024

Objective

Pfannenstiel incision was described in 1900 and is widely used for C-section. Obstetricians tear the rectus muscles and posterior sheath apart and don’t reapproximate this layer. As consequence, it leaves a gap between both recti which allows herniation of abdominal contents between the anterior rectus sheath and muscle. The aim was describing this defect and its characteristics as well as propose an awareness strategy to avoid symptomatic patients being dismissed after “normal” scan or physical examination.

Method

A prospective observational study was conducted on 32 patients, between January 2019–2024. Data collected (history, examination, and relevant investigations) was entered in a proforma, tabulated, and analysed.

Most of patients presented with discomfort, swelling, intermittent nausea and all reported a bulge. Distension was noted in 42%. On physical examination all had some degree of asymmetry. However no cough impulse or palpable defect was detected. They were mainly diagnosed on CT scans (77%) although some radiology reports denied the presence of a hernia because the anterior sheath was intact. The rest were found incidentally at laparoscopy for unrelated conditions. Most defects were repaired with sutures while larger defects were repaired with mesh. Two patients presented with small bowel obstruction.

Conclusion

Pfannenstiel hernia is atypical with unique anatomic features and the radiological signs may be subtle. Increased awareness by surgeons and radiologists should avoid this condition being missed. It may be preventable by attention to closing the posterior layer at the index operation.