bluuebunny/crossref_metadata_2025 huggingface dataset:
LAPAROSCOPIC EXTENDED TOTALLY EXTRAPERITONEAL (e-TEP) TECHNIQUE FOR LATERAL VENTRAL HERNIA REPAIR: STEP BY STEP
Authors: Trujillo J , Gómez J R , Concejo P , Montenegro M A , Schenone F , Jezieniecki C , Martín del Olmo J C
Published: May 2024

Aims

Ventral hernias are one of the most common pathologies in general surgery, however, lateral hernias are not so common, so their minimally invasive approach is not yet very popular, much less through the laparoscopic eTEP approach. The surgical technique for repairing this type of hernia is ideally a neuromuscular or preperitoneal technique, which is a good technique due to the more anatomical position of the mesh and lower rates of complications and recurrences in the short and long term. In the following video we present the usefulness and steps to follow to perform a laparoscopic e-TEP approach to treat lateral abdominal hernias.

Methods

Video-case presentation.

Results

43-year-old male patient. Pathology history: laparoscopic right nephrectomy. Physical examination: right lateral hernia EHS: L2W2 (8–9 cm). CT scan: 8 × 9 cm lateral hernia with small bowel inside the hernial sac without obstruction signs. 4 weeks ago 400UI botulinum toxin (according Ibarra-Hurtado technique) was placed in the abdominal wall in order to reach a better abdominal wall reconstruction. We decided to perform a laparoscopic extraperitoneal technique (eTEP).

We use 4 ports (2 × 12 mm, 2 × 5 mm) to perform the surgery. The surgery begins dissecting the right retromuscular space using a dissector balloon. We placed the other ports and complete a lateral dissection until the neurovascular bundles, at this point we continue with the TAR procedure, in this case of hernias we performed it up-to-down transecting the lateral posterior rectus sheath and complete the dissection of the preperitoneal space. We continue the dissection towards the pubis, and finally we complete the dissection of the hernial sac, we open the sac and reduce all its contents and release the adhesions, completing a complete dissection of the preperitoneal space until reaching at least an overlap of 5 cm per side. The next step is the closure of the posterior sheath using V-Lock 2-0 and the closure of the anterior sheath (hernial defect) using Stratafix 0. We measure the space placed and place an 18 × 30 cm Dynamesh CICAT mesh fixed with fibrin and without drainage.

The patient presented a satisfactory evolution without complications and was discharged in 1°POD.

Conclusions

The minimally invasive e-TEP approach is a good and effective option in cases of lateral ventral hernias, as in the case presented, without increasing the incidence of postoperative complications and with good postoperative recovery, little postoperative pain, short hospital stay and faster return to routine activities and work life, and lower health care costs.
ABDOMINAL WALL RECONSTRUCTION AFTER EXCISION OF A GIANT DESMOID TUMOUR
Authors: Tuñón-Féquant C I , López-Monclus J , Blázquez-Hernando L A , Robin-Valle de Lersundi A , Muñoz-Rodríguez J , Medina-Pedrique M , Avilés-Oliveros A , Crespo-Álvarez M A , García-Ureña M A
Published: May 2024

Introduction

Desmoid tumors are histologically benign proliferations of stromal cells that grow slowly and infiltratively, but may be locally aggressive. They arise from musculoaponeurotic stromal elements. Due to poor response to systemic medical treatment, radical resection and reconstruction should be performed.

Material and Methods

We present the case of a 24-year-old female patient with abdominal and thoracic tumours, diagnosed in Bangladesh as an endometrioma. She had an increasement of them during her pregnancy. A complementary study was performed showing 4 masses which were biopsied with the result of low-grade mesenchymal tumour.

Results

After multidisciplinary consensus, a two-stage surgical approach was adopted. First, the thoracic-retroperitoneal mass was removed.

Botulinum toxin was then administered to the contralateral side, followed by abdominal surgery. En bloc excision of the entire mass was performed, which was infiltrating the left rectus, obliques and transverse muscles. A dissection of retromuscular preperitoneal disection from central tendon to both Cooper ligaments and from left psoas muscle to the right quadratus lumborum was planned. Then, subsequent reconstruction of the abdominal wall with the combination of absorbable and giant synthetic mesh with reimplantation of muscles into an area of 13 × 10 that was left as a bridge. Only fixation to Cooper ligaments were made. A second synthetic mesh covering the bridge was also implanted as bridge reinforcement. The patient was discharged uneventfully on the 7th postoperative day.

Conclusions

Radical resection with immediate mesh reconstruction is a safe procedure and can provide definitive cure without functional disability for patients with anterior abdominal desmoid tumours.
HYBRID SURGERY FOR GIANT L2-4W3 INCISIONAL HERNIA: E-TEP AND LAPAROSCOPIC MADRID-PCS
Authors: Vaello V , Martínez C , Avilés A , Urbani A , Medina M , Casanova A , Morejón S , García-Ureña M A
Published: May 2024

Objective

To present a hybrid laparoscopic/open technique for the repair of a giant incisional hernia.

Methods

A 79-year-old patient with a large L2-4W3 incisional hernia following a left nephrouretherectomy was treated with a hybrid laparoscopic/open approach following injection of botulinum toxin A. The initial stage involved an endoscopic totally extraperitoneal (e-TEP) approach. Subsequently, the dissection was extended laterally by sectioning the posterior rectus sheath (PRS) entering pre-transversalis fascia space cranially and preperitoneal space caudally to the hernia. The procedure was then converted to an open approach for final dissection of the hernia sac, lysis of adhesions, and mesh placement in our standard technique: a BioA mesh serving as a scaffold and a large polypropylene mesh that enveloped the abdominal wall (taco conformation). The patient experienced no complications and was discharged on the 5th postoperative day.

Results

The hybrid laparoscopic/open approach provided the advantages of minimally invasive surgery, including reduced postoperative pain and improved recovery, enabling direct visualization and safe dissection of critical structures for our modification of posterior components separation. The open conversion enabled a complete dissection of the hernia sac, lysis of adhesions, and secure mesh placement.

Conclusion

The hybrid laparoscopic/open approach offers a viable option for repairing giant incisional hernias, particularly when a purely minimally invasive approach is not feasible due to the extent of the defect. The combination of minimally invasive dissection and open access for critical structures provides a balance between the benefits of both techniques.
ROBOTICALLY ASSISTED TOTALLY EXTRAPERITONEAL MIDLINE INCISIONAL HERNIA REPAIR AFTER OPEN CYSTECTOMY
Authors: Vogel R , Heinzelmann F , Büchler P , Mück B
Published: May 2024

Introduction

This case report describes a 72-year-old male patient who underwent robotically-assisted total extraperitoneal hernia repair. The patient had a history of complete cystectomy with orthotopic neobladder reconstruction and temporary colon diversion via transversostomy through midline laparotomy four years prior. The transversostomy was relocated six months before the current operation, when the patient presented in our outpatient department with a midline incisional hernia. A CT scan revealed a E2, M2, M3, M4 hernia, with an orifice measuring 6 × 20 cm. This case illustrates the feasibility of robotically-assisted total extraperitoneal repair even after open cystectomy with resection of the ligamentum umbilicale.

Methods

The initial entry into the retroperitoneal space was achieved through the right upper rectus sheath. The initial phase of the operation was conducted endoscopically. Following the creation of the left retro rectus space, three 8 mm robotic ports were strategically placed along the left semilunar line, and the robotic system was docked. The retzius space was completely developed extraperitoneally using the robotic system, irrespective of the previous surgical procedure. Subsequently, a cross-over maneuvre was executed through an incision of the posterior rectus sheath on the contralateral side. After developing the retrorectus space on the contralateral side, the former stomasite reached the lateral border of the right posterior rectus sheath. To fully overlap the hernia site, a partial right-sided transversus abdominis release was performed. Following this, an uncoated synthetic mesh (18 × 32 cm) was placed, ensuring sufficient overlap of the hernia site.

Results

The postoperative phase was uneventful and the patient was discharged on the second postoperative day. No complications occurred.

Conclusion

Robotic assisted totally extraperitoneal hernia repair is offers a suitable approach for treatment of midline hernias even following partial resection of the peritoneum and the ligamentum umbicale.
TOTAL EXTRAPERITONEAL ENDOSCOPIC INGUINAL HERNIOPLASTY (TEP). DEALING WITH THE ROUND LIGAMENT
Authors: Zárate Gomez J , Peinado Iríbar B , Supelano Eslait G , Álvarez de Sierra P , Gil López J M , García Munar M , Lechuga Alonso I , Merello Godino J
Published: May 2024

Background

International guidelines recommend the laparoendoscopic approach to treat inguinal hernia in women. When performing this technique we have to deal with the round ligament of the uterus and the doubt arises: to divide or not to divide. The peritoneum may be intensely attached to the round ligament and its dissection may be technically challenging. There is no specific statement or consensus on this matter included in the guidelines.

Method

Video presentation: three different options to manage the round ligament during TEP inguinal hernioplasty.

Results

Management options regarding the round ligament of the uterus:

Division: the round ligament is dissected proximally to avoid injuring the genital branch of the genitofemoral nerve. Place 5 mm endoclips close to the peritoneum before dividing it.

Dissection: The round ligament is usually difficult to liberate from the peritoneal sac. Care must be taken to preserve the peritoneal sac integrity.

Open the peritoneum: To save the round ligament, the peritoneal sac can be cut to obtain a flap followed by closure of the defect with 5 mm endoclips.

Conclusion

There is no consensus regarding the round ligament of the uterus’ preservation in TEP surgery, this matter needs further evaluation. We describe three valid management options, but we recommend preservation over division. Nevertheless, sometimes the ligament needs dividing in order to perform a proper repair with mesh placement. If this is the case, the surgeon must have the genital branch of the genitofemoral nerve in mind to avoid chronical postoperative pain.
IS MINIMALLY INVASIVE HERNIA REPAIR SAFE IN PATIENTS WITH PREVIOUS PROSTATE SURGERY?
Authors: Abad Moret R , Salido S , Zapata C , Gutiérrez E , de Mora Á , Piñero S , Fondevila C , Guevara-Martínez J
Published: May 2024

Aim

Laparoscopic inguinal hernia repair after previous radical prostatectomy is considered complex due to the subsequent preperitoneal fibrotic reaction. For this reason, it has been considered a contraindication, and many surgeons have opted for open surgery. The aim of this study is to describe the outcomes of inguinal hernia repair after previous prostate surgery in our center.

Patients and Methods

We retrospectively analyzed a total of 566 patients who underwent inguinal hernia repair during a 1 year period (from May 2022 to May 2023). Patients with previous radical prostatectomy were identified, and outcomes of laparoscopic versus open hernia repair techniques were compared.

Results

Twenty-three patients with prior prostate surgery were identified, among whom four underwent minimally invasive repair (MIS) (17%; 2 TEP and 2 TAPP). Longer mean operative time was observed in the MIS group (100 min) compared to the open surgery (67 min). There were no MIS to open conversions. Perioperative complications included 1 bladder injury and 2 seromas in the MIS group, and 1 hematoma and 1 recurrence in the open group.

Conclusions

MIS for inguinal hernia after prostate surgery remains infrequent in our experience. Although MIS hernia repair after prostatectomy is considered safe, potentially serious complications may arise, and care must be taken regarding patient selection and operative management.
RARE CASE OF OBSTRUCTING SIGMOID CARCINOMA ENCOUNTERING WITHIN A SCROTAL HERNIA
Authors: Alifanov D , Alifanova E , Krajinovic K
Published: May 2024

Aim

To present our experience with treatment of obstructing sigmoid carcinoma encountering within a scrotal hernia and to find out the best approach for oncological bowel resection and simultaneous hernia repair in this situation.

Materials and Methods

We want to report about our case and to present a current literature review from PubMed and Google Scholar database, performed in January 2024.

In our case we chose to perform a conventional oncological left-sided colon resection with anastomosis via median laparotomy. During the operation an en-bloc left-sided orchiectomy was needed for oncological reasons. The suture repair for a scrotal hernia was performed because of contamination. The patient has uneventful postoperative course and was discharge from hospital on the postoperative day 9.

Results

Scrotal hernia is a common surgical condition. It's quite rare — less than 0,4% of the cases in which colon adenocarcinoma presents within a inguinal hernia sac. A literature search on inguinal hernias containing a primary colon carcinoma revealed 29 cases. Scrotal hernia associated with obstructing sigmoid carcinoma is even more rare.

Conclusions

A surgeon may encounter a challenging scenario requiring both an oncologic resection and a repair of a large hernia in contaminated field. Thus, it is important to be prepared to realize the difficulties and to apply the correct treatment of both conditions.
TAPP FOR RECURRENT INGUINAL HERNIA IN OUR HOSPITAL
Authors: Ando M , Saito T , Ueda S , Shinohara K , Yasui K , Osawa T , Matsumura T , Fukami Y , Komatsu S , Kaneko K , Sano T
Published: May 2024

Background

Laparoscopic surgery for recurrent inguinal hernias is technically advanced but has the advantage of better understanding of the anatomy of the recurrent form and mechanically strong repair. Transabdominal preperitoneal repair (TAPP) is the first choice for inguinal hernia surgery and is also the first choice for recurrent inguinal hernias at our hospital. We review the results of TAPP for recurrent inguinal hernias at our hospital.

Methods

We reviewed 29 patients who underwent TAPP for recurrent inguinal hernia at our hospital from January 2015 to December 2023.

Results

The previous surgical procedures were mesh plug in 11 cases, tension repair in 8 cases, tension free repair with unknown technique in 3 cases, UHS in 3 cases, TAPP in 2 cases, Lichtenstein in 1 case, and Polysoft in 1 case. Nine patients underwent repair using the modified intraperitoneal onlay mesh (mIPOM) technique. The median operative time (range) was 109 minutes (73–217). 2 patients (6.9%; 1 with bowel obstruction, 1 with mesh infection) had postoperative complications. No apparent recurrence has been observed to date.

Conclusions

No recurrence was observed, but shortening the operation time and decreasing complications are future issues. IPOM is not recommended for first inguinal hernias, but the mIPOM may decrease complications in recurrent cases.
TRANSVERSUS ABDOMINIS MUSCLE RELEASE (TAR) IN GIANT INCISIONAL HERNIA
Authors: Baćo S , Mitrić M
Published: May 2024

Background

We present a case of giant ventral incisional hernia, where a favorable outcome was achieved with Transversus Abdominis Muscle Release technique (TAR), in a contaminated environment without perioperative complications and recurrence after 36 months, with the placement of inexpensive non-absorbable ‘Paha’ mesh.

Materials and Methods

A 70-year-old man, who had undergone two previous operations presented with a giant incisional hernia. The rectus defect in the umbilical region was 20 cm in the transverse direction wide and 20 cm in the vertical direction and a defect area of 400 cm2 with the bowel adherent to the skin. We were compelled to resect approximately 15 cm of the intestine tenui and constructed a T-T anastomosis, alert to the risk of the operating field contamination. Two non-absorbable, monofilament polypropylene mesh sized 30 × 30 cm were placed retro muscular.

Results

The problem of extending the dissection from the rectus abdominis muscle to the lateral compartment was resolved by Novitsky et al. Mesh is placed sublay and perforators to the rectus muscle are preserved. TAR could be an ideal hernia repair technique for complex defects because it weakens the lateral sides of the abdominal wall to augment the midline repair, thereby also increasing the lateral abdominal wall compliance and reducing the pressure on the midline.

Conclusion

Our case shows that even the most challenging abdominal wall hernias can be reconstructed with TAR. It is a safe, effective, and reliable technique with low perioperative morbidity (reduced risk of skin necrosis and surgical site infection).
OPEN VS. ROBOT-ASSISTED PREPERITONEAL INGUINAL HERNIA REPAIR. ARE THEY TRULY CLINICALLY DIFFERENT?
Authors: Bel R , Rodrigues-Gonçalves V , Verdaguer-Tremolosa M , Martínez-López P , Fernandes N , López-Cano M
Published: May 2024

Introduction

Inguinal hernia repair lacks a standard repair technique, with laparo-endoscopic and open preperitoneal methods showing similar outcomes. Despite higher costs, the popularity of robotic surgery is on the rise, driven by technological advantages. Controversies persist in comparing open repair techniques with the robotic approach, given contradictory results. The objective of this study was to compare postoperative outcomes, including complications, chronic pain, and recurrence, between open and robotic-assisted preperitoneal inguinal hernia repair.

Methods

This single-center retrospective study encompassed patients undergoing elective inguinal hernia repair in a specialized unit, employing both open preperitoneal and robotic-assisted laparoscopic approaches from September 2018 to May 2023. Comparative analysis of short- and long-term outcomes between these techniques was conducted. Additionally, multivariate logistic regression was employed to explore predictors of postoperative complications.

Results

A total of 308 patients met the inclusion criteria. 198 (64%) patients underwent surgery using an open preperitoneal approach and 110 (36%) using robot-assisted laparoscopy. Patients in the robot-assisted group were younger (P = 0.006) and had fewer comorbidities (P <0.001). There were no differences between the groups in terms of postoperative complications (P = 0.133), chronic pain (P = 0.463) or recurrence (P = 0.192). Multivariate analysis identified ASA ≥III (OR, 1.763; 95%CI, 1.068–3.994; P = 0.027) and inguinoscrotal hernias (OR, 2.371, 95%CI, 1.407–3.944; P = 0.001) as risk factors of postoperative complications.

Conclusion

Both open preperitoneal and robotic-assisted laparoscopic approaches show similar outcomes for complications, chronic pain, and recurrence when performed by experienced surgeons. The open preperitoneal approach, with its quicker operative time, may be advantageous for high-comorbidity cases. Treatment choice should consider patient factors, surgeon experience, and healthcare resources.
BOTTOM-UP ROBOTIC E-TEP HERNIA REPAIR STANDARTIZATION: THE LANDING RUNWAY CONCEPT
Authors: Biscuola Garcia R , Nogueira Costa T , Armando Buzzo M , Pascotini Pereira N , Zugaib Abdalla R
Published: May 2024

Introduction

The e-TEP (extended totally extraperitoneal) technique has gained popularity due to its minimally invasive nature and reduced postoperative pain and infection rates compared to open hernia repair. This paper aims to describe standardization of bottom-up robotic e-TEP hernia repair. With trocars located in suprapubic area there is a different perspective, and landmarks and standardization can make learning curve easier and faster.

Methods

We use landmarks previously described by Ramana in 2020 and new ones for standardization of Bottom-up E-tep hernia repair, based on the concept of fatty trident described by Garcia-Ureña in 2022.

Results

Use of the following concepts and landmarks: inferior crossover to create sufficient space for trocar insertion below the arcuate line; lamppost sign, to prevent arcuate line injuries so as neuvascular bundles iatrogenic lesions; volcano sign, to complete dissection of lateral hernia margins; inverted Y concept to identify the iliac and epigastric vessels; frenulum sign, to identify the correct planes at xyphoid process area; runway concept, where we can identify the whole hernia defect, and visualize the hernia limits.

Conclusion

Standardizing this technique requires addressing challenges related to the learning curve, cost, accessibility, and technical limitations. The Bottom-up approach in midline hernias is feasible in M1 to M4 and some lateral hernias. Is a good alternative when abdominis rectus muscles are narrow, because in these cases the space to lateral approach. Also allows a more precise incision at medial posterior sheath of rectus abdominis muscle.
LAPAROSCOPIC APPROACH TO COMPLEX INGUINAL HERNIA: A FEASIBLE OPTION
Authors: Bravo-Salva A , Navarro-Barbancho A , Riba-Combatti L , Perez-Guitart M , Pereira-Rodríguez J A
Published: May 2024

Aim

The aim of our study is to demonstrate the safety of laparoscopic approach of complex inguinal hernia, defined as multirecurrent or with previous pelvic surgery according to the European Hernia Society (EHS).

Material and Methods

A retrospective cohort study was conducted, including all patients undergoing laparoscopic inguinal hernioplasty in our Abdominal Wall Surgery Unit from 2020 to 2022. Comparative analysis between two groups: the study group with complex inguinal hernia (multirecurrent and/or with previous pelvic surgery) and the control group was performed.

Results

132 cases were included in the study, with 28 (21.2%) having complex inguinal hernia. The mean follow-up was 12.7 +/- 7.44 months. 120 cases (90.9%) had comorbidities. Study groups were comparable, except for a higher number of smokers in the study group (14 (13.5%) vs. 9 (32.1%); p = 0.025). Hernia characteristics showed a higher percentage of bilateral hernias in the control group (68 (65%) vs. 12 (42.9%); p = 0.027) and a higher percentage of recurrent hernias in complex cases (33 (31.7%) vs. 16 (57.1%); p = 0.013). No differences were found in complications, both groups were comparable (8 (7.7%) vs. 2 (7.1%); p = 0.642). One case of recurrence was observed in the control group, one case of conversion and reintervention due to occlusion in the study group, and one readmission in each group. Finally, in long-term follow-up, there was one case of chronic pain in the study group and only one recurrence in the control group.

Conclusions

The laparoscopic approach to complex inguinal hernia appears feasible, with results like non-complex cases.
A NEW MODEL TO LEARN AND TEACH
Authors: Calabrò M , La Terra A , Latham L , Scalambra S M , Muratore A
Published: May 2024

E. Agnelli Hospital is a tertiary hospital routinely performing mini-invasive gastro-enteric surgery such as rectal or gastric resections. Surgical repair of abdominal wall herniae, usually open is one of the most common operation performed. Laparoscopic approach to abdominal wall herniae has become the gold-standard approach in many surgical department. In order to introduce this type of approach in our surgical department, a three-step training program was planned. Two surgeons have been assigned to learn mininvasive abdominal wall surgery and we start from laparoscopic inguinal hernia.

First, once we made the program and kept in contact we moved to Fate Bene Fratelli Hospital in Erba (Italy) to see the technique. We spent one day and we saw three interventions of bilateral inguinal hernia, they showed us the intervention and some tips and tricks.

Second, in the following week, Erba hospital surgeons come to our hospital to follow us during our interventions, we performed one bilateral inguinal hernia with intraperitoneal technique (TAPP) and another one with extraperitoneal technique (TEP).

Third, one week later, we operated in our hospital on two bilateral inguinal hernias remotely connected live with the teaching surgeon in Erba; thanks to our integrated operatory theatre system, they could have laparoscopic vision during all the interventions, and they could give suggestions at the same time to help us and to avoid mistakes. In this third date we performed a TAPP, as the first intervention, in a 66 yo male patient with a direct hernia on the left and direct and indirect hernia on the right. The second one was a TEP in a 72 yo male patient with a direct, indirect and femoral hernia on the left and indirect on the right. The defects were both repaired by the BD 3D mesh.

Patients were discharged the following day in good condition and without pain. We saw the patients 48 hours after the procedure to remove the compression bandage, 8 days later to remove the stitches, and one month later; they didn't have any complications.

Our experience has continued, we have performed 20 bilateral inguinal hernia repairs without major complications, three patients reported small haematomas at the trocar sites.

Surgeons have less and less time to learn and teach, so the remote device could help them grow in technically demanding procedures, allowing them to share knowledge where it is needed most, when someone needs it, without wasting time travelling to another city.

New project it will start to approach incisional hernia with total extraperitoneal technique, with this remote modality and laparoscopic component separation too.

The new experience was possible thanks to our hospital equipment, we have a multi-integrated operating theatre that allows us to share not only the laparoscopic camera image with external resources through a dedicated link on WEBEX, but also voice and sound from the theatre and most importantly with our colleagues at Erba Hospital.
TRANSABDOMINAL SUTURING OF INTERNAL INGUINAL ORIFICE DURING LAPAROSCOPIC TAPP REPAIR OF L3 HERNIAS: 6-MONTH FOLLOW-UP OF 15 PATIENTS
Authors: Chamzin A , Theodoropoulos C , Ioannou T , Triantafyllou A , Galyfos G , Michalopoulos N V , Toutouzas K G , Theodorou D
Published: May 2024

Aim

To present mid-term follow-up data on suturing of the internal inguinal orifice during transabdominal preperitoneal (TAPP) repair of large inguinal hernias.

Methods

This study involved a prospective documentation of surgical outcomes and quality of life in patients with large indirect inguinal hernias who underwent laparoscopic internal ring suturing during TAPP repair.

Results

Between November 2022 and March 2023, 15 patients underwent laparoscopic transabdominal repair of symptomatic L3 inguinal hernias, which included suturing of the internal inguinal ring and preperitoneal mesh placement. All patients were men, with a mean age of 42.4 years (range 23–74). The average size of the hernia defect was 3.8 ± 0.3 cm (range: 3.0–5.4 cm). The mean operative time was 56.8 ± 8.2 minutes (range: 36.2–85.7 minutes), and the time required for internal ring suturing averaged 8.2 ± 1.9 minutes (range: 5.2–11.6 minutes). Patients were assessed clinically for signs of hematoma, seroma, or recurrence on the 1st and 7th postoperative day, and at the 3rd and 6th postoperative month. Additionally, postoperative pain and comfort were assessed using the Visual Analogue Scale (VAS) for pain and the Carolinas Comfort Scale, respectively. All patients reported no postoperative pain and exhibited excellent comfort levels.

Conclusions

Transabdominal internal ring suturing during laparoscopic TAPP repair of L3 inguinal hernias appears to be safe, is not associated with chronic pain, and helps in reconstituting the floor of the inguinal canal for mesh placement. This technique potentially reduces mesh eventration and the consequent risk of recurrence.
INITIAL EXPERIENCE IN INTRODUCING RIVES STOPPA TECHNIQUE IN A WELL-ESTABLISHED ABDOMINAL WALL SURGERY UNIT
Authors: Comas J , Subirana H , Crusellas O
Published: May 2024

Aim

To analyze initial experience with Rives Stoppa Technique in a well-established Abdominal Wall Surgery Unit.

Material and Methods

We analyzed 45 consecutives Rives Stoppa procedures in our center since January 2020, when we introduced at our center, to August 2023.

Results

16 (35%) were male and 29 (65%) female. Median length of transverse defect was 6.17 cm (W2 of EHS classification). One patient required preoperative progressive pneumoperitoneum. In two patients right colectomy for colon cancer was associated. In one patient radical nephrectomy for renal cancer was associated. One case was performed in an Emergency setting.

8 patients presented postoperative adverse events in first 30 postoperative days (17%). Seven related to surgery: 2 hematoma (one subcutaneous that no required treatment, and one preperitoneal that required percutaneous drainage) and 6 seromae (3 non requiring treatment, and 3 requiring percutaneous drainage). One patient presented a transient ischemic stroke that required medical treatment. 75% of adverse events were Clavien Dindo I-II and 25% IIIa. No surgical site infection was observed.

At 6 months follow up (100% of patients), only one patient presented radiological asymptomatic seroma. No incisional hernia recurrence was observed. At one year follow up (54% of patients) no recurrence was observed. At two year follow up (26% of patients) 1 recurrence was observed.

Conclusion

In our center the introduction of Rives Stoppa technique was safe and effective with good results regarding recurrence and adverse events.
WHAT IS IMPORTANT TO KNOW ABOUT SPORTSMAN HERNIA AND ATHLETES PUBALGIA
Authors: Dudai M , Ganiem M
Published: May 2024

Sportsman Hernia (SH) and Athletes Pubalgia (AP) is a new complex pathology involving two different medical fields: Sport Injury and Inguinal Hernia (IH). SH is different from IH and must be diagnosed as such because the treatment and surgery are different.

SH is traumatic athletic damage to the groin wall leading to weakness of the area and pain. The injury expands as the athlete continues the athletic activity to the Pubic Bones, AP.

The diagnosis is based on a clinical history and physical examination when the US and MRI imaging aren't always diagnostic. SH has a typical Chronic pattern of groin pain in sports activities and continues to everyday activities. Pain over 3 months not responding to conservative treatment, is a surgery indication. Nowadays most patients are sports activities amateurs and not professionals. The surgery is by Bilateral TEP approach but is different from a standard IH surgery. The surgery is complete with a dedicated Athletics Muscle Rehabilitation Program (AMRP) that is 5–12 weeks long depending on the severity. Since 2016 we have operated on 468 athletes, 353 has also another hernia and the majority returned to sporting activity.

Treatment of SH requires surgeon with unique expertise in the diagnosis and surgery, but also having a follow-up system for performing the AMRP. A general surgeon should know how to differentiate SH from IH. The presence of chronic pain must light a red lamp, performing surgery like IH and not the specific SH procedure, the chronic pain will continue after the surgery!
TREATMENT OF W1 VENTRAL HERNIAS WITH PREFORMED MESH – SIMPLE SOLUTION FOR A “NOT” SO SIMPLE PROBLEM?
Authors: Gaspar B , Ribas S , Oliveira F
Published: May 2024

Background

In literature there is no agreement on the best method for surgical treatment of ventral hernias and thus, more and better studies are required. The aim of this study is to describe the results of W1 ventral hernias open repair with a preformed mesh.

Method

Was conducted an observational retrospective study of all adult patients who underwent elective W1 ventral hernia open repair with a preformed mesh between January 2022 and September 2023. The characteristics of the patient group, the size of the hernias and the results obtained based on complications and recurrence were analysed.

Results

26 patients were included with an average age of 52 and an average MBI of 28 kg/m2. The average of the hernia defect was 2.2 cm (with defects from 0.6 cm until 4.4 cm) and the average of overlap was 3,7 cm. In all of them, the defect was closed with suture. One case had the mesh placed intraperitoneally, while in all other cases the meshes were placed pre-peritoneal. 19.2% of complications were detected, one classified as Clavien-Dindo (CD) III-b and the others classified as CD I and II. There were no recurrences in this group of patients, with an average follow-up of 5 months.

Conclusion

In our study, preformed meshes showed to be effective. Despite the high number of complications detected in this group of patients compared to the 4.4–6.7% described in the literature, this was not reflected in an increase in recurrence, and can be related with a small sample.
AUTOIMMUNE/AUTOINFLAMMATORY SYNDROME INDUCED BY ADJUVANTS (ASIA SYNDROME) AFTER POLYPROPYLENE MESH IMPLANTATION – PROTOCOL OF A PILOT STUDY FOR DIAGNOSTICS AND TREATMENT
Authors: Gielen M J C A M , van Rest K L C , Bouvy N D , van Koeveringe G A , Kowalik C R , Roovers J P W R , Roumen R M H , Slot M C , Willems H P J , Zwaans W A R
Published: May 2024

Purpose

An increasingly vocal movement of patients with systemic complaints, supposedly linked to polypropylene mesh implants, is leading to growing numbers of patient-preferred non-mesh surgical repairs for inguinal hernia. However, current literature does not support any association between polypropylene implants and Autoimmune Syndrome Induced by Adjuvants (ASIA). This prospective pilot aims to examine autoimmunity in patients in whom ASIA is suspected, based on previously described criteria. We aim to demonstrate the effectiveness of Mesh Allergy Testing and to investigate the natural evolvement of ASIA symptoms and the effect of mesh removal on ASIA-complaints.

Methods

This multi-center, prospective pilot study will include patients with symptoms of the ASIA syndrome following Shoenfeld’s Criteria. Physical examination, immunologic blood tests, and Mesh Allergy Tests will be performed and assessed by an experienced immunologist/allergologist. Questionnaires on improvement of symptoms, psychological susceptibility, and connective tissue disease will be collected at predefined time points. When patients’ wish for mesh removal is persistent, despite repeated elaborate discussion on the risks, mesh implants will be removed surgically. All meshes will be assessed histopathologically. Follow-up is 12 months.

Discussion

Current evidence on a causal relation between polypropylene mesh and ASIA syndrome is lacking, as is a treatment algorithm. Objective diagnostic tests are absent, expensive and/or aspecific. In this study, Mesh Allergy Testing will be evaluated as a first screening test specific for polypropylene implants. This study will be performed to further clarify knowledge gaps on diagnosis and prognosis on ASIA with polypropylene adjuvants.
TEXTBOOK OUTCOME IN W3 INCISIONAL HERNIA REPAIR. NATIONAL MULTICENTER STUDY
Authors: Gomis Martin A , Zaragoza Zaragoza C , Parra Chiclano J , Rubio García J J , Duque Alvarez N X , Ramia Ángel J M
Published: May 2024

Background

Textbook Outcome (TO) is a quality tool based on multiple postoperative endpoints that classifies a surgical intervention as successful. To the best of our knowledge, there has not been previously reported TO in W3 incisional hernias interventions. This study aims to determinate TO in W3 incisional hernia repair using data from a national multicenter database and analyze the variables associated to achieve TO.

Method

Retrospective observational study of W3 incisional hernia repair from a Spanish multicenter database between January 2012 and December 2022. TO was defined as: hospital stay <8 days, no Clavien-Dindo complications >IIIa and no mortality or readmission in the 30 postoperative days. A comparative analysis was performed between TO group versus non-TO group.

Results

Of the 2763 patients included, 2100 (76%) obtained TO. Significant variables associated to the achievement of TO in both univariable and multivariable analysis were lower age, transverse hernia size, colostomy, lower ASA classification, elective surgery, clean surgery, minimal invasive access and need for mesh. Variables associated with failure to achieve TO were intraoperative complications (such as visceral injuries), component separation technique and intraperitoneal position of the mesh. Higher ASA classification was the most significant variable associated with failure to achieve TO (OR 7.439 p <0.001).

Conclusion

The TO rate in our study was 76%. The variables identified with the success to achieve TO in W3 incisional hernia repair need to be further investigated in other studies to validate these preliminary results.
INGUINAL HERNIA WITH ADULT NEMATODE WORM
Authors: González-Valverde F M , Rodríguez-Lucas J M , Medina-Manuel E , Valero Soriano M , Sandoval-Marin J , Moreno-García C , Jimenez-Moreno I M , Hurtado Vázquez A M , Del Valle-Ruiz S R
Published: May 2024

Clinical case

A 32-year-old black male patient from Cameroon with a diagnosis of inguinal hernia. During dissection of the hernia sac, a sheathed structure resembling a suture thread was found. After opening the capsule, it was found to be formed by a coiled adult worm, which measured approximately 4 cm when extended. Hernioplasty was performed without immediate complications and the patient did not return for revision.

Comment

Filariasis is a group of parasitic diseases due to infestation by filarial nematodes that invade blood vessels and lymph nodes as well as subcutaneous and deep tissues. They are classified according to the location of the adult worm and are endemic in tropical regions of Asia, Africa and Central and South America. They are extremely rare in western countries.

Microfilariae are found in the blood of infected individuals and are ingested by haematophagous insects where, after completing part of their life cycle, they are transmitted to healthy individuals through a new bite. In this case, and given the location, it may have been an adult worm of Onchocerca volvulus.

Pharmacological treatment of filariasis is based on an anthelmintic such as albendazole, which requires the simultaneous administration of ivermectin or diethylcarbamazine to eliminate the microfilariae.
TRAUMATIC DIAFRAGMATIC HERNIA
Authors: González-Valverde F M , Rodríguez-Lucas J M , Medina-Manuel E , Valero Soriano M , Sandoval Marin J , Moreno García C , Jimenez-Moreno I M , Hurtado Vázquez A M , Del Valle-Ruiz S R
Published: May 2024

Introduction

Traumatic rupture of the diaphragm is an infrequent injury, produced as a consequence of blunt or penetrating trauma. We present 3 cases treated by laparoscopic approach.

Case 1

26-year-old male with stab wound in the 9th–10th left intercostal region. CT scan showed pleural effusion. Exploratory laparoscopy showed a 5 cm diaphragmatic rupture through which the gastric fundus was ascending. Frenorrhaphy was performed with continuous non-absorbable suture. Perforating wounds were found on the anterior and posterior gastric wall, which were also sutured.

Case 2

35-year-old male admitted after an accident with a broken femur. CT scan showed an intrathoracic stomach. Laparoscopic approach was performed, reducing the stomach to the abdominal cavity through a 10 cm diaphragmatic rupture. The gap was repaired with continuous non-absorbable suture and a titanised polypropylene mesh fixed with tackers.

Case 3

A 29-year-old man was admitted to the ICU after being run over. The CT image was interpreted as a "pulmonary hydatid cyst". Laparoscopically, a complete herniation of the stomach into the thorax was found with a defect of 8–10 cm. We repaired the rupture with continuous polypropylene suture and porcine dermis mesh fixed with loose stitches.

Conclusions

Laparoscopic correction of traumatic diaphragmatic hernias is an appropriate method in haemodynamically stable patients who do not require laparotomy or thoracotomy for other causes, as it is a technique that respects the principles used in open surgery.
ABDOMINAL WALL RECONSTRUCTION AFTER NEUROFIBROSARCOMA RESECTION
Authors: Gotor Santos T , Galán Raposo L , Sánchez-Brunete Medina V , Sutil Reguera N , Gómez Shevyakova O , Gisbert Aparicio M , de Diego Domínguez A , Fernández Fernández-Rebollos A , Medrano Montero I , Herrera Kok J H , Diago Santamaría M V
Published: May 2024

Neurofibrosarcoma (NFS) is a highly malignant neurogenic neoplasm that can arise anywhere in the body. It is most common in adults, with an incidence of 2–29% in patients with neurofibromatosis type 1 (NF1).

Aim

To describe the reconstruction of the abdominal wall after excision of a NFS.

Material and Methods

We present a case of a 27-year-old patient with NF1 and a diagnosis of NFS located between the greater and lesser oblique muscles of the left flank. After performing a complete extension study, the tumour was excised en bloc including the last costal arches, lateral abdominal wall and left iliac blade. The left deep epigastric artery was preserved to ensure perfusion of the muscle flap. The peritoneum was sutured using polyglycolic acid mesh. Subsequently, biosynthetic trimethylene carbonate mesh and irreabsorbable polyvinylidene fluoride mesh were interposed. Then, a left latissimus dorsi muscle free flap and a free skin graft were performed.

Results

Postoperative course without complications, discharge after 20 days. Histological result confirmed complete excision with a minimum margin of 1 cm. Treatment was completed with adjuvant chemotherapy. At 2 years follow-up there were no recurrences or incisional hernia.

Conclusions

NFS is a rare and invasive neoplasm that requires an aggressive and complex procedure. Its approach requires a multidisciplinary team with experience in the treatment of soft tissue sarcomas.
INTRODUCING ROBOTIC ABDOMINAL WALL SURGERY IN A GERMAN HERNIA CENTER – ONE YEAR EXPERIENCE
Authors: Gröger C , Kundel L , Adam U , Köckerling F , Riediger H
Published: May 2024

Background

Robotic surgery is the latest innovation in abdominal wall surgery. After implementing robotic surgery at our hernia center, we want to analyze our experience and present the perioperative data.

Method

We present our 1-year experience of robotic abdominal wall surgery regarding the type of operations and perioperative data.

Results

Between January 2023 and December 2023, we performed 59 robotic hernia operations. Consecutively, 20 inguinal hernias and 4 umbilical/epigastric hernias were repaired with preperitoneal mesh placement (TAPP-technique). Altogether 28 incisional hernias were treated either with preperitoneal or retromuscular mesh placement. Furthermore, seven parastomal hernia repairs (Pauli procedure) were performed. Additionally, one Morgagni Hernia was repaired with preperitoneal Mesh placement. Altogether, in 25 cases transversus abdominis release (TAR) was necessary for tension free closure of the defect and sufficient mesh overlap. In the postoperative course, there were three minor complications (haematoma, wound infection, intestinal paralysis). One patient underwent diagnostic laparoscopy to rule out any bowel injury. Another patient underwent laparotomy for repair of a small bowel injury after extensive adhesiolysis. Even though anticoagulated one patient developed severe pulmonary embolism. The mean hospital stay was 2,6 days (range: 1–9).

Conclusion

The implementation of robotic abdominal wall surgery in a hernia center with well-founded experience is safe and shows promising results. Regarding operative trauma and postoperative outcome, preperitoneal approaches for primary ventral hernia as compared with conventional methods seems a promising alternative due to the limited dissection. Patient selection and cost effectiveness as well as long term outcomes needs further investigation.
PERITONEAL FLAP CREATION FOR INCISIONAL HERNIA REPAIR VIA eTEP
Authors: Guevara Martínez J , Zapata C , Gutiérrez E , Abad R , Asencio L , Monjde B , Fondevila C , Salido S
Published: May 2024

Background

Peritoneal flaps assist in achieving abdominal wall closure, eliminating the need for mesh bridging and component separation techniques such as the endoscopic transverse abdominis release (eTAR). While maintaining the same concept as the open approach, in eTEP repair, the flap remains anchored to the preperitoneum and posterior rectus sheath (PRS) through its most distal dissection angle rather than its laterals.

Aim

To describe the peritoneal flap creation for incisional hernia repair via eTEP.

Materials and Methods

During hernia dissection via eTEP, we create a flap anchored to the distal angle of our midline preperitoneal dissection, releasing it from the PRS along both lateral edges if required. Following a complete retromuscular dissection, we close the PRS commencing from the most distal angle where the flap remains anchored. Subsequently, we close each lateral aspect of the peritoneal and PRS defect towards the proximal angle while incorporating the flap.

Results

We present 39 patients with midline incisional hernia out of a total of 62 hernia repairs via eTEP. Twenty-eight percent of cases were recurrent, and 30,9% were classified M3. The median width of the defects was 70 mm in both groups, with a maximum of 104 mm for the non-eTAR group and 143 mm for eTAR. Only 17,9% required TAR. We observed a 26,3% complication rate (4 cases) within the eTAR group while no complications in the non eTAR (p = 0,617). Complications included seroma and hematoma.

Conclusions

Peritoneal flap is a helpful technique for incisional hernia repair via eTEP, allowing midline closure without the need of eTAR.
UNCOVERING THE MYSTERY OF THE OBTURATOR HERNIA: THE OVERLOOKED ENTITY IN ABDOMINAL WALL SURGERY
Authors: Gutiérrez C , Serrano A , Guerrero P , Carreno-Sáez O , Garcia-Pastor P , Bueno-Lledo  , Pous-Serrano S
Published: May 2024

Background

We present a paradigmatic clinical case of a female patient, attended in the emergency room for small bowel occlusion due to an incarcerated obturator hernia.

Material and Methods

80-year-old woman with abdominal distension, pain and nausea for several days. She went to the emergency department on two occasions, with a clinical diagnosis of constipation and treatment with laxatives. On the fourth day, the patient associated vomiting and absolute oral intolerance. The CT scan shows a strangulated obturator hernia as responsible for the obstructive condition.

Laparoscopic approach was initially attempted to achieve reduction of the hernia. However, intestinal ischemia and perforation are identified, so we converted to open surgery. A 10 cm segment of small bowel was resected; the hernia defect was treated by primary closure of the obturator hole.

Results

Postoperative evolution was complicated by persistent ileus and the two abdominal collections that were drained by interventional radiology. In addition, infection and dehiscence of the upper third of the surgical wound, treated with negative pressure therapy cures. Fortunately, after the torpid evolution, the patient is well and six months later there is no hernia recurrence.

Conclusions

Obturator hernia is an uncommon pathology. It appears in old, thin women, mainly on the right side. Its diagnosis is based on physical examination and imaging tests (CT is the gold standard test), although clinical suspicion from the first moment is essential to make an early diagnosis and treatment to avoid complications (strangulation, resection). Treatment is based on primary closure of the hernia or the use of flaps or prostheses.