bluuebunny/crossref_metadata_2025 huggingface dataset:
RARE CAUSE OF BOWEL OBSTRUCTION – CASE REPORT OF AN APPENDICULAR TOURNIQUET INSIDE AN ILEOSTOMY REVERSAL SIDE HERNIA SAC
Authors: Koumenis A , Piperos T , Manthas A , Nannou E , Mariolis-Sapsakos T
Published: May 2024

Background

The aim of this case report is to outline a rare instance of an appendicular tourniquet presented as bowel obstruction inside an incisional hernia at the ileostomy reversal site (IRS).

Material and Methods

A 65-year-old female patient presented to our outpatient clinic on a schedule appointment with a profound neglected IRS hernia. She had previously undergone an open low anterior resection with loop ileostomy for rectal cancer. The ileostomy was reversed four months postoperative. The patient was complaining of intermittent mild abdominal pain and constipation which she was managing by her own with laxative. A CT scan was ordered which showed a large hernia containing mostly small intestine protruding from two different hernia sides – one as an IRS incisional hernia and a concurrent middle line incisional hernia.

Results

In agreement with the patient an operation was schedule, and the patient was to follow a strict diet until the operation date. Two weeks after the initial appointment the patient was admitted to the emergency department with severe abdominal pain and vomiting. The hernia side was found to be red and tender on touch and metallic bowel sounds were heard on osculation over it.

An emergency surgery was deemed necessary to examine the cause of the obstructive ileus. A midline incision was chosen and an extensive symphysiolysis was conducted. After mobilization of most of the intestine from the hernia sac, an appendicular tourniquet was discovered. Τhe appendix was fused in a loop strangulating the bowel section under it which started to show signs of ischemia. We continued the symphysiolysis until all the protruding sections where reduced and an appendectomy was also performed. A hernioplasty with dual mesh onlay placement was performed to reinforce the abdominal wall.

Conclusion

Although a rare occurrence an appendicular tourniquet inside a hernia sac is possible causing irreversible bowel strangulation and subsequent necrotization deeming the condition a surgical emergency.
BIOMECHANICAL HIP AND LEG FUNCTIONS CHANGES AFTER INGUINAL HERNIA REPAIR USING DIFFERENT MINIMALLY INVASIVE METHODS
Authors: Kubiliūtė E , Margelis E , Jasaitis K , Kiudelis M
Published: May 2024

Background

Medical researchers typically assess patient recovery post minimally invasive hernia repair with visual analogue scales or short surveys. Yet, data on hip and leg function changes following surgery via objective tests is scarce. This study aims to determine the impact of minimally invasive hernia repair methods on patient mobility, recovery speed, and resumption of daily activities.

Methods

A prospective randomized clinical study with 123 male patients undergoing primary inguinal hernia repair randomly divided them into two groups (transabdominal pre-peritoneal (TAPP) and total extraperitoneal (TEP) inguinal hernia repair). The groups were assessed for surgical complications, recovery time, hip and leg strength measured by dynamometer, mobility measured by goniometer, and hip and leg stability measured by the Y balance test. All tests were performed before the procedure, on the first postoperative day, and at 1, 2, and 4 weeks after the procedure. Differences between preoperative and postoperative results were calculated and compared.

Results

66 patients were included in the TAPP group, and 57 in the TEP group. There were no significant differences in surgery time, complications, hospital stay, and recurrence rate between the two groups. Almost all hip and leg functions for patients who underwent TAPP recovered one to two weeks faster compared to those who underwent TEP. Only leg adduction strength recovered faster after the TEP procedure.

Conclusions

TAPP inguinal hernia repair showed smaller biomechanical hip and leg changes and faster function recovery than the TEP procedure with the same early and late postoperative results.
HIGH PREVALENCE OF CHOLELITHIASIS IN PATIENTS PRESENTING WITH UMBILICAL HERNIA, AND VICE VERSA
Authors: Kulacoglu H , Sahin A , Ugurlu C , Celasin H , Akin K
Published: May 2024

Background

We aimed to find the prevalence of the coexistence of cholelithiasis in a prospective multicenter cross-sectional study.

Method

The main outcome measures were the presence of cholelithiasis in patients who admitted with an umbilical hernia (UH) and the presence umbilical hernia in patients who were diagnosed with cholelithiasis (CL). Patients with an umbilical hernia were examined by biliary ultrasound.

Results

25.9% of CL were diagnosed with umbilical hernia, while 29.6% of UH were diagnosed with cholelithiasis. In multivariate analysis, obesity was an independent risk factor for umbilical hernia in the CL group, whereas female sex was an independent risk factor for cholelithiasis in the UH group.

Conclusion

The prevalence of cholelithiasis in patients with umbilical hernia and the prevalence of umbilical hernia in patients with cholelithiasis are both high. Umbilical hernia patients especially who have high BMI values should be examined with biliary ultrasound before planning a hernia repair.
INTERFASCIAL BLOCKAGES OF THE ABDOMINAL WALL WITH THE ERAS PROTOCOL IN VIDEOLAPAROSCOPIC SURGERY FOR INGINAL HERNIA
Authors: Lysenko R , Tarasenko K , Osipov O , Cherkun M , Slipukha D , Shiyanovsky R
Published: May 2024

Actuality

Up to 75% of postoperative patients experience pain, while less than half of these patients can note the adequacy of postoperative pain therapy. Inadequate control of perioperative pain leads to medical, economic, and social adverse events. A modern approach to postoperative analgesia is a multidisciplinary ERAS strategy, a component of which is multimodal analgesia, especially with the use of regional nerve blocks.

Goal of the Work

Assessment of the effectiveness of recovery in the early postoperative period of patients who underwent video laparoscopic interventions for inguinal hernias, depending on the use of interfascial blockades of the abdominal wall as part of anesthesiological support of multimodal analgesia.

Materials and Methods

A prospective comparative study of the effectiveness of postoperative recovery of 89 patients after videolaparoscopic interventions for inguinal hernias was conducted. All of them underwent alloplasty according to the transabdominal preperitoneal repair (TAPP) technique in the period 2020–2023. 75.3% were male. Patients had a mean age of 52.3 years and a mean BMI of 29.2.

The patients were divided into 2 groups: in the main group – 46 people (52%) as part of anesthesiological intraoperative support, transversus muscle blocks (TAP-blocks), quadrato-lumbar blocks (QL-blocks) and rectus abdominal muscles sheath blocks were additionally performed; in the comparison group – 42 people (48%) additional interfascial blocks were not performed. The following were evaluated: intraoperative Fentanyl consumption, the need for additional administration of analgesics in the postoperative period, assessment of postoperative pain according to the visual analog scale (VAS), recovery time of motor activity within the ward, the time of discharge from the hospital.

Research results

In the patients of the main group, compared to the comparison group, the following features were noted: under the condition of using interfascial blocks of the abdominal wall intraoperative fentanyl consumption decreased by 2.4 times, the frequency of additional administration of analgesics in the postoperative period was 1.9 times lower, postoperative pain assessment according to VAS was 1.6 times smaller, recovery of motor activity within the ward took place earlier by an average of 5.5 hours, the time of discharge from the hospital decreased by 1.8 times, the average bed-day was 1.2 days.

Conclusions

Interfascial blocks of the abdominal wall are an important component of the ERAS protocol, which have positive medical, social and economic effects.
THE CLINICAL EFFECTIVENESS OF A TEACHING COURSE ON THE USE OF TOTALLY EXTRAPERITONEAL APPROACH FOR INGUINAL HERNIA REPAIRS
Authors: Mackenzie A , Chidambaram S , Howell A M R , Muirhead L , Brewer J O L , Fakih-Gomez N , Smellie J W B , Warren O J
Published: May 2024

Background

There is an increasing shift towards the use of laparoscopic techniques for repair of inguinal hernias, namely the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. Previous work has reported shorter post-operative length of stay (LOS), better pain control and faster return to function with laparoscopic techniques. Hence, we designed and conducted a one-day training course on TEP repairs for senior minimally invasive surgeons. This study aims to assess the clinical effectiveness of the course in changing our unit’s clinical practice and characterise the associated post-operative outcomes.

Methods

This is a single-center retrospective cohort study of hernia repairs performed by six consultant minimally invasive surgeons. All adult patients who underwent inguinal hernia repairs at our hospital between April 2022 – April 2023 were included. The primary outcome measures are the approaches used for each operation and post-operative LOS. Secondary outcome measures were conversion to open, incidence of complications, re-admissions, and re-interventions.

Results

We performed 223 hernia repairs over a 12-month period, with 88 and 135 procedures before and after the intervention, respectively. The mean age of patients was 60.7 (15.2). While the number of open repairs increased by 43% from 67 to 96, the number of TEP procedures increased eight-fold from 4 to 33 (p < 0.05). The number of TAP repairs decreased from 17 to 6 in the same time period. There were two conversions of TEP to open repairs. Post-operatively, the length of stay was lower for TEP than open repairs at 0.27 and 0.42 days, respectively (p < 0.05). The incidence of hematoma/seroma was higher with open repairs (n = 7) than TEP repairs (n = 1). However, all were conservatively managed till resolution, with no re-interventions at follow-up.

Conclusion

The implementation of a teaching course tailored to the surgical expertise of laparoscopic surgeons can update and change local clinical practice, and attain the clinical outcomes reported in literature.
QUALITY OF LIFE, POSTOPERATIVE COMPLICATIONS AND HERNIA RECURRENCE RATE FOLLOWING LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA) TECHNIQUE FOR PRIMARY AND INCISIONAL HERNIA REPAIR
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). To date, no studies have been published on the impact of the laparoscopic intracorporeal rectus aponeuroplasty technique (LIRA) on the QoL of patients. The purpose of this study was to evaluate the quality of life (QoL), early postoperative complications and hernia recurrence rate following LIRA for PVH and IVH repair at the six month follow up.

Method

A retrospective review of a prospectively maintained database of all patients undergoing LIRA from August 2022 to May 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 LIRA.

Results

17 patients met the inclusion criteria. PVH was the most common pathology (70.6%). The median follow-up time was 6 months. 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 (11.6 vs. 1.41, p <0.001), restrictions (median of 13.1 vs. 1.35, p = 0.001), cosmetic appearance (10.8 vs. 2.82, p = 0.001) with a Total Score (35.4 vs. 5.59, p <0.001).

Conclusion

Abdominal wall repair using the LIRA approach improves subjective QoL variables with and acceptable post-operative complications and without hernia recurrence in a short-term follow-up. So far, this is the first published study where QoL is evaluated in patients undergoing LIRA.
MESH INFECTION AFTER VENTRAL HERNIA REPAIR: A CASE REPORT
Authors: Medina Manuel E , Del Valle Ruiz S R , González Valverde F M , Rodríguez Lucas J M , Valero Soriano M , Jiménez Moreno I M , Hurtado Vázquez A M , Candel Arenas M F
Published: May 2024

Aim

Mesh infection represents a major health problem, as it increases patient morbidity as well as the rate of readmissions, reinterventions and healthcare costs. The aim of this communication is to present a case of mesh infection which required mesh explantation to raise awareness of the importance of its prevention.

Material and Method

80-year-old woman, obese, hysterectomized, who presented an incisional ventral hernia. Abdominal wall repair was performed by placing an intraperitoneal mesh. The aspiration drain was removed on the third day. She was readmitted a week later due to an abdominal wall hematoma (6 × 7 × 11 cm) that was drained. Empirical antibiotic treatment was established. After six months of wound care with persistence of purulent drainage and a positive culture for Proteus mirabilis, the mesh was removed with a new abdominal wall repair according to Rives-Stoppa technique.

Discussion

The increasing use of prosthetic material has led to an increase in complications associated with it, such as seroma, infection, extrusion or displacement. Once mesh infection is suspected, a culture must be taken, and empiric antibiotic treatment should be instituted, making it essential to perform wound healing treatment with irrigation and drainage. If resolution is not achieved, the mesh can be removed but with a higher risk of complications.

Conclusions

Considering the impact of this complication on the morbidity of patients, as well as on the health system, its prevention is essential. Treatment must be individualized based on the patient's characteristics, the type of prosthesis and the extent of the infection.
THE IMPORTANCE OF DETAILED RECORDS ON INGUINAL HERNIA – OUR EXPERIENCE
Authors: Melo Pinto D , Moreira Marques T , Quintela Silva C , Saraiva P , Guerreiro E , Ferreira F , Correia J
Published: May 2024

Background

Hospital records are essential to standardize information about the similar procedures in different patients as well as to compare findings to what is described in literature. It is also fundamental to carry out retrospective studies. Our department implemented an inguinal hernia record that is carried out in three main points: pre-operative, immediately after surgery and post-operative appointment.

Method

We performed a retrospective study to analyze the records between 2021 and 2022. It was also asked our team to answer a questionnaire about the impact of this new tool in our practice.

Results

During this period records were filled in 78 out of 148 patients (53%), mainly by out Abdominal Wall Unit (67%). In the pos-operative appointment only 34% of patients had their record filled and of those only 46% were completed. The majority of unfilled parameters are regarding procedure complications and follow-up. When asked to our colleagues, 71% found this tool easy to access and it even helps collecting important data for a good clinical history. Nevertheless, 43% did not know about this tool.

Conclusion

In despite of the universal and known advantages of uniformized hospital records, it is fundamental to publicize its existence in order to increase adherence.
ARCUATE LINE HERNIA, A RARELY SUSPECTED LESION. A CASE REPORT
Authors: Menor-Duran P D , Gómez-Torres I , Gamón-Giner R L , Jara-Benedetti G , Queralt Escrig M , Vidal-Escrig N , Alcobilla-Ferrara E
Published: May 2024

Background

Arcuate line hernias are a rare type of hernia, with few cases published in the literature. They consist of a partial or complete fascial defect located at the lower limit of the posterior fascia of the rectus abdominis muscle, and their symptoms are atypical, often requiring imaging tests for diagnosis.

Material and Methods

We present a 71-year-old female patient with left paramedial abdominal pain. Given the suspicion of Spiegel hernia, an abdominal CT scan was performed, revealing a defect at the level of Douglas' arch with small bowel herniation, suggestive of uncomplicated arcuate line hernia.

Results

Scheduled surgery with laparoscopic approach is performed, confirming the diagnosis. Reduction of the small bowel content and peritoneal sac reduction are carried out. Subsequently, an anatomical repair was performed with fixation of the sac to the abdominal wall. Postoperative evolution was favorable, with discharge from the hospital after 24 hours of admission. After 1 year of surgery, the patient has not presented recurrence or any other complication.

Discussion

The presence of this type of hernia should be suspected in cases of retrorectal mass or asymmetry, with atypical pain or digestive symptoms. The preferred test is CT, and the finding of retro-muscular fat or enteric content will provide a presumptive diagnosis. The definitive surgical technique is still under debate, with laparoscopy suggested as the ideal approach. Surgical management described in the literature ranges from open surgery with mesh placement, laparoscopy with or without intra-abdominal mesh, single-port laparoscopic repair, and even robotic surgery.
OUTCOMES OF COMPLEX ABDOMINAL WALL RECONSTRUCTION IN PATIENTS WITH CONNECTIVE TISSUE DISORDERS: A SINGLE CENTER EXPERIENCE
Authors: Messer N , Prabhu A S , Miller B T , Krpata D M , Beffa L R A , Phillips S E , Petro C C , Maskal S M , Ellis R C , Figueiredo S , Fafaj A , Rosen M J
Published: May 2024

Introduction

Individuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. There is a scarcity of data on outcomes for these patients undergoing hernia repair. We sought to describe our outcomes in performing abdominal wall reconstructions in these complex patients.

Methods

We have detected adult patients with CTD undergoing open, elective, posterior component separation with permanent synthetic mesh from January 2018 to October 2022 at the Cleveland Clinic Center for Abdominal Core Health instituted. We evaluated 30-day wound morbidity, perioperative complications, long-term hernia recurrence, and patient-reported quality of life.

Results

Twelve patients were identified. Connective tissue disorders included Marfan’s n = 7 (58.3%), Loeys-Dietz syndrome n = 2 (16.7%), Systemic Lupus Erythematosus n = 2 (16.7%), and Scleroderma n = 1 (8.3%). Prior incisions included three midline laparotomies and nine thoracoabdominal, mean hernia width measured 14 cm, and 9 were recurrent hernias. Surgical site occurrences were observed in 25% of cases, and 16.7% necessitated procedural intervention. All twelve patients were available for long-term follow-up, with a mean of 34 (12–62) months. There were no instances of reoperation or mesh excision. One patient developed a recurrence after having his mesh violated for repair of a new visceral aneurysm. Mean HerQLes scores at 1 year were 70 and 89 at ≥2 years; Mean PROMIS scores were 30.7 at 1 year and 36.3 at ≥2 years.

Conclusion

Ventral hernia repair with TAR is feasible in patients with connective tissue disorder and can be a suitable alternative in patients with large complex hernias.
GROIN HERNIA RECURRENCE AFTER TAPP FOR RECURRENT HERNIA
Authors: Music Medic M
Published: May 2024

Aim

The aim of this study was to investigate our long-term results following TAPP (transabdominal preperitoneal repair) surgery for recurrent groin hernias, following open Lichtenstein surgery. In our institution, TAPP is used to treat recurrent groin hernias. There are many types of meshes and fixation methods that surgeons use to perform TAPP repair (self-fixing mesh, lightweight mesh with tackers, or glue fixation).

Methods

A retrospective analysis of our database system was performed. A total of 40 patients with recurrent, unilateral hernias were treated with TAPP surgery. The median follow-up period was 6 years (4–9 years). Following hernia repair, all patients were interviewed by telephone, and the standard questionnaire was used to assess the quality of their lives. A CT scan and clinical examination were performed if there was any doubt.

Results

Out of 40 patients, 39 responded (97,5%). There were 35 male and 4 female patients. We identified and confirmed 3 recurrences (7,7%). There were no recurrences in the group with self-fixating mesh (0/21), 2 recurrences in the group with lightweight mesh + tacker (2/7), and 1 recurrence in the group with lightweight mesh + glue (1/11).

Conclusions

Long-term analysis showed a high rate of recurrence, but other authors have reported similar results. Our findings suggest that the most effective technique for repairing recurrent groin hernia in TAPP procedures is through the use of self-fixating mesh.
DOES THE ANGLE OF TROCAR INSERTION AFFECT THE FASCIAL DEFECT CAUSED? A PORCINE MODEL
Authors: Paasch C , Meyer J , Hunger R , Krollmann N , Heisler S , Mantke R
Published: May 2024

Introduction

With an incidence of 0–5.2% trocar site hernias frequently occur following laparoscopy. It is unclear to what extent the angle of trocar insertion affects the size of the fascial defect caused. Hence, we performed a porcine model.

Methods

In October 2022, a total of 5 female pigs were euthanized. In alternating order 3 bladeless and 2 bladed conical 12 mm trocars were inserted at an angle of 45° on each side for 60 minutes twice each pig. For this purpose, an epoxy resin handmade cuboid with a central channel that runs at an angle of 45° was used. Subsequently, photo imaging and defect size measurement took place. The results were compared with those of our previously conducted and published porcine model, in which the trocars were inserted at an angle of 90°. Effects of trocar type and angle on defect size were analysed using a mixed model regression analysis.

Results

The bladeless trocars caused statistically significant smaller defects at the fascia than the bladed (23.4 (SD = 16.9) mm2 vs. 41.3 (SD = 14.8) mm2, p <0.001). The bladeless VersaOne trocar caused the smallest defect of 16.0 (SD = 6.1) mm2. The bladed VersaOne trocar caused the largest defect of 47.7 (SD = 10.5) mm2. The defect size of the trocars used at a 45° angle averaged 30.5 (SD = 18.3) mm2. The defect size of trocars used at a 90° angle was significantly larger, averaging 58.3 (SD = 20.2) mm2 (p = 0.007).

Conclusion

When conical 12 mm trocars are inserted at a 45° angle, especially bladeless ones, they appear to cause small fascial defects compared with insertion at a 90° angle. This might lead also to a lower rate of trocar hernias. Bladeless trocars might cause smaller fascial defects than bladed trocars.
EFFECTS OF THE COVID-19 PANDEMIC ON INGUINAL HERNIA SURGERY IN A SINGLE CENTER IN PORTUGAL: ANALYSIS OF EMERGENCY CASES AND TREATMENT PATTERNS
Authors: Paiva de Oliveira G , Oliveira M , Parreira M E , Guimarães S , Melo J , Branco A , Luz C
Published: May 2024

Background

The COVID-19 pandemic triggered substantial shifts in healthcare priorities, redirecting resources to address unprecedented emergency needs. Concerns about how COVID-19 might affect surgical outcomes prompted our investigation, given the complex interplay of factors across diverse healthcare settings. Our study sought to understand the impact of emergency declarations on the treatment of inguinal hernias, examining changes in elective versus emergent surgeries, as well as variations in surgical techniques and care settings.

Method

Analyzing five years of data (2019–2023) from a single institution in Almada, Portugal, we collected demographic and procedural information, comparing patients treated during the pandemic's confinement period (March 18, 2020, to April 30, 2021) with those treated before and after this period.

Results

Of the 1764 identified patients, 1004 underwent surgery elsewhere, leaving 760 for analysis. While only 2.9% required emergency surgery, some elective cases were labeled as "delayed urgencies" or "high priority," suggesting potential influences of emergencies on elective treatment decisions. Before the pandemic, 4.3% underwent emergency surgery, dropping to 1.1% during the emergency period, and rising to 3.1% afterward, though these changes lacked statistical significance. Laparoscopic surgeries increased gradually, while ambulatory procedures decreased, likely due to local restrictions rather than COVID-19.

Conclusion

Our findings echo previous research indicating a decrease in emergency surgeries contrary to expectations. However, data biases may exist, highlighted by an uptick in patients receiving surgery within 15 days, possibly reflecting shifts in healthcare accessibility rather than direct COVID-19 effects.
LONG-TERM OUTCOME OF COMPLEX ABDOMINAL WALL RECONSTRUCTIONS WITH CROSS-LINKED ACELLULAR DERMAL MATRIX – A 23 YEAR SINGLE CENTRE EXPERIENCE
Authors: Pecorella I , Davies J , Patel K , Giordano P
Published: May 2024

Aim

To review the clinical outcomes of complex abdominal wall reconstructions (AWR) with cross-linked acellular dermal matrix1 (CADM) implants over 23 years and how the indications to its use may have changed overtime.

Materials and Methods

Retrospective analysis of patients who underwent complex abdominal wall hernia surgeries with the use of CADM between September 2000 to June 2023, including elective and emergency procedures.

Results

95 procedures were performed in 88 patients. 24% of patients had 1 or 2 comorbidities, 66% had at least 3 comorbidities. BMI was 30 or above in 75% of patients. Overall, 27 (31%) procedures were performed as an emergency, 73% of which were performed since 2020. Fascial closure was achieved in 60% of patients; however, in the emergency group, fascial closure was 10%. Postoperative events occurred in 62% of cases. Postoperative mortality was 3%. 81 patients were available for long-term follow up, the median length of which was 64 months (range 0–214 months). Clinical recurrence was present in 25 (28%) patients and in all cases it presented in the first 2 years. Twenty-one patients had died of unrelated causes during follow up. Two patients required further intervention for unrelated causes and no adverse mesh related events were recorded in the long-term.

Conclusions

CADM biologic implants for AWR are safe and early results appear to be maintained overtime without long-term adverse events. CADM seems to perform well in particularly challenging situations like emergencies which appears to be becoming its main clinical application.
EVALUATION OF POSTOPERATIVE COMPLICATIONS AND REOPERATIONS IN PATIENTS UNDERGOING OPEN UMBILICAL HERNIA REPAIR
Authors: Rothman J V , Henriksen N A
Published: May 2024

Background

Umbilical hernia repair is a common surgical procedure. Open repair is recommended for small to medium size hernias, and use of mesh reduces recurrence. The primary aim was to evaluate the risk of postoperative complications and reoperations after emergency and elective open umbilical hernia repair, and secondly to evaluate whether complications and reoperations were associated to type of repair.

Methods

A single center retrospective cohort study of patients undergoing open umbilical hernia repair from October 2022 to September 2023. Data was extracted from the patient charts.

Results

A total of 151 had an umbilical hernia repair, 103 (68%) elective surgeries and 48 (32%) emergency surgeries. For the elective repairs, 37 (36%) got a suture- and 66 (64%) a mesh repair. There was no difference in complications, 5.4% versus 7.6%, p = 0.675. A higher percentage of emergency surgeries had the mesh placed in the onlay position 45.8% (22/48) compared to elective surgeries 30.1% (31/103), which more often received a preperitoneal mesh 34% (35/103). The overall complication rate tended to be higher for emergency repair compared with elective surgery, 6.8% and 14.6%, p = 0.124, with a tendency towards more complications with the use of mesh 12.1% (12/99) compared with suture repair 3.8% (2/52), p = 0.096. The most frequent complications were wound related (seroma, hematoma, wound infection). There were three (3%) reoperations in the elective group due to infection, and correspondingly two (4%) in the emergency group.

Conclusion

There is no difference in postoperative complication regarding suture or mesh repair of umbilical hernias.
SURGICAL MANAGEMENT OF W3 INCISIONAL HERNIAS: EVALUATING THE SUCCESS OF ETEP APPROACH
Authors: Salido S , Guevara-Martínez J , Gutiérrez E , Zapata C , Reinoso F , Georgiades A , Monje B , Fondevila C
Published: May 2024

Aim

Treatment of incisional hernias using the extended totally extraperitoneal (eTEP) approach presents significant technical demands. Mostly eTEP is used for W1 and W2 defects due to the challenges posed by larger defects. This study evaluates outcomes applying eTEP for incisional hernias classified as W3 according to the European Hernia Society (EHS).

Materials and Methods

This prospective observational multicenter study included patients with incisional hernias larger than 10 cm in width, conducted at Fundación Jiménez Díaz and La Paz hospitals in Madrid from September 2019 to January 2024. Surgical intervention was performed through the eTEP approach. Preoperative, intraoperative, and postoperative data were collected.

Results

16 patients were included (7 males and 9 females). The American Society of Anesthesiologists (ASA) classification yielded 13 (81.3%) as ASA-III. The median age was 76 years (64–87), and the median body mass index was 30 (21–40). Seven patients had midline defects and 9 lateral defects. The median width of the defect on computed tomography (CT) was 117 cm (18–176). Botox treatment was administered to 43.8% of the patients. Surgical duration had a median of 171 minutes (92–240), with 7 patients requiring transversus abdominis release and 3 patients need endoscopic fascial traction. Complications were observed in 25% of patients, with no reported recurrences during a median follow-up period of 12 months (6–52).

Conclusions

The eTEP technique demonstrates successful application in selected W3 incisional hernias with low conversion rates, recurrence, and complication rates. However, the use of adjuncts before and during surgery is often necessary in these cases.
DEVELOPING A ROBOTIC ABDOMINAL WALL RECONSTRUCTION SERVICE IN THE UK – SINGLE CENTRE EXPERIENCE
Authors: Sharma A , Simpson G
Published: May 2024

Aim

A minimally invasive approach (MIS) to complex abdominal wall reconstruction (CAWR) is expanding and offers advantages in enhanced recovery. We report our single-centre experience in the introduction of Robotic CAWR.

Methods

A retrospective analysis of a prospectively maintained database was carried out from March 2023 to January 2024. All patients undergoing CAWR using a MIS approach were included. Data was collected for the following: sex, age (years), BMI (kg/m2), length of hospital stay (LOS, days), operative time (hours), and post-operative complications.

Results

30 patients underwent MIS CAWR (22 robotic; 8 laparoscopic). Male to female ratio was 18:12. The median age was 59 years (IQR 47–66) and BMI 36 kg/m2 (IQR 32–37). Operations included eTEP retro-rectus Rives-Stoppa (RS) + diastasis plication +/- TAR repair using macroporous polypropylene non-absorbable synthetic mesh. Three patients (10%) had TAR and another 3 (10%) had simultaneous inguinal hernia repairs. The median operating time for RS was 3.3 hours (IQR 3.1–3.5) whilst 7.5 hours (IQR 7.2–7.8) for RS + TAR. The median LOS was 2 days (IQR 1–2).

Seven (23%) patients developed post-operative urinary retention requiring catheterization. 1 (3%) patient developed a post-operative chest infection. Twenty-two of 27 (82%) patients undergoing MIS Rives Stoppa required oral post-operative analgesia only.

1 (3%) patient had laparoscopic converted to open procedure due to bowel involvement.

Conclusion

MIS/Robotic CAWR is a safe approach and can be performed in a similar length of time to open procedures. However, LOS is significantly reduced and patients can be successfully managed with oral analgesia.
ANTERIOR PREPERITONEAL REPAIR FOR INGUINAL HERNIA: AN UPDATE
Authors: Sinha R
Published: May 2024

Background

A continuing prospective study to compare our anterior Preperitoneal [APP] repair for inguinal hernia[IH], with Lichtenstein repair [LR], Laparoscopic Transabdominal preperitoneal [TAPP] and totally extraperitoneal [TEP] repairs.

Method

IH patients, after exclusions and subsequent matching for age, type, and extent of hernia, were assigned randomly for APP, LR, TAPP and TEP repair. The same surgical team performed all operations. Data of predefined endpoints, for all the three groups were statistically compared.

Results

224 patients underwent APP, 81 patients LR, 281 patients TAPP, and 126 TEP. The operating time for both unilateral and bilateral hernias in the APP group was significantly shorter than in LR and TAPP and TEP groups. APP patients were discharged in significantly less time than LR patients but later than TAPP and TEP patients. The postoperative VAS score at 24 hours in the APP patients was significantly less than LR but at 48 hours the difference was equivocal. But VAS score after APP at 24 and 48 hrs was more than in TAPP and TEP patients. However, the pain score across all the three groups was similar at 7 days. There was no surgical site infection (SSI) or mesh infection in any patient. Chronic postoperative inguinal pain (CPIP) was seen less often after APP than after LR but was even less in TAPP and TEP patients. Recurrence across all the four groups was not much different.

Conclusion

APP is a better choice for open IH repair than LR and matches the advantages of Laparoscopic repairs.
SURGICAL TREATMENT FOR ADVANCED COLORECTAL CANCER WITH ABDOMINAL WALL INVASION AND IMPLANTATION
Authors: Song Z , Yang J , Gu Y , Tang J
Published: May 2024

Aim

The prognosis of abdominal wall invasion and implantation from colorectal cancer (CRC) is not good. With radical resection and abdominal wall reconstruction (AWR) technique, locally advanced CRC patients with resectable abdominal wall invasion and implantation may achieve longer tumor-free survival time and an improved quality of life.

Methods

15 patients were retrospectively analyzed. All patients underwent preoperative three-dimensional visualization reconstruction of the abdominal wall and evaluation with a multidisciplinary team (MDT). Patient information, including tumor size, defect size, operation time, intraoperative bleeding, length of hospital stays, and other factors, was collected.

Results

All 15 locally advanced CRC patients with abdominal wall invasion and implantation underwent radical abdominal wall tumor resection followed by AWR. The average tumor dimension and abdominal wall defects after resection were 98.13 ± 71.70 and 270.07 ± 101.95 cm2 respectively; and accurate abdominal wall classification and zoning were obtained for all patients. The average operation time was 431.7 ± 189.2 min, and the average blood loss was 513.3 ± 244.6 ml. The incidence of incisional hernia and CRC recurrence were 6.0% and 13.3%, respectively.

Conclusions

With comprehensive preoperative evaluation, results of radical resection of abdominal wall invasion and implantation in locally advanced CRC patients is satisfactory and safe.
COMPARATIVE STUDY BETWEEN SUBCUTANEOUS ONLAY LAPAROSCOPIC APPROACH (SCOM/SCOLA) AND LAPAROSCOPIC INTRAPERITONEAL ONLAY REPAIR PLUS OF UMBILICAL AND PARA UMBILICAL HERNIA
Authors: Surya Srikanth Saride N S , Pandian K , Alexander N
Published: May 2024

Aim

To compare the techniques between subcutaneous onlay laparoscopic approach (SCOM/SCOLA) and laparoscopic intraperitoneal onlay repair plus (IPOM plus) in terms of duration of surgery, postoperative pain, seroma, duration of stay and cost of surgery.

Methods

It is a prospective observational study. Basic information of the volunteers satisfying the inclusion criteria- Age, sex, defect size of 5 cm or less, with or without rectus abdominis diastasis, single primary umbilical and paraumbilical hernia was included in the study after informed consent. Patients were divided into two groups- Subcutaneous onlay laparoscopic approach (30) and Laparoscopic intraperitoneal onlay repair plus (30). The duration of stay, postoperative pain, seroma, cost and duration of surgery were compared and analysed between the two groups.

Results

In this study shorter duration of surgery was reported in IPOM plus. The postoperative pain was high in IPOM plus than SCOM/SCOLA. Only 6 patients presented with seroma in SCOM/SCOLA and 1 patient in IPOM plus in 3rd week, with no significant difference. Duration of stay is high in SCOM/SCOLA. Cost of surgery is high in IPOM plus group.

Conclusion

The study concludes that patients undergoing treatment for umbilical or para-umbilical hernia can be benefited from both groups where SCOM/SCOLA proves to be effective due to less incidence of postoperative pain and low cost whereas, IPOM plus technique reports a lower incidence of seroma in 1st week and reduced hospital stay.
TREATMENT STRATEGY AND OUTCOMES FOR MEDIAN VENTRAL HERNIA IN OUR DEPARTMENT
Authors: Ueno N
Published: May 2024

Aim

Retro-rectus mesh repair (e-/MILOS) based surgery is performed for ventral hernias in our department. The treatment strategy and results are reported.

Material and Methods

From April 2020 to October 2023, 104 surgeries were performed on median ventral hernias. Based on the current situation in Japan where BOTOX is not approved for the abdominal wall, we applied prehabilitations (physical therapy and nutritional guidance) before surgery (61 cases).

In addition, because of experience of SSI and cancer dissemination in surgery after mesh repair, reconstruction without a mesh (non-mesh e-/MILOS) with retro rectus component separation and reinforcement of Linea alba around the orifice was performed for the younger (under 60 years) and in cases after malignant tumor surgery who don’t refuse in the informed consent (73 cases).

Results

In the cases with prehabilitations, TAR was performed in 2 cases (3.2%), analgesics was prescribed at 2 weeks after surgery in 4 (6.6%), and recurrence occurred in 2 cases (1.6%) what was significantly lower than those without (13.1%, 14.0% and 7.9%, 3–44 months) (p <0.01).

In the non-mesh group, analgesics were prescribed at 2 weeks after surgery in 4 cases (5.4%) and recurrence occurred in 1 (1.3%), significantly lower than the mesh group (12.9%, 9.7%, 3–44 months) (p <0.01).

Conclusions

Prehabilitations may help reduce postoperative pain and prevent recurrence. Non-mesh not only prevents complications associated with mesh but may be non-inferior in therapeutic effect compared to using mesh.

Prospective trials should be planned.
IMPLEMENTATION OF A LAPAROSCOPIC INGUINAL HERNIA REPAIR PROGRAMME. INTRAOPERATIVE OUTCOMES OF A FOUR-YEAR PROGRAMME
Authors: del Valle Ruiz S R , González Valverde F M , Medina Manuel E , Rodríguez Lucas J M , Valero Soriano M , Jiménez Moreno I M , Hurtado Vázquez A M , Sandoval Marín J , Moreno García C , Candel Arenas M F
Published: May 2024

Background

Laparoscopic inguinal hernioplasty was first described in the early 1980s. However, according to the Spanish national database, only a small number of patients have actually undergone this technique.

Material and Methods

Descriptive and retrospective study of patients who underwent elective Totally Extraperitoneal (TEP) surgery between October 2019 and January 2024. Four surgeons with experience in laparoscopic surgery (1 also with advanced colorectal surgery experience, 2 also with advanced bariatric surgery experience) participated in training courses. Selection criteria were: bilateral hernias, recurrent hernias with previous anterior approach, ASA ≤ III, age ≥18 and primary unilateral hernias in athletic patients or patient's personal preference.

Results

214 patients underwent surgery, 87.4% male, mean age 57.6 (SD 13.07, range: 20–88) years. The body mass index was 25,65 (SD 3.57, range: 17.3–42.1). Of these, 131 had bilateral hernias, and 83 unilateral (30 left side, 53 right side). 345 hernias were operated, 60 (17.39%) were recurrent. The mean operative time was 60 (SD 26.47, range: 20–180) minutes. There were 3 TEP to TAPP conversion and 7 to open approach (2 patients with recurrent hernias). Minor complications were: 1 inferior epigastric artery bleeding, the peritoneum was opened in 72 cases (closed with running sutures in 4 cases and with clips in 32 cases). There were 3 major complications: 1 preperitoneal haematoma reoperated within 12 hours, 1 intraoperative bladder perforation and 1 intraoperative external iliac vein injury.

Conclusions

TEP is feasible and safe, but there are many challenges, particularly in terms of a learning curve.
OBESITY AND HERNIA – ALGORITHM AND EVIDENCE
Authors: Vashistha A
Published: May 2024

Materials and Method

Obesity with abdominal wall hernia is always a concern for the patient and surgeon. BMI is an inflammatory state and very high risk of recurrence, surgical site infection, or Subacute Obstruction, if we decide to do Metabolic surgery and Hernia together or defer the Hernia surgery.

IPOM Plus was done with dual mesh with three port technique by Laparoscopy or Robotic for Hernia and Sleeve Gastrectomy

Conclusion

We compared our data and found that Hernia repair and Metabolic surgery can be done in the same sitting with favourable hernia and favourable obesity.

Data

Concomitant Bariatric with Hernia repair. (January 2008 to December 2021).

Total number of patients: 21.

BMI: 46.26 +/- 6.6.

No. of Sleeve Gastrectomy: 19/ IPOM/ No Recurrence/ No SSI.

No. of Gastric Bypass: 1/ PR/ No Recurrence.

No. of MGB: 1/ PR/ 3 years later IPOM + Repair.

Mean hospital stay: 2.5 days.

No. of Post op Mesh infections: 0.
DEVELOPING A SCORING SYSTEM FOR THE OBJECTIVE ASSESSMENT OF TOTALLY EXTRAPERITONEAL MINIMALLY INVASIVE INGUINAL HERNIA REPAIR SURGERY
Authors: Yeşilsoy M , Halil Özata I , Karahan S N , Sucu S , Tüfekçi T , Bozkurt E , Toprak S , Salim Uymaz D , Özoran E , Ağcaoğlu O , Balık E
Published: May 2024

Background

While existing checklists and scoring systems assess open surgery and TAPP (transabdominal preperitoneal procedure) surgeries, there is currently a lack of evaluation criteria and a dedicated checklist for TEP (totally extraperitoneal procedure) surgery. This study aims to develop a comprehensive checklist for guiding the procedural steps of minimally invasive TEP surgery and to establish a scoring system applicable to resident training.

Methods

This observational study, conducted at a single center, involved the evaluation of 60 unedited surgery videos performed by expert surgeons and 34 videos of residents by two independent experts. İnter-rater reliability between the two evaluators and construct validity of the scoring system assessed.

Results

The study demonstrated a robust level of inter-rater reliability, with a Cronbach's Alpha coefficient of 0.94. The median score (Interquartile Range, IQR) of resident surgeons was significantly lower than that of expert surgeons (17 [14-19] vs. 18.5 [17–19.375], p <0.01). However, the median score of senior resident surgeons did not exhibit a statistically significant difference compared to expert surgeons (17 [16–20] vs. 18.5 [17–19.375], p = 0.192).

Conclusion

The developed scoring system demonstrates efficacy in evaluating TEP surgery and indicates a correlation with experience. Further investigations are needed to assess its applicability in diverse settings.

TEP Checklist Trocar insertion - 4 points Entering the preperitoneal space by taking the rectus muscle laterally 0 1 2 Entering adequately two trocars of 5 mm in the pre-peritoneal space 0 1 2 Creation of the preperitoneal space- 6 points Identifying the pubic symphysis in medially 0 1 2 Developing space laterally to the level of SIAS 0 1 2 Identifying the epigastric vessels and staying below it ventrally 0 1 2 Reduction of hernia sac - 4 points Reduction of hernia sac and cord lipomas 0 1 2 Peeling away the peritoneum down to the Cooper's ligament 0 1 2 Description of anatomy - 4 points Identification of ductus deferens and spermatic vessels 0 1 2 Determining the location of the iliac artery and vein 0 1 2 Mesh deployment - 2 points Closing all the potential hernia defects with an excellent appearance 0 1 2 TOTAL 20
Tiam1 is part of a novel mechanism for morphine tolerance and hyperalgesia
Authors: Mangutov Elizaveta , Pradhan Amynah A
Published: May 2024

This scientific commentary refers to ‘Tiam1-mediated maladaptive plasticity underlying morphine tolerance and hyperalgesia’ by Yao et al. (https://doi.org/10.1093/brain/awae106).
Pain experience reduces social avoidance to others in pain: a c-Fos-based functional connectivity network study in mice
Authors: Li Jiali , Qin Yuxin , Zhong Zifeng , Meng Linjie , Huang Lianyan , Li Boxing
Published: May 2024

Pain experience increases individuals’ perception and contagion of others’ pain, but whether pain experience affects individuals’ affiliative or antagonistic responses to others’ pain is largely unknown. Additionally, the neural mechanisms underlying how pain experience modulates individuals’ responses to others’ pain remain unclear. In this study, we explored the effects of pain experience on individuals’ responses to others’ pain and the underlying neural mechanisms. By comparing locomotion, social, exploration, stereotyped, and anxiety-like behaviors of mice without any pain experience (naïve observers) and mice with a similar pain experience (experienced observers) when they observed the pain-free demonstrator with intraperitoneal injection of normal saline and the painful demonstrator with intraperitoneal injection of acetic acid, we found that pain experience of the observers led to decreased social avoidance to the painful demonstrator. Through whole-brain c-Fos quantification, we discovered that pain experience altered neuronal activity and enhanced functional connectivity in the mouse brain. The analysis of complex network and graph theory exhibited that functional connectivity networks and activated hub regions were altered by pain experience. Together, these findings reveal that neuronal activity and functional connectivity networks are involved in the modulation of individuals’ responses to others’ pain by pain experience.
CAIMP: Cross-Architecture IoT Malware Detection and Prediction Based On Static Feature
Authors: The Dung Luong , Ngoc Toan Nguyen , Nghi Phu Tran
Published: May 2024

IoT malware and cross-platform malware are currently the top threats to information systems. This paper proposes a robust cross-architecture IoT malware detection and prediction model based on machine learning and opcode features using a novel approach. In our method, a feature opcode transformation model between chip architecture platforms is proposed to facilitate the process of building a detection model for cross-architecture malware on IoT devices. The feature transformation model is capable of converting opcodes between different architecture platforms using an unsupervised machine learning approach. In our approach, a machine learning model is used for the detection of cross-platform malware based on the proposed opcode features. Experiments have demonstrated that our method is effective in detecting and predicting cross-platform malware with an accuracy of up to 99.4% and an F1-score of 99.3%. The method is capable of learning on one architecture platform and detecting malware on a different architecture platform. Therefore, the method can be used to develop cross-architecture detection and zero-day malware prediction solutions on IoT devices.