bluuebunny/crossref_metadata_2025 huggingface dataset:
A NEWER METHOD OF SEROMA REDUCTION BY FENESTRATION OF PSEUDO-SAC DURING LAPAROSCOPIC REPAIR OF DIRECT INGUINAL HERNIA: A RANDOMISED, CONTROLLED PILOT STUDY
Authors: Parihar Y K
Published: May 2024

Background

Minimally invasive surgeries for inguinal hernia repair have been reduced post-operative morbidity. However, certain complications such as seroma formation are unavoidable. In this study, we introduce a newer technique of reducing seroma formation by fenestration of the pseudo-sac (thickened transversalis fascia) in patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia.

Patients and Methods

A randomised, controlled pilot study was conducted from January 2019 to December 2020 for the patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia. Study participants were randomised into interventional group and control groups. Demographics, operative duration and complications including post-operative pain and seroma on days 1, 10 and 30 were analysed between both the groups.

Results

A total of 20 cases with 30 hernias were included in the study. Demographic data were comparable between the two groups. The intervention group showed a statistically significant decrease in the incidence of seroma formation on the post-operative day 10 (13.3% vs. 46.6%, P = 0.046). The mean volume of seroma on day 10 was also less compared to the non-fenestration group (2.5 vs. 6.58 ml, P = 0.048). After the 30th day, no patient had a presence of seroma. There were no statistically significant differences in terms of mean operative duration, post-operative pain and other complications.

Conclusion

Fenestration of pseudo-sac in laparoscopic hernia repair for uncomplicated direct inguinal hernia is a simple and effective technique. It has reduced the incidence and volume of seroma formation without any increased risk of infection, acute or chronic pain and recurrence.
EXTRA-ABDOMINAL APPENDICITIS: A CASE REPORT FROM AN AMYAND HERNIA
Authors: Pera R , Frazão J , Fragoso M , Alves P , Mira P
Published: May 2024

Introduction

Hernioplasty is one of the most common procedures in general surgery. The post-operative period extends until 6 months of surgery, to detect early recurrence.

This aims to share the management of appendicitis in a recurrent hernia.

Methods

This is a case report based on a patient who presented as an Amyand hernia, complicated with appendicitis.

Results

This case is from a male patient aged 50 years, who was submitted to an elective right inguinal hernia repair 8 months before, without other relevant past medical history. He presented in the emergency room with right groin pain, nausea, vomiting and fever. Blood tests showed increased white blood cells (14,000/mm3) and increased C-reactive protein (11 mg/dL). In the ultrasound performed, there were signs of recurrence of the hernia, the appendix was noted to be part of the hernia contents and it had findings suggestive of appendicitis. The patient underwent emergency surgery. Intraoperatively, there was incarceration of the appendix and the cecum. Appendectomy was completed without further intestinal resection. The hernia defect was corrected with a mesh based technique. Postoperative period went without complications and the patient was discharged on day 2 postoperative with amoxicillin-clavulanate. Histology showed appendicitis.

Discussion

This case reports the rare event of appendicitis in the context of an Amyand hernia. This is important to raise awareness for this condition, which can mimic an incarcerated hernia. The management of the patient is relevant to be shared and discussed with hernia experts to improve management of future patients with the same condition.
SHEATHED GORING CAUSING AN OCCULT TRAUMATIC EVISCERATION
Authors: Plazas-Font P J , Gómez-Torres I , Menor-Duran P D , Martínez-Hernández A , Queralt-Escrig M , Alcobilla-Ferrara E , Laguna-Sastre J M
Published: May 2024

Background

Bull horn lesions entail one of the Spain’s most common cause of politraumatism. These, result mostly in musculocutaneous lesions, and they are more frequent in the lower limbs and perineum.

However, it exists a less usual entity that is the abdominal hernia due to closed trauma, which in the case of bullfighting corresponds to sheathed goring.

This kind of injury is caused by a blowout mechanism in areas of fascial weakness such as the ones close to the iliac crest or lateral to rectus muscles. Furthermore, they do not compromise the integrity of the overlying skin, and this is why they can go unnoticed.

Material and Methods

During the last 10 years, 958 patients were treated in our health area because of bull horn injuries. 6 of them presented abdominal herniation due to sheathed goring. All of them were men, with an average age of 33 years old.

Results

All the patients underwent emergency surgery. Given the condition of infection of the surgical wound and destructuring of the fascia, only 2 defects could be repaired by placing a retromuscular mesh in the Rives space. The other 4 cases were repaired by an edge refreshing following the Friedrich technique and fascial raffia.

Discussion/Conclusion

This kind of lesion can compromise the patients’ lives, especially due to the severity of the associated intraabdominal injuries.

Therefore, in the case of high-energy trauma such as sheathed goring, there should be a high diagnostic suspicion even though no external injuries are evident.
OUR SURGICAL TREATEMENT STRATEGY IN A CASE OF COMPLEX INCISIONAL HERNIA
Authors: Prodan A , Matei M , Beuran M , Turculet C , Cancea B
Published: May 2024

Background

We present the case of a 38-year-old man with a giant incisional hernia, related to multiple abdominal surgeries and Staphylococcus aureus infection, for more than 5 years. This pathology is more unusual and very challenging in terms of surgical management.

Material and Methods

The computer tomograf (CT) and measurements showed that we have a case of loss of domain. Physical examination revealed a giant, irreducible incisional hernia.

The purpose of the complex hernia was to eliminate Staphylococcus aureus infection, repair the incisional hernia defect, strengthen the abdominal wall, prevent recurrences and recover the functionality of the abdominal wall. We treated the incisional hernia using a combined approach consisting of: surgical mesh excision, antibiotic treatment, Botox injection after three months, pneumoperitoneum (PPP) one month after Botox injection and the transversus abdominis release procedure (TAR).

We performed separation of the posterior components obtaining a large retromuscular space. After reduction of the incisional hernia, the abdominal wall was reconstructed by placing a large 50/50 cm macroporous polypropylene mesh, in the retromuscular space created by the TAR.

Results

The patient was discharged on the eighth postoperative day. At three-month follow-up, the patient had no recurrence of hernia, chronic pain, or other complications. The patient also noticed a significant improvement in his quality of life.

Conclusion

This case represents a successful combined approach of surgery, Botox, and PPP to treat a complex incisional hernia in a 38-year-old man with good results.
NO RECURRENCE AFTER 16 YEARS PROSPECTIVE LONG-TERM FOLLOW-UP OF OPEN TEP/TIPP INGUINAL HERNIA REPAIR
Authors: Ribokas D
Published: May 2024

Aim

Evaluation of long-term follow-up results after open transinguinal preperitoneal (TIPP) technique with preformed lightweight mesh (PLM).

Material and Methods

This unicentric study included 102 patients treated with surgery for groin hernia by the same surgeon using the same technique, with PLM, June 2008–September 2009. All patients were postoperatively followed with clinical control 1 month later, and a survey follow-up 40–54 months after surgery, in January 2013.Those reporting any complaints were invited for outpatient review. Chronic pain, hernia recurrence and reoperation were documented.

Results until January 2024 were retrieved from the Swedish Hernia Register.

Results

102 hernia repairs; 46 with local anaesthesia with no intraoperative complications.

Clinical control after 1 month:

No infection of the mesh.

No clinical recurrence.

No re-operation required.

Questionnaire follow-up:

Mean follow-up time: 47 months.

95 patients (93%) followed-up.

Light, not permanent pain in 8.8% of patients who did not require the consumption of systematic painkillers and are not limited in their activities. No re-operations have so far been recorded in the Swedish Hernia Register with a median follow-up of 182 (range 176–187) months and 79 patients still alive.

Conclusions

No recorded recurrences after almost 16 years of follow-up are encouraging. This technique consisted of the placement of a patch in the preperitoneal space, which combines the benefits of the anterior approach (safe technique, short learning curve, local anaesthesia, low cost) and the preperitoneal placement of the mesh (less recurrence, less pain).

PLM = BARD®POLYSOFT®Hernia Patch
HYBRID APPROACH FOR MADRID POSTERIOR COMPONENT SEPARATION IN LARGE LATERAL HERNIAS: EARLY RESULTS OF A MULTICENTRIC STUDY
Authors: Román García de León L , Munoz-Rodriguez J M , Blazquez Hernando L A , Garcia-Urena  , Valle de Lersundi A R , Medina Pedrique M , Remirez Arriaga X , Gil Cidoncha L , Fernández Rodríguez M , Lopez-Monclus M A J
Published: May 2024

Aim

This study evaluates the results of the hybrid approach (extended totally extraperitoneal (e-TEP) and open) to perform Madrid-Posterior Component Separation (PCS) for the treatment of lateral hernias.

Material and Methods

A retrospective multicentric study was conduced involving patients with lateral hernias operated by hybrid approach between 2021 and 2023. The inclusion criteria were lateral hernias with associated midline defects and large defects involving the semilunar line. The technique performed was in all cases a Rives – Stoppa with PCS according to the Madrid modification.

Results

A total of 12 patients with lateral incisional hernia were analyzed. Three of them were L4 and the rest L3 (EHS Classification). The mean transverse size of the defect was 10,3 cm (range 6–14). Seven of them had a concomitant midline hernia, all of them were W1.

In 4 patients only the Rives-Stoppa (RS) dissection was performed by e-TEP approach and the PCS was done open, performing a Reverse-TAR. In the rest, the complete dissection including the PCS was done by e-TEP approach and the open part was used only to complete the posterolateral reconstruction. The mean operative time was 255 minutes (range 240–350).

No patient presented complications or recurrence with a median follow-up of 10,6 months (range 4–24).

Conclusions

The hybrid approach for performing Madrid-PCS in the treatment of medium-large lateral hernias is a feasible technique with both technical and patient advantages, allowing to maintain the benefits of minimally invasive but ensuring the principles of abdominal wall reconstruction.
DOES THE OPEN PREPERITONEAL HERNIOPLASTY DECREASE THE RATE OF CHRONIC GROIN PAIN? AN ANALYSIS OF OUR SERIES
Authors: Ruíz Marzo R , Otegi-Altolaguirre I , Rico-Arrastia A , Blázquez-Lautre L , Sebastián-Labayen J L , González-Tolaretxipi E , Arana-Iñiguez I
Published: May 2024

Background

International guidelines list an overall incidence of chronic postoperative groin pain of 10 to 12%. With the analysis of our series, we intend to demonstrate the lower rate of postoperative chronic groin pain in open preperitoneal approach.

Method

We present the retrospective analysis of the patients operated on in our centre of inguinocrural hernia between January 2017 and June 2022 using open preperitoneal hernioplasty. We include both primary and recurrent hernias, as well as those operated both on a scheduled and urgent surgery.

Regarding the surgical technique, we use polypropylene meshes fixed with stitches of long-lasting resorbable monofilament. A visit is made a month after the intervention, where postoperative pain is assessed quantitatively, among other items, using a VAS scale. We consider as chronic pain the presence of it with a VAS > 3 for 6 months or more. In case of pain, we carry out follow-up and referral to the Unit of Pain.

Results

In this period studied, 544 patients (173 primary hernias and 371 recurrent hernias) were operated on using this technique. Five patients with chronic postoperative pain were registered (0.9%), who continue to be followed up by us and the Unit of Pain.

Conclusions

The open preperitoneal approach shows excellent rates of postoperative chronic pain because the preperitoneal space is accessed anatomically away from the iliohypogastric and ilioinguinal nerves.

In conclusion, both the literature and our series show that open preperitoneal approaches produce less neuroinjury than anterior or posterior laparoscopic approaches.
EVALUATION OF ROBOTIC TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR (RTAPP) IN OUR HOSPITAL
Authors: Saito T , Ando M , Shinohara K , Ueda S , Yasui K , Osawa T , Matsumura T , Fukami Y , Komatsu S , Sano T
Published: May 2024

Background

Robot-assisted surgery, particularly RTAPP utilizing the da Vinci Surgical System, has been recognized for its potential to enhance surgical precision in inguinal hernia repairs. In December 2018, our hospital established a time-limited task protocol alongside initiating RTAPP. This protocol divides the surgery into three phases: peritoneal dissection, mesh placement, and peritoneal suturing, aiming to enhance patient safety and surgical efficiency.

Methods

This retrospective review analyzed RTAPP procedures from December 2018 through November 2023, assessing operative times, complication rates, recurrence rates, adherence to our innovative time-limited protocol, and the progression of the surgical learning curve.

Results

The analysis included 66 patients (101 lesions; 35 bilateral, 31 unilateral), predominantly male (62 males, 4 females), with a median age of 73 years and a BMI of 24.2 kg/m². Lesions were categorized into 55 indirect and 46 direct types. Median operative and console times were 126 and 88 minutes, respectively. Complications were minimal, including one seroma, one SSI (both Clavien-Dindo grade I), and one injury to the inferior epigastric artery, all adhering strictly to the protocol. The learning curve demonstrated stabilization after 38 procedures.

Discussion

Our protocol for RTAPP significantly improved early safety and efficiency. Strategic planning and focused training were essential for integrating this technology effectively.

Conclusions

RTAPP has effectively met the challenges of inguinal hernia repair for introduce, enhancing surgical precision and patient safety. The structured protocol facilitated rapid proficiency among surgeons, demonstrating the technique's significant potential for improving robotic-assisted surgeries.
POSTOPERATIVE RESULTS AND QUALITY OF LIFE AFTER INGUINAL HERNIA REPAIR. COMPARATIVE BETWEEN OPEN AND LAPAROSCOPIC REPAIR OF 466 INGUINAL HERNIAS
Authors: Sánchez Sáez E , Valverde E S , Mercader Bach C , Orbeal Saenz R , Silvio Estaba L , Corredera Cantarín C , Díaz Padillo A , Guasch Marcé M , Jurado Ruiz C , Pareja Nieto E , Comajuncosas Camp J
Published: May 2024

Objective

The objective of this study is compare the postoperative results of open and laparoscopic inguinal hernia repair.

Material and Methods

Retrospective cohorts from a prospective database of inguinal hernia repair between December 2016–December 2021. The variables analyzed are: demographic data, intraoperative and postoperative, quality of life evaluated with EVA, Carolina Comfort Scale (CCS), postoperative complications and recurrence.

Results

466 patients were included (85.4% man). 212 cases (45.5%) were open and 254 (54.5%) laparoscopic. The average follow up is 13 months (11–26). The laparoscopic treatments were trans abdominal pre-peritoneal (TAPP). There were no differences in complications (p = 0,763), Clavien-Dindo classification (p = 0,106), seroma (p = 0,155), hematoma (p = 0,152), wound infection (p = 0,463), recurrence (p = 0,290). According to quality of life at 1 month follow up there were significant differences CCS = 0 (39,1% laparoscopic vs. 11,8% open, p = 0,038), no significant differences at 6 month and 1 year follow up. The EVA scale alt 6 month follow up were less in laparoscopic but no significant (p=0,085 & p = 0,063). At 1 year the laparoscopic approach had better pain control (EVA p = 0,016 i EVA = 0 p = 0,018).

Conclusions

According to this study in our center, laparoscopic and open approach have comparable results in postoperative complications at 30 days and no differences in recurrence. The laparoscopic treatment have better quality of life at 1 month follow up and this trend remains at one year follow up with no significance.
RANDOMIZED CONTROLLED TRIAL (RCT) ON PREOPERATIVE CESSATION VS NO PREOPERATIVE CESSATION OF ASPIRIN IN LAPAROSCOPIC INGUINAL HERNIA REPAIR
Authors: See I , Lee S , Arunoda P , Wijerathne S , Loo L , Lomanto D
Published: May 2024

Background

The incidence of inguinal hernia is increasing in view of the ageing population worldwide. Cardiovascular and cerebrovascular co-morbidities are the commonest indications for use of anti-thrombotic agents (including aspirin) in this age group. This highlights the need to understand risk of adverse thromboembolic events like acute myocardial infarction and strokes (when ceasing aspirin) versus risk of bleeding (when not ceasing aspirin) in patients undergoing laparoscopic inguinal hernia repair.

Method

A prospective RCT was designed to recruit 100 patients with either unilateral or bilateral reducible inguinal hernia undergoing laparoscopic inguinal hernia repair in a tertiary hospital. Exclusion criteria include patients who are unfit for general anaesthesia, had obstructed or strangulated hernias. Primary outcome was post-operative bleeds while secondary outcomes included post-operative thromboembolic events, surgical-site infections, and duration of hospitalisation.

Results

Our interim results reveals 65 patients recruited since 2015. 30 have been randomised to continue aspirin preoperatively (46.2%) while 35 have been randomised to stop aspirin 5 days preoperatively (53.8%). Most patients were male, had similar mean BMI (23.6 vs. 24.0), American Society of Anaesthesiologists (ASA) grading, had primary bilateral hernias and comparable mean defect size. There was no statistically significant difference in all post-operative complications. Mean follow up duration was 190.9 days.

Conclusion

Aspirin vs. no aspirin cessation preoperatively had no statistically significant difference between post-operative bleeding or thromboembolic events. This study challenges the practice that aspirin needs to be withheld before an elective laparoscopic inguinal hernia repair.
HYBRID TECHNIQUE VS LAPAROSCOPIC IPOM FOR LARGE VENTRAL HERNIA REPAIR
Authors: Serdarov N , Ymamgulyev J , Mamenov S
Published: May 2024

The aim of this study is to investigate the immediate and long-term outcomes of a hybrid technique for abdominal wall repair, which combines open and laparoscopic methods, compared to the laparoscopic IPOM method.

The study involved 58 patients with ventral hernias (22 primary, 36 postoperative) who underwent surgery using either the laparoscopic IPOM method or the hybrid method (laparoscopic IPOM with open access). The patients were divided into two groups: the first group underwent the standard laparoscopic IPOM procedure, while the second group underwent the hybrid technique of operation. The size of the hernia orifice was distributed as follows: 46 patients had W2 hernias, and 12 patients had W3 hernias. The main evaluated parameters included the duration of the operation, hospital stay, the occurrence of early postoperative complications (seroma, postoperative wound infection), and the occurrence of hernia relapse.

Thirty patients underwent laparoscopic IPOM ventral hernia repair, while a combined open and laparoscopic hernia repair (hybrid technique) was used in 28 patients. The open stage of the hybride method provided separation, reduction, and closure of the hernia sac, while the laparoscopic procedure consisted of adhesion dissection, mesh placement, and fixation. A composite mesh was used in all cases.

In the first group, there were three cases of seroma formation and two recurrences. Seroma formation and hernia relapses were not detected in the second group. The use of the hybrid method in surgery for patients with W2 and W3 hernias saved time during the operation and reduced immediate postoperative complications.
A CHALLENGING CASE OF MANAGEMENT OF AN INFECTED MESH WITH LAPAROSCOPY, ADHESIOLYSIS AND REMOVAL OF THE MESH
Authors: Shah I , Kapsampelis P , Gerogiannis I
Published: May 2024

Aim

To present a challenging case of an infected mesh in an obese patient managed with a combination of laparoscopy and open incision.

Material and Methods

An 57-year-old woman with diabetes type 2, obstructive sleep apnoea requiring Continued Positive Airway Pressure (CPAP) and a BMI of 43 presented to be seen in the outpatient clinic. Her visits were related to a infected mesh in her right upper quadrant of the abdomen as a result of a laparoscopic repair of incisional hernia post open cholecystectomy 13 years ago. The CT scan confirmed an infected mesh.

A laparoscopy approach was used initially. Insufflation: Optic trocar COz 17 mmHg (left paramedian line).

Ports: Leftt 10 mm, 2 × 5 mm LUQ and lower epigastric (midline).

Findings: Laparoscopy: Adhesions of the omentum with the anterior abdominal wall, Cirrhotic liver, hepatic flexure below the area of the infected mesh but without any obvious colonic fistula.

Open incision for fistulectomy: Long thick tract leading to preperitoneal space. Large cavity containing an infected mesh 15 × 15 polypropylene mesh. Metallic tacks present in the cavity.

Procedure

Adhesiolysis. Findings as above. Simultaneously laparoscopy and open exploration of the area of the fistula was performed with a surgeon on each side. Fistula was removed intact. A preperitoneal cavity was found which was the source of infection. Mesh was removed intact with tacks on. Sent for micro. Very good wash of the cavity with betadine.

Exploration laparoscopically. Hepatic flexure was below the area of the infected mesh. As there was a suspicious area which might corresponded to a colonic fistula, further adhesiolysis was performed. The hepatic flexure was mobilised making sure that there was no bowel involvement. In order to maintain bowel wall and avoid injury, an area of the peritoneum was left on the bowel. Right colon was checked for injury – negative. Peritoneal defect was closed with 1 prolene (× 2) interrupted sutures with endoclose device. A 30 Fr Robinson's drain was left in the Rt paracolic gutter via the lower 5 mm port. Exsuflation of COz, extraction of trocars. Closure of the anterior abdominal wall with J PDS interrupted. 14Fr Redivas in the subcutaneous tissue.

Results

The patient's postoperative course was uneventful. She was discharged the 5th post operative day. At 3 months follow-up the patient is well and asymptomatic with a small induration of the skin in the area of the previous infection.

Conclusion

Mesh infection is a devastating complication. A surgeon with an interest and experience in abdominal wall surgery can offer a safe and efficient approach to these cases.
GIANT HIATAL HERNIA WITH ACUTE MANIFESTATION OF COMPLETE ESOPHAGEAL OBSTRUCTION: CASE REPORT
Authors: Schutz S O , Pazin J , Husarova T , Havlova K , Koblihova E , Pohnan R
Published: May 2024

Introduction

Hiatal hernia is a common condition with rising incidence in western society. The prevalence rises in patients with morbid obesity, age and female gender. Up to 95% are sliding hernias, often asymptomatic or causing symptoms typical for gastroesophageal reflux disease, 5% are paraesophageal hernias which according to the grading may be asymptomatic. Symptomatic hernias are associated with more severe symptoms, higher rate of complications and need of acute surgical management.

Case Presentation

We present a case of a 64-year-old female patient with BMI 39 and acute upper abdominal pain, nausea and vomiting. Computed tomography showed giant paraesophageal hernia containing the entire stomach, oral part of duodenum with D2 stenosis and head of the pancreas. We performed laparoscopic reposition of giant hernia and Nissen fundoplication. Defect was reconstructed with semi-absorbable mesh, gastropexy to diaphragm was performed and Jackson-Pratt drain was inserted in the remaining cavity. The patient was discharged on day 6. Post-operatively tolerating liquids. One month later, the patient presented with inability of per os consumption and vomiting. Computed tomography verified impacted solids in distal esophagus along with compression by seroma in mediastinum. Acute gastroscopy was performed and mechanical clearance of impacted food was accomplished. CT navigated percutaneous drainage of collection was considered, but was technically unfeasible. Further course of hospitalization was uneventful and the patient was discharged tolerating liquid diet.

Discussion

Postoperative therapy and rate of complications in grade IV giant paraesophageal hiatal hernias is challenging, burdened by high morbidity including long-term seroma formation.
SIMULATED ABDOMINAL WALL — A VALUABLE EDUCATIONAL TOOL FOR ABDOMINAL WALL RECONSTRUCTION AND SMALL BITE CLOSURE TECHNIQUES
Authors: Smith O , Ritchie C , Aylward K , Green S , Chitsabesan P , Chintapatla S
Published: May 2024

Background

Incisional hernia is a common complication following laparotomy and may require reconstructive repair techniques. Studies suggest that poor closure contributes to incisional hernia. European and American guidelines have suggested closing with the "small-bites technique". Junior trainees are often left to close the abdominal wall and may be unfamiliar with such techniques. Simulated training has gained traction. Reduction in theatre training hours necessitates simulated training.

This study aims to

generate a synthetic abdominal wall model use this model as a simulated training tool for general/plastic surgical trainees for closure and reconstructive abdominal wall repair techniques

Method

2021: literature search and research. Theatre observation of complex abdominal wall procedures and techniques. Cadaveric lab attendance at Leeds University.

2022: prototype – first model produced from medial grade silicone

2022: amendments – alterations to the prototype

2023: accreditation and delivery – Small Bites Course delivered and accredited by RCS Edinburgh.

Results

86% of course attendees found the abdominal wall models "as realistic as possible". Attendees felt more confident to perform small bites closure and simple abdominal wall reconstruction. Total cost saving per model compared with competitors = £1109.50.

Conclusion

Our simulated abdominal wall model is realistic and cost effective. It is an ethical and improved way to train junior surgeons in the small-bites technique and some elements of abdominal wall reconstruction. These models have been implemented on training courses for surgical trainees within the deanery.
LICHTENSTEIN INGUINAL HERNIA REPAIR WITH TRASVERSALIS PLICATION. IS PLUG STILL NECESSARY?
Authors: Soldini G , Latham L , Casali A , Intelisano A , Antonini I , Musolino C , Callipari R , Scalambra S M
Published: May 2024

Introduction

Inguinal hernia repair with Lichtenstein technique is one of the most widespread surgical procedure in the world.

Almost 20 million people undergoes inguinal hernia repair in a year all over the world, for what it concerns in Italy a number of 150 000 patients per year.

75% of all hernias are monolateral and the risk of having an inguinal hernia is 27% for male patients and 3% for female patients.

The golden standard technique for the open approach is the tension free approach Lichtenstein – Amid.

Some considerations need to be made for the use of the hernia plug.

In literature the use of the plug is associated to some complications: chronic pain, lesions of the deferent duct, lesions of small bowel, and some anecdotal complications as migration into the bladder and migration into the ileum or into the colon as well (Int Surg (2019) 104 (1–2): 16–20.)

To avoid these complications in the last decades some hernia centers are avoiding the use of the plug during inguinal hernia repair.

Materials and Methods

We report our experience in the open inguinal hernia repair with Lichtenstein – Amid repair without plug.

From 15th of January till now we performed 238 Lichtenstein – Amid repairs for inguinal hernia. Before positioning the mesh we performed the trasversalis recostruction with an absorbable running suture reducing the inner inguinal ring to 1 cm diameter (Gilbert classification type I).

All the inguinal hernia repairs were for primitive hernia, 234 were male patients and 4 were female patients, 20 cases were scrotal – inguinal hernias.

Results

The median operation time was 45 minutes, intraoperative complications were represented only by 1 lesion of the testicular vessels esitated in an orchiectomy. Post-operative complications were: 2 hematomas, 4 seromas, 7 moderate inguinal pain.

After 6 months of follow-up no chronic pain was detected neither major complications.

Discussion

“Modified” Lichtenstein-Amid technique, performed by experienced surgeons, is a safe procedure for inguinal hernia repair with a small risk for intraoperative and postoperative complications. It is also a fast and cheap procedure in terms of operative time and materials costs avoiding the use of plug.
THE MANAGEMENT OF INGUINAL HERNIA REPAIR DURING THE COVID-19 PANDEMIC — A NATIONWIDE, RETROSPECTIVE COHORT STUDY FROM SWEDISH HERNIA REGISTER
Authors: Stolt R , Ruiz-Jasbon F , Österberg J , Ticehurst K , de la Croix H
Published: May 2024

Aim

Inguinal hernia repair (IHR) in Sweden is mainly performed in elective daycare setting. As the COVID-19 spread rapidly and caused global pandemic in 2020, the Swedish healthcare initially postponed all elective surgeries to reallocate their sources. Our aim is to investigate the impact of COVID-pandemic on IHRs and the clinical outcomes in short- and long-term.

Methods

Retrospective cohort study from Swedish Hernia Register (SHR) on data from 109 656 inguinal hernia repairs between 2015–2021 to compare the quality of IHRs before and during the pandemic. The results are presented according to STROBE checklist after using multivariate logistic regression analysis to calculate the complication risks.

Results

In 2020, inguinal hernia repairs reduced by 22,3%, going from 16321 repairs/year to 12686 repairs. Notably, the percentage of acute IHRs increased from 4,8% to 5,7% as the elective surgery decreased. The risk for emergent IHR was higher for patients >70 years (OR 4:53, p = 0.039) and ASA score >3 (p < 0.001), and highly associated with severe postoperative complications (Clavien-Dindo 3b-5) within 30 days (OR 3,85, p <0.001). The 30-day mortality and recurrence rates did not differ between the groups.

Conclusions

We noticed a slightly increased number of acute IHRs for older patients with higher comorbidity during the initial phase of pandemic. Despite that, the presumed level of IHRs was reached by the end of 2021 without increased overall complication rates.
A RARE CASE REPORT OF ROBERTS-SC PHOCOMELIA SYNDROME
Authors: Tavakkoli N
Published: May 2024

Introduction

Phocomelia is a condition that occurs in rare cases where the proximal aspect of an extremity is absent and has been associated with various syndromes. Among them, Robert's syndrome is one of the most common cases. Roberts-SC phocomelia syndrome is a malformation that has an autosomal recessive inheritance pattern and is determined through skeletal deformations, particularly symmetrical limb reduction and craniofacial anomalies.

Case Presentation

The fetus was referred to our center followed by legal abortion in the 13th week of pregnancy. In the ultrasound report of the fetus at the 12th week, hypoplasia of the limbs and agenesis of the lower vertebrae of the spine were noted. In the physical examination, multiple congenital anomalies such as short stature, severe shortness of four limbs, oligodactyly, low-set ears, and micrognathia were seen. The family history, clinical, and radiographic examination were performed. Considering that many phocomelia syndromes were suspected in the differential diagnosis, thus WES was recommended for the evaluation of this fetus. WES was done using the Illumina platform and Agilent SureSelect V7 library preparation kit.

The homozygous (c.417del; p. Lys139AsnfsTer6) mutation in ESCO2 was identified in the fetus. Confirmation of this mutation and evaluation of the unaffected parents were done by Sanger sequencing. The parents were heterozygous.

Conclusion

Roberts-SC phocomelia syndrome can be attributed to a homozygous mutation in ESCO2, as confirmed by our findings. Genetic counselling for this couple and other relatives is highly recommended as the first line of prevention and leading to effective prenatal diagnosis.
LONG-TERM TREATMENT RESULTS OF SURGICAL POSTERIOR NEURECTOMY IN PATIENTS WITH ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME
Authors: ten Have T , Jacobs M L Y E , Scheltinga M R M , Zwaans W A R , Roumen R M H
Published: May 2024

Background

The current step-up treatment approach for Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) involves tender point injections, pulsed radiofrequency, and surgical neurectomy. If anterior neurectomy fails or pain recurs, a secondary posterior neurectomy is considered as a final surgical option. We analyzed long-term treatment outcomes of a posterior neurectomy.

Method

All ACNES patients (2012–2022) who underwent unilateral posterior neurectomy received a questionnaire regarding their current pain status. Patients who not completed the questionnaire were excluded. Primary outcome was short- and long-term treatment success, defined as ≥50% pain relief. Based on the indication for posterior neurectomy patients were stratified: a. persistent pain and, b. recurrent pain (>3 months) after initial anterior neurectomy. Short-term outcomes were derived from medical records, long-term outcomes from the questionnaires.

Results

258 of the 379 patients (68.1%) were included. Short-term outcomes were similar between in- and excluded patients, suggesting no selection bias. The recurrent pain group had significantly better treatment outcomes compared to the persistent pain group, in both short-term (7 weeks; treatment success 79.2% vs. 53.2%, p <0.001) as well as the long-term (58 months; treatment success 61.1% vs. 41.9%, p <0.001). Additionally, 24 of the 37 patients (64.9%) with recurrent pain after posterior neurectomy were again successfully treated. Fifteen (minor) complications (5.8%) were reported, resulting in three re-interventions (1.2%).

Conclusion

Posterior neurectomy shows favorable success rates (60%), especially for recurrent pain cases. Persistent pain after the first anterior neurectomy has significantly less successful results (40%). These data are helpful in proper patient counseling.
SAFETY AND PATIENT-REPORTED OUTCOME MEASURES IN ELDERLY PATIENTS UNDERGOING TOTALLY EXTRAPERITONEAL (TEP) INGUINAL HERNIA REPAIR
Authors: Tsakanov S , Moolan Y , Badiani S , Rajkumar K , Berney C R
Published: May 2024

Background

Laparoscopic hernia repair has become a popular minimally invasive surgical option in recent decades, offering advantages such as reduced postoperative pain, shorter hospital stays, and faster recovery. However, there is ongoing debate regarding its safety and effectiveness in elderly patients.

Methods

This retrospective cohort study included all consecutive patients aged ≥75 years old who underwent elective laparoscopic (TEP) inguinal hernia repair between 2005 and 2023. Data collected included pre-operative and post-operative Visual Analogue Score (VAS), Modified Carolina's Comfort Scale (MCCS) and CCS scores, complications, as well as associated pathologies.

Results

There were 93 patients (79 males: 84.9%) with a mean age of 79.3 years who underwent 122 TEP inguinal hernia repairs, including 18 (14.8%) recurrence. Twenty-nine (31.2%) were bilateral, 80 (65.6%) were indirect. Associated pathologies consisted of 10 femoral hernias, with three (21.4%) occurring in 14 females and seven (8.9%) in 79 males. Additionally, 10 obturator hernias were identified, with five occurring in females (35.7%) and five in males (6.3%). Minor complications were observed in seven (7.5%) individuals, but no major complications.

The average preoperative VAS pain score was 3.4, which decreased to 1.0 at 2-weeks and 0.11 at 6-weeks postoperatively. The preoperative cumulative average MCCS score was 12/75 (ratio: 0.16 +/- 0.2), and postoperative average CCS scores were 3.57/100 (ratio: 0.04 +/- 0.07) at 2-weeks and 0.64/115 (ratio: 0.01 +/- 0.02) at 6-weeks respectively.

Conclusion

TEP inguinal hernia repair in elderly patients offers satisfactory outcome with minimal morbidity and significant improvement in functional and pain scores.
IMPLEMENTATION OF ERAS PRINCIPLES IN TREATMENT OF PATIENTS WITH INGUINAL HERNIAS REPAIRED WITH LICHTENSTEIN OPERATION
Authors: Ushnevych Z O , Khomyak V V , Lerchuk O M
Published: May 2024

Background

More than 60% of patients operated for inguinal hernia (IH) are at working age, so quick recovery of working capacity is main goal and 40% are elderly patients, who requires special attention to prevention of postoperative complications. Goal – effect of implementing ERAS principles in the perioperative period of treatment of patients with IH.

Method

In 2023, in surgical department of the Lviv Regional Clinical Hospital 77 patients were operated on for IH by the Lichtenstein operation, average age – 54.6 ± 11.3 years, all patients were men. Patients were divided: I group (n = 36) – classical preoperative preparation; II group (n = 41) – perioperative ERAS principles: no premedication, stop solid food 6 hours and drinking liquids 2 hours before surgery, inhalation anesthesia in combination with a TAP block, prevention of nausea and vomiting.

Results

The dosages of Fentanyl used during surgery and the blood glucose levels were significantly lower in the group II (P <0.05). The VAS scores of the group II were considerably lower at 4, 12, 24 and 48 h after surgery (P <0.05). In postoperative period opioid analgesics were used for pain relief (4 hours after the operation) in all patients group I and not used in group II patients. Group I vs. II respectively, 5 (13.9%) vs. 1 (2.4%) on the 1st day post-surgery experienced nausea and vomiting. Postoperative hospitalization time was longer in group I patients (2.5 ± 0.5 days vs. 1.5 ± 0.5 days).

Conclusion

ERAS principles in clinical practice allows to speed up recovery of patients and reduce frequency of postoperative complications.
THE DEVELOPMENT OF A 3D IN VITRO RECTUS SHEATH TISSUE MODEL FOR THE PURPOSE OF HERNIA MESH TESTING
Authors: Whitehead-Clarke T , Grillo A , Khader R , Nerincx C , Mitchell R , Mudera V , Kureshi A
Published: May 2024

Background

The are many models and experimental comparators used in the field of mesh testing. Overall, the field lacks standardization and requires improvement. Over recent decades the advent of cell culture and tissue engineering have given rise to the development of 3D tissue models. Such models have been used to study disease processes and assess treatments, but not to examine medical devices. We introduce the first work developing a 3D rectus sheath tissue model to test hernia meshes.

Method

Primary rectus sheath fibroblasts (RSFs) were isolated from posterior rectus sheath of human volunteers. Cells were seeded into 3D fibroblast populated collagen matrices and used to assess a selection of commercial meshes for 3 comparators: rate of mesh shrinkage, rate of fibroblast migration across mesh and effect of meshes upon cell viability.

Results

Our model induced notable shrinkage of around 10% in one mesh, without significant difference in any other mesh groups. Cell viability was not significantly impacted by any of the meshes compared to our non-mesh control. Fibroblasts were seen to migrate through each of the meshes without significant difference between the products.

Conclusion

Whilst none of our experiments yielded statistically significant results, our work introduces a number of important discoveries. This is the first study to prove the viability of culturing primary human RSFs alongside hernia mesh. Our work has proven the capacity of Human RSFs to shrink mesh in vitro, for RSFs to migrate through mesh, and for their metabolic activity to be measurable in 3D culture.
DOUBLE-MESH FOR MANAGEMENT OF FULL-THICKNESS ABDOMINAL WALL DEFECTS FOLLOWING TUMOR RESECTION. CAN FURTHER SEQUELS BE AVOIDED?
Authors: Zanellato A , Coke E , Goudie S , Patton S
Published: May 2024

Undifferentiated pleomorphic sarcomas are high-grade, aggressive soft-tissue sarcomas capable of invasion, recurrence, and metastasis. En bloc surgical excision is the mainstay of treatment with adjunctive. A 63-year-old man was referred with a painful, enlarging, 27 × 13 cm mass on the anterior left rectus muscle. Once diagnosed as a high-grade sarcoma on biopsy, the patient underwent surgery. Following tumour resection, reconstruction of the abdominal wall was performed in 3 steps/layers: 1) covering of the viscera after a TAR to mobilize the right posterior rectus sheath to the left side and close the gap by suturing to remaining transversalis on the left side, 2) reinforcement of the posterior leaflet with implantation of 30 × 45 Poly-4-hydroxybutyrate mesh (an extensively overlapping, flank-to-flank mesh and 3) stabilization of defect by bridging with inlay trimmed heavy polypropylene mesh. The large absorbable mesh was used to create an overlap up to the psoas bilaterally and so wrapping the whole abdomen from flank to flank. The defect was stabilized by suturing the wound borders into the non-absorbable mesh. A week following the initial operation, the patient was surgically fit for discharge. This procedure allowed a complex abdominal wall reconstruction after full thickness tumor resection, avoiding a vascularised tissue transfer (pediculated graft) and its sequels, giving a good functional and cosmetic results.
Media-Based Social Work as a Modality for the Enhancement of Public Awareness of Violence against Women: A Comparative Analysis of Two Cases Covered by the Israeli Media during the COVID-19 Pandemic
Authors: Ben-Shlomo Shirley , Levin-Keini Noga , Primor Shani
Published: May 2024

Utilising framing theory and conceptual metaphor theory, the present study delves into how media can aid social workers in enhancing public awareness of social problems. A comparative content analysis was conducted, focusing on two Israeli cases involving the attempted murder of women by their partners during the coronavirus disease 2019 pandemic. Of the 570 reports analysed, 210 reports focused on the two cases of attempted murder of women by their partners. The first case received only episodic framing in contrast to the second case, which transitioned from episodic framing to thematic framing, leading to noteworthy social and legislative changes. Three transformative factors were identified as contributors to the shift in media coverage: the timing of the event; the willingness of the victim to be interviewed and the presence of a family member or professional accompanying the media story. This study also underscores the importance of understanding the metaphorical language employed by the media in influencing public awareness. On a practical level, the findings of the study offer insights into the essential elements of media-based social work that can foster the recognition of social problems and their prevention, complementing other social work interventions.
Failure of C9orf72 sense repeat-targeting antisense oligonucleotides: lessons learned and the path forward
Authors: Cammack Alexander J , Balendra Rubika , Isaacs Adrian M
Published: May 2024

The recent failure of two independent clinical trials targeting C9orf72 sense repeat-containing RNAs with antisense oligonucleotides was a great disappointment for the field. Cammack et al. discuss the data from these trials, possible reasons for the failures, and the future of C9orf72 therapeutic targeting moving forward.
Does self-employment provide a bridge to retirement?
Authors: Hoogendoorn Brigitte , O’Hagan-Luff Martha , Ramezani Sanaz , van Stel André
Published: May 2024

Non-employment including early retirement among individuals of older working age is a considerable concern. As life expectancies across the developed world continue to increase, individuals’ retirement savings often turn out to be inadequate. In policy circles, given the increasing old-age dependency ratio, self-employment is often seen as a potential route to extend the working lives of older labour force participants. By studying labour market switches of wage workers of 50 years and older, we investigate to what extent self-employment serves as a bridge to retirement. Using a longitudinal data base in European countries over the period 2005–2015, our findings suggest that although self-employment does serve as a bridge to retirement, this is much less likely to be the case for precarious wage workers—especially those with poor job prospects—than for wage workers at the higher end of the labour market, including those who are in good health and who have good job prospects in their current wage job. We also find that wage workers with precarious job conditions are more likely to switch into non-employment rather than into self-employment. Policy implications are discussed.
Feet on the Clouds, Head against the Ground: Antonio Cassese’s Militant Legal Idealism
Authors: Gradoni Lorenzo
Published: May 2024

This article examines Antonio Cassese’s profound engagement with international law through the lens of intellectual biography. Drawing from unexplored archival materials and early writings, it illuminates the evolution and nuances of Cassese’s international legal thought and practice before his rise to prominence as an architect of post-Cold War international criminal law, including his thinly disguised espousal of natural law thinking; his early defiance of the Italian school’s formalism, matched by an enduring attachment to it; his complicated attitude towards Marxism – a major intellectual force in Italy until the late 1970s – and his brief association with Third-Worldism. This article shows how Cassese’s formation within a school that emphasized the exclusively scientific character of legal scholarship inculcated in him a strong culture of expertise that he sought to exploit politically, reconnecting with a Euro-American reformist or ‘progressive’ tradition for which such expertise was instrumental to the realization of a grand design for world peace and justice.
Season, household registry and isolated birth defects: a population-based case-control study in Danyang, China
Authors: Miao Shuhan , Liu Liqun , Tang Yanlin , Ge Hongyan
Published: May 2024

Background

A birth population-based study was conducted in Danyang, Jiangsu Province, to evaluate major birth defects in emerging regions in China with similar maternal and neonatal care conditions.

Methods

We conducted a population-based study in a cohort of infants born in Danyang from 2014 to 2021, including 55 709 perinatal infants. Four categories of isolated birth defects were defined as cases: congenital heart defects (CHDs; n=2138), polydactyly (n=145), cleft lip with or without palate (CL/P; n=76) and accessory auricles (n=93). Infants with congenital malformations were identified by the Chinese Birth Defects Monitoring Network.

Results

Compared with autumn, conception in spring (OR=1.31 [1.16–1.48]) and winter (OR=1.39 [1.23–1.58]) was associated with an increased risk of CHD. Increased risk of CHD, CL/P and accessory auricles was significantly associated with non-local registered residence (OR=1.17 [1.07–1.28], OR=2.73 [1.52–4.88] and OR=2.11 [1.20–3.71], respectively). Individuals of Han nationality were less likely to have polydactyly (OR=0.23 [0.05–0.98]).

Conclusions

The season of pregnancy was significantly associated with CHDs. Offspring of mothers with non-local registered hometown had greater risks of CHDs, CL/P and accessory auricles.