bluuebunny/crossref_metadata_2025 huggingface dataset:
OPEN PARASTOMAL HERNIA REPAIR (OPSHR): TECHNIQUES AND OUTCOMES AT A TERTIARY HERNIA CENTER
Authors: Holland A , Lorenz W , Mead B , Ku D , Scarola G , Augenstein V , Heniford B T , Polcz M
Published: May 2024

Background

Parastomal hernia is a common complication that can impact quality of life or lead to intestinal obstruction. Repairs are complex, have high recurrences, and are without a clear best technique. Though repairs may be performed minimally invasively, a complex subset of patients require open parastomal hernia repair (OPSHR). OPSHR outcomes at a high-volume center are described.

Methods

A prospectively maintained database was queried for patients who underwent OPSHR at a tertiary hernia center. Operative details and outcomes are analyzed.

Results

Of 97 OPSHRs, mean age was 61.9 ± 12.6 years, 56.7% were female, 24.7% were diabetic, and average BMI was 31.3 ± 6.5 kg/m2. Defect size averaged 125.3 ± 130.0 cm2 and 41.2% were recurrent. Stomas were colostomies (56.7%), ileostomies (30.9%), and urostomies (12.4%). Patients underwent concurrent ventral hernia repair (56.7%), panniculectomy (22.7%), component separation (30.9%), and stoma resiting/reversal (40.2%). When stomas were not resited or reversed, techniques included suture repair (n = 7, 12.1%) or mesh reinforcement (n = 51, 87.9%; biologic – 54.9%, synthetic – 45.1%) with Sugarbaker (66.0%; preperitoneal – 63.6%, intraperitoneal – 33.3%, retrorectus – 3.0%), keyhole (28.0%), or onlay (6.0%) approaches.

Wound complications occurred in 18.6% (infection – 10.3%, breakdown – 9.3%, hematoma – 3.1%, cellulitis – 2.1%, seroma requiring intervention – 2.1%). Rates differed by colostomy (10.9%), ileostomy (23.3%), and urostomy (41.7%) (P = 0.031).

Mean follow-up was 31.6 ± 35.9 months with a 20.6% recurrence rate. On univariate analysis, patients with recurrence were younger (55.4 ± 12.6 vs. 63.6 ± 12.1 years; P = 0.008) with smaller mesh (470.4 ± 336.6 vs. 680.2 ± 388.1 cm2; P = 0.045). Recurrence did not differ by technique (onlay – 25.0%, primary repair – 21.4%, Sugarbaker – 18.2%, keyhole – 10.0%; P = 0.077). When stomas were relocated (26.8%), prophylactic mesh (84.6%) did not significantly impact recurrence (27.3% vs. 50.0%; P = 0.563).

Conclusions

This study represents the largest institutional series describing OPSHR outcomes. Larger meshes and older patients had fewer recurrences. Optimal OPSHR technique remains unclear, but these results may inform preoperative discussions and tailor surgical planning.
COMPARISON OF NON-MESH DESARDA TECHNIQUE VERSUS LICHTENSTEIN TECHNIQUE FOR INGUINAL HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 14 COMPARATIVE STUDIES
Authors: Issa M T , Mohamedahmed A Y , Noureldin K , Kauser M , Sillah A K
Published: May 2024

Background

Inguinal hernia is common, and its repair is described in different ways. However, Lichtenstein mesh repair [LT] has been recognized as a standard and safe repair, but it still carries mesh drawbacks. Desarda technique (DT) is a tension-free technique with no synthetic foreign-body materials used. This meta-analysis and systematic review aimed to compare the outcomes of the two techniques for inguinal hernia repair.

Methods

A systematic literature search for RCTs comparing DT and LT was conducted using electronic databases and Google Scholar services. Studies were evaluated for operative time, time to return to work (TTRW), recurrence, and post-operative complications. We pooled the data using the fixed and random effects models after assessing the heterogeneity among the included studies.

Results

A total number of 14 RCT studies were included: 9 RCTs and five observational ones. The total number was 3673 patients: 1794 in the Desarda group and 1879 in the Lichtenstein group. There was no statistical difference in recurrence or hematoma formation between the two groups [P = 0.50, 0.12 retrospectively]. There was a lower rate of overall postoperative complications [P = 0.0001], seroma [P = 0.0002], and surgical site infections (SSIs) [P = 0.03], operative time [P = 0.01] and TTRW [P = 0.008] with the Desarda technique.

Conclusion

DT and LT were found to have comparable results regarding recurrence rate and hematoma formation. DT is superior to LT in reducing postoperative mesh-attributed complications, such as SSI and Seroma formation, with less operative time and quicker return to regular activity.
RISK FACTORS FOR INCARCERATION/STRANGULATION IN PATIENTS WITH GROIN HERNIA: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Kandemir H , Dönmez T , Sürek A , Gümüşoğlu A , Canöz Ö , Karabulut M
Published: May 2024

Background

Groin hernia is one of the most common benign pathologies requiring surgical intervention. Incarcerated groin hernia is a cause of serious morbidity and mortality. In our study, to better understand the factors associated with incarceration, we studied patients who applied to our clinic for groin hernia and underwent surgery.

Method

A prospective observational study was performed, including all patients who applied to the general surgery out patient clinic or emergency department at Bakırköy Dr Sadi Konuk Training & Research Hospital and were diagnosed with groin or incarcerated groin hernia and underwent hernia repair surgery. Patients were divided into two groups: elective surgery and emergency surgery (incarcerated hernia). Multivariate logistic regression was performed to identify risk factors for incarceration.

Results

The study was performed with a total of 654 cases between January 2021 and February 2023. Of these, 79.4% (n = 519) had elective surgery and 20.6% (n = 135) had emergency surgery. Increase in defect width, which was determined according to the EHS classification, was significantly associated with an incarcerated hernia (ODDS ratio 4.463 and 17.636, respectively). Additionally, female gender, femoral hernia type, chronic cough, and chronic constipation were found to be independent risk factors for incarceration.

Conclusion

Female gender, chronic cough, chronic constipation, femoral hernia type, and increased defect diameter are independent risk factors for urgent surgery and therefore incarceration in groin hernia.
MINIMALLY INVASIVE BILAYER SUTURING TECHNIQUE FOR THE REPAIR OF CONCOMITANT VENTRAL HERNIAS AND DIASTASIS RECTI
Authors: Ngo P
Published: May 2024

Aim

Evaluation of a technique of repair of concomitant ventral hernia and diastasis recti without mesh.

Methods

The technique combines suturing repair of the hernia orifice and diastasis correction by suture and includes an open step through peri-umbilical incision and an endoscopic step.

The study is an observational report on 77 cases of concomitant ventral hernias and DR.

Results

The median diameter of the hernia orifice was 1.5 cm (0.8–3).

The median inter-rectus distance was 60 mm (30–120) at rest and 38 mm (10–85) at leg raise at tape measurement and 43 mm (25–92) and 35 mm (25–85) at CT scan respectively.

Postoperative complications involved 22 seromas (28.6%), 1 hematoma (1.3%) and 1 early diastasis recurrence (1.3%).

At mid-term evaluation, with 19 (12–33) months follow-up, 75 (97.4%) patients were evaluated. There were no hernia recurrences and 2 (2.6%) diastasis recurrences.

The patients rated the result of their operation as excellent or good in 92% and 80% of the cases at global and esthetic evaluations respectively. The result was rated bad at esthetic evaluation in 20% of the cases because of skin wrinkles, due to discrepancy between the unchanged cutaneous layer and the narrowed musculoaponeurotic layer.

Conclusion

The technique provides effective repair of concomitant ventral hernias up to 3 cm and diastasis recti. Nevertheless, the esthetic result can be flawed, because of the discrepancy between the unchanged cutaneous layer and the narrowed musculoaponeurotic layer.
STAGED, LAPAROSCOPIC HYBRID EPAULI REPAIR FOR LARGE PARASTOMAL HERNIA – CASE REPORT
Authors: Andersen G , Elden E , Haukø L G , Vorontsov D , Græslie H
Published: May 2024

Background

Managing large parastomal hernias poses significant challenges due to their high recurrence rates and the elevated risk for peri- and post-operative complications.

Method

Case report of a successful repair of a large parastomal hernia using a staged minimally invasive, hybrid approach.

Results

The patient underwent uncomplicated laparoscopic total colectomy in 2016 for ulcerative colitis. Several years later, in 2020, the patient presented to our hospital with a large parastomal hernia with obesity as comorbidity. To address this complex hernia, the patient was referred to the obesity team and underwent laparoscopic gastric sleeve resection in autumn 2021. In 2022, the patient's BMI had decreased to below 30, prompting the decision to proceed with hernia surgery. In May 2022, we performed chemical component separation using 300 units of Botox. Four weeks later, laparoscopic hybrid Epauli repair was undertaken. The laparoscopic component involved reducing hernia contents, abdominal wall dissection with Transversus Abdominis Release (TAR), mesh placement, and closing the posterior layer. Open surgery was interspersed throughout the laparoscopic procedure and at its conclusion. This included temporary stoma closure and reduction, temporary stoma site closure, medial repositioning of the stoma through rectus, excess skin excision, and stoma re-suturing. The patient experienced an uncomplicated recovery. In January 2023, the patient underwent complete abdominoplasty. A one-year postoperative CT scan and clinical control demonstrated a satisfactory outcome.

Conclusion

For complex and large parastomal hernias, hybrid surgery, combining open and minimally invasive approaches, offers a valuable operative strategy for managing such large hernias.
eTEP FOR GIANT TYPE 2 INGUINAL DIRECT HERNIA
Authors: Baste N
Published: May 2024

Standard 3 port technique

65/male

Large inguinal swelling 10 years.

H/O reducibility 6 months back, now irreducible since 6 months.

No symptoms of obstruction; BMI 35.

Steps of operative procedure:Standard 3 port eTEP.Extended extraperitoneal space creation.Retzius space dissection.Bogros space dissection.Identification of direct hernia.Dissection of sac from pseudosac.Defining boundaries of defect.Excision of pseudosac.Closure of direct hernia defect.Mesh placement.Drain placement.

Operative time 1.5 hours.

Blood loss 100 cc.

Post op drain kept.
CASE OF A LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) REPAIR FOR GIANT INGUINOSCROTAL HERNIA
Authors: Caruso R , Ferri V , Vicente E , Quijano Y , Duran H , Diaz E , Fabra I , Malave L , Ruiz P
Published: May 2024

Background

Giant inguinoscrotal (GIS) hernias are rarely encountered in clinical settings and are often associated with mental neglect for many years. This type of hernia is defined as “giant” if it descends belowthe mid-point of the inner thigh of a patient in an upright position. The laparoscopic repair approach of a GIS hernia is technically challenging. It has been claimed that laparoscopic surgery has several advantages over the open surgical approach, with less pain and an earlier recovery. The aim of this video is to evaluate the efficacy of TAPP (laparoscopic transabdominal preperitoneal) in order to treat a GIS hernia.

Case presentation

A 65-year-old male without a relevant past medical history was admitted to the emergency service with abdominal pain, belching and nausea. He denied any other symptoms, and no previous surgical operations were recorded. Physical examination showed a large mass in the left scrotum below the mid-point of the inner thigh of the patient in an upright position. A CT scan confirmed the diagnosis of a GIS. A laparoscopic TAPP procedure was decided upon as the best course of treatment.

Results

The patient underwent a successful repair procedure. The operation time was 150 min. No intraoperative blood transfusion was necessary. The patient’s diet was resumed on the first day post-surgery, and the post-operative hospital stay was three days.

Conclusions

Laparoscopic TAPP repair is a safe and feasible method for surgically managing GIS hernias.
LIRA WITHOUT TRAUMATIC FIXATIONS
Authors: Curado-Soriano A , Infantes-Ormad M , Sanchez-Ramirez M , Valera Sanchez Z , Naranjo Fernandez J R , Morales Conde S
Published: May 2024

Introduction

Over the last decade we have made progress in laparoscopic mesh fixation, mainly to avoid post-operative pain. Post-operative pain can be significant, causing discomfort and delaying discharge.

One of these advances has been the use of adhesives as a fixation system, there is currently a wide range available, from biological adhesives to cyanoacrylate derivatives. In our case, we present the absence of traumatic fixation systems in a LIRA type repair with glue.

Case

We present the case of a 49-year-old female patient who underwent laparoscopic appendectomy and presented with an incisional hernia over the umbilical trocar of 10 mm, with a defect of 4 cm in diameter in the transverse axis, multisacular, with associated diastasis. We used three trocars arranged in a fan between the left hypochondrium, left flank and left iliac fossa.

After releasing the preperitoneal fat, the aponeurotic flap of the posterior aponeurosis of the rectum was prepared, turned and sutured in the midline. We placed the mesh and fixed it completely with adhesive (n-butyl-2-cyanoacrylate). The patient was discharged the day after surgery, and at 15 months follow up, there were no recurrence or complications.

Discussion

The evolution of fixation systems has brought us the existence of cyanoacrylates that allow precise fixation without leakage at the point of application, combined with an adequate mesh that allows a low postoperative pain.

There are still gaps in the long-term results, it is therefore necessary to conduct studies on a larger number of patients to assess the long-term results.
PAIN PLUG EXPLANT USING TAPP TECHNIQUE
Authors: Curado-Soriano A , Infantes-Ormad M , Sanchez-Ramirez M , Valera Sanchez Z , Naranjo Fernandez J R , Morales Conde S
Published: May 2024

Introduction

Chronic pain in patients after inguinal hernia repair can be a serious problem that affects patients' lives. It is therefore important to prevent, as far as possible, the situations that can cause it, one of which is excess mesh and its placement in an inappropriate area.

Case

We present a very thin male patient who underwent surgery for a right inguinal hernia using a mesh plug technique three months post-operatively and began to experience persistent groin pain that worsened with exertion and left him incapacitated throughout the day.

This pain was not consistent with a dermatoma. Examination revealed induration in the area, with no clinical recurrence. The patient was referred for surgery due to pain and the previous mesh explant. A laparoscopic approach was performed with a transabdominal laparoscopic approach (TAPP), where no recurrence was observed but a folded mesh plug was found. Explant and repair with flat mesh without traumatic fixation were performed. The patient reported an improvement in pain, although it did not disappear completely. No recurrence at follow-up 12 months.

Discussion

The use of mesh plugs has been questioned on many occasions, not only because of problems related to chronic postoperative pain but also because of the migration of the plug into the cavity.

The excessive folding of the mesh favours the formation of meshomas which are difficult to explant due to their proximity to blood vessels and nerve structures, which can be injured by compression or irritation.
THE HALLEY’S COMET OF HERNIAS: GRYNFELT HERNIA
Authors: Gámez Alastuey M , García Galocha J L , Fra Corral D , Charef El-Jari L , Gallardo Robles A , Ossola Revilla M E , Peña Soria M J , García Torres J A
Published: May 2024

Background

This video aims to address the clinical presentation, diagnostic approach, and surgical treatment options for Grynfelt's lumbar hernia, a rare type of abdominal wall hernia, through the analysis of a clinical case and a review of the literature.

Method

A video is presented of a 72-year-old female patient who came to the clinic with onset lumbar pain. After confirming the diagnosis of Grynfelt hernia by CT scan, laparoscopic lumbar hernioplasty with mesh was performed.

Results

The patient underwent a laparoscopic lumbar hernioplasty, with the defect being corrected using a mesh. The postoperative period was uneventful, with the patient reporting good pain control and no signs of hernia recurrence or complications during the follow-up visit three weeks post-intervention. The use of abdominal tomography played a crucial role in the diagnosis and surgical planning, allowing for a clear visualization of the muscular wall and the herniated contents.

Conclusions

Grynfelt's lumbar hernia, although rare, can be effectively managed with a laparoscopic approach, ensuring minimal tissue damage and low recurrence rates. The introduction of synthetic meshes has significantly improved surgical outcomes. This case highlights the importance of a thorough diagnostic process, including abdominal tomography, for the successful treatment of lumbar hernias, emphasizing the effectiveness of laparoscopic surgery with mesh reinforcement in achieving durable repairs.
LINDBLOM HERNIA: URETER INCARCERATION IN LEFT SCIATIC FORAMEN. LAPAROSCOPIC APPROACH
Authors: Galocha J L G , Peña M J , Antoñanzas L L , Romera J L , Charef L , Torres A J
Published: May 2024

Background

Sciatic hernias are thought to be secondary to a partial loss of pelvic fascia, atrophy of the piriformis, congenital deformity, or a combination of either.

Hernia sac may contain small bowel, ureter, ovary, colon or bladder. Patients may have diverse symptoms and signs ranging from abdominal or pelvic pain or with complications due to incarceration of their contents such as ureteric or bowel obstruction.

The Curlicue sign is described as ureteric obstruction with U-shaped tortuosity through the sciatic foramen which is pathognomonic of uretero-sciatic hernia.

Various surgical approaches have been reported in the literature, from open laparotomy, abdominoperineal/trans-gluteal approach, to laparoscopy and minimally invasive approach to repair it. The defect can be repaired with a mesh, non-absorbable sutures, and reinforced with a peritoneal flap or epiplon.

Method

We describe a laparoscopic approach of a left-sided ureterosciatic hernia (Lindblom hernia) who associate an ipsilateral inguinal and obturator defect.

Results

80-year-old female come to our center with left flank pain associated with a decline in renal function. A CT scan showed severe left-sided hydro-nephrosis, and the diagnosis of Lindblom hernia was made. A JJ tube was inserted, which relieved the obstruction and improved the renal function preoperatory. A laparoscopic approach via TAPP was perform and the patient was discharged without complications in 24 hours.

Conclusion

Sciatic hernia are a rare cause of chronic pelvic pain and various surgical approaches have been reported to repair it.
ABDOMINAL WALL RECONSTRUCTION FOR GIANT BILATERAL SUBCOSTAL INCISIONAL HERNIA
Authors: Garcia-Urena M A , Medina M , Aviles A , Morejon S , Casanova A , Robin A , Munoz-Rodriguez J , Lopez-Monclus J , Roman L , Blazquez L A
Published: May 2024

Aim

Management of subcostal incisional hernias (SIHs) is particularly complicated, due to their proximity to costochondral limits added to the lack of aponeurosis in the lateral side of the abdomen. We present a case of abdominal wall reconstruction with posterior component separation (PCS) but using the same previous incision as a safe and reproducible technique for these complex cases.

Methods

This is a 59-year-old man who underwent Whipple procedure for pancreatic carcinoma in 2019.

He developed a big incisional hernia on the entire length of the previous incision, measuring about 30 cm wide and 17 cm long. After adequate optimization, we scheduled for abdominal wall reconstruction following a stepwise preperitoneal dissection in 4 different areas: subdiaphragmatic, lateral preperitoneal, retromuscular and midline preperitoneal. In order to join all these spaces, a medial release (Rives) and a lateral release (PCS) need to be made. The main anatomical landmarks are shown during the video recording.

Results

The patient was discharged uneventfully on the 5th postoperative day. After 2,5 years, the patient remains asymptomatic without signs of recurrence clinicalle and radiologically.

Discussion

These incisional hernias can be technically challenge and should be made in centers dedicated for abdominal wall reconstruction. Lessons learned from posterior component separation has helped us to develop this stepwise dissection using the same incision and avoiding risk of nerve injury.

PCS technique for the repair of SIHs through the same incision is a safe procedure avoiding harming to the linea alba.
WHITE LIGHT WITH ICG MODE AS A TECHNICAL RESOURCE IN URGENTE SURGERY: INTESTINAL HERNIA SECONDARY TO GASTRECTOMY
Authors: Gómez Menchero J , Navarro-Morales L , Licardie-Bolaños E , Moreno-Suero F , Morales-Conde S
Published: May 2024

Aim

Urgent esophagogastric procedures are a complex field even in expert hands; even more so is the second procedure in cases of reinterventions. For this reason, it is important to apply safe techniques to minimize the clinical risk of unwanted events. Image-guided surgery based on indocyanine green fluorescence (ICG) has gained strength in recent years thanks to its widespread use. The combination of a white light probe along with the ICG mode of the tower facilitates the identification and safe dissection of structures during revisional surgery.

Methods

We present a case report.

Results

58-year-old man with a history of total Roux-Y gastrectomy for distal esophageal adenocarcinoma, with anastomotic leak and need for endoscopic stent, uncomplicated posterior hernia and adequate follow-up at home. Consultation 5 months later due to chest pain and dyspnea for 48 hours. CT scan showed a giant paraesophageal hernia with signs of strangulation.

An urgent laparoscopic surgical intervention was decided upon with the discovery of a large volume of herniated jejunal loops that could be reduced after chelotomy. The use of the device allows us to safely visualize the path of the esophagus and the anastomosis, for correct and safe adhesion and reduction. Finally, a raffia of the pillars and a pexy of the jejunum loop of the anastomosis to the crura are performed. After 6 days of hospitalization, he was discharged without complications.

Conclusion

The use of the white light probe with the intraoperative ICG mode, provides greater safety during the procedure, thus being a surgical technical resource.
LAPAROSCOPIC APPROACH TO INGUINAL HERNIA WITH INCARCERATED OVARY IN A PATIENT WITH ENDOMETRIAL NEOPLASIA
Authors: Gutiérrez C , Serrano A , Antón I , Carreño-Sáez O , García-Pastor P , Bueno-Lledó  , Domingo S , Pous-Serrano S
Published: May 2024

Background

To present an infrequent case of inguinal hernia with ovarian content in an adult patient, as well as its minimally invasive approach in the context of an endometrial neoplasia.

Material and Methods

A 67-year-old female patient presents at the emergency department with a history of progressive weakness and asthenia of months of evolution. Given the finding of iron-deficiency anemia, admission was decided. Computed tomography revealed an endometrial neoplasia associated with a right inguinal hernia, describing a heterogeneous and nonspecific lesion of 8 cm inside it. Further imaging studies were requested by gynecology, establishing the suspicion of endometrial neoplasia with left parametrial invasion. Biopsy confirmed the presence of endometrial adenocarcinoma. Magnetic resonance imaging reported strangulated ovarian content inside the right inguinal canal.

Results

A joint scheduled surgery was decided, involving laparoscopic radical hysterectomy, selective sentinel lymph node biopsy, and hernioplasty simultaneously. Inguinal hernia repair was performed using trans-abdominal pre-peritoneal hernioplasty (TAPP), with prior excision of the right adnexa for deferred study. Polyvinylidene fluoride (PDVF) mesh was used and fixed with absorbable tackers. The patient was discharged without complications on the second postoperative day. The final surgical specimen showed a low-grade endometrioid carcinoma with mucinous differentiation, clear surgical margins, and two positive nodes (pT2N1).

Conclusion

Inguinal herniation of the ovary is an uncommon phenomenon. The treatment of this pathology can be safely performed through laparoscopic approach, even in patients with concurrent gynecological neoplasias requiring radical hysterectomy during the same surgical procedure.
A HYBRID APPROACH TO ABDOMINAL WALL REPAIR IN M2-3W2 HERNIA WITH CROHN´S HISTORY
Authors: Gutiérrez E , Guevara-Martínez J , Zapata C , Abad R , Fondevila C , Salido S
Published: May 2024

Objective

This presentation aims to showcase the case of a 68-year-old male with fistulizing Crohn's disease and a history of two prior surgeries involving ileocecal resection and resection of enterocutaneous fistulas. The main objective is to emphasize the benefits of a hybrid approach (combining laparoscopic and open surgery) in repairing certain incisional hernias resulting from extensive abdominal surgeries.

Materials and Methods

Preoperative evaluation included abdominopelvic CT and Botox administration for abdominal wall prehabilitation. The surgical intervention utilized a hybrid approach, incorporating laparoscopic eTEP for intrabdominal adhesion release, retrorectal space dissection, unilateral TAR, and closure of the posterior plane to isolate viscera from the mesh. Open surgery followed for the placement of a 30 × 30 cm polypropylene mesh and closure of the anterior aponeurosis.

Results

The video presents the clinical case, displaying preoperative tests, essential surgical steps, and postoperative outcomes with photographs and a follow-up computed tomography at 6 months. Through this, we aim to highlight the benefits of the hybrid approach, emphasizing its advantages in terms of laparoscopic dissection time and concluding with open surgery for mesh placement and aponeurotic closure. This proves especially valuable in cases where excessive tension might impede laparoscopic closure or necessitate the removal of redundant skin flaps.

Conclusion

This presentation advocates for the hybrid approach, highlighting its advantages in laparoscopic dissection time, convenient mesh placement, and the ability to address excessive tension and skin redundancy, making a compelling case for its application in specific scenarios.
ACUTE INTESTINAL OBSTRUCTION DUE TO A PARASTOMAL HERNIA EHS GRADE IV
Authors: Hansske B , Wannberg M
Published: May 2024

Background

Acute complications of parastomal hernias are a demanding entity in the field of abdominal wall reconstruction.

Method

An 82-year-old female patient with an incisional hernia and parastomal hernia presented at the emergency department due to vomiting and abdominal pain. She had formerly been operated for a rectal cancer with a deviating sigmoideostoma.

Results

A computed tomography scan could diagnose intestinal obstruction with stomach lying in the incisional hernia and smaller bowel in the parastomal hernia. Per-oral contrast did not proceed sufficiently to the larger bowel, contact was established with the referral hospital for parastomal hernias. A laparoscopy was performed there and after mobilisation of the stomach from the incisional hernia we decided even to mobilise the parastomal hernia to be able to perform an adequate hernia treatment. A smaller bowel perforation was handled by performing a stapled side-to-side anastomosis with the Barcelona technique. After approximation of the incisional as well as the parastomal hernia with slowly resorbable running sutures, a Sugerbaker procedure was performed using a 15 × 15 cm mesh. The incisional hernia was treated by using a 20 × 15 cm IPOM mesh. 10 days postoperatively the patient could be discharged. 2 months postoperatively the patient was completely satisfied with the result of the 4-hour long operation.

Conclusion

To achieve better outcomes in parastomal hernia treatment, these patients should be ccentralized. By discussing elective treatment much earlier, complicated emergency cases could diminish.
CENTRAL TENDON DIAPHRAGMATIC HERNIA LAPAROSCOPIC REPAIR WITH MESH FOUND INCIDENTALLY DURING MINIMALLY INVASIVE SURGERY FOR MULTIPLE POST-OPERATIVE ABDOMINAL HERNIAS
Authors: Kechagias A , Kirkilesis G , Hillegersberg R , Kritikos N
Published: May 2024

Aim

Spontaneous Hernias of the Central Tendon of the Diaphragm are extremely rare in adults. We show the operative video of the laparoscopic repair with mesh of a spontaneous Central Tendon Diaphragmatic Hernia (CTDH) found incidentally during the repair of multiple post-operative hernias in an adult patient.

Materials and Methods

A 66-year-old overweight (BMI 37.5) lady underwent laparoscopic surgery for the repair of multiple incisional hernias. Symptoms included pain from a large incarcerated incisional para-umbilical hernia, and an unexplained dull pain behind the right-lower costal area. Surgical history included open cholecystectomy and appendectomy, multiple laparoscopic gynecologic and uro gynecologic operations, and two spine operations. There was no history of accident or iatrogenic injury at the diaphragm. The CT scan showed seven incisional hernias. Our video shows the dissection of the hernias with special focus on the laparoscopic repair of a 7 cm incidental right CTDH with incarcerated abdominal fat. The hernia fat was reduced and after a partial thoracoscopy the CTDH was repaired with a dual-faced 15 × 15 cm mesh fixated with absorbable tacks. The rest of the hernias were repaired with multiple meshes using the IPOM technique.

Results

The post-operative course was uneventful. The patient was discharged at 48-hours with the need of minor analgesics. A post-operative re-evaluation of the CT scan identified the missed CTDH. Clinical examination and ultra-sound were unremarkable at three months.

Conclusions

Minimally-invasive surgery with mesh is appropriate for the repair of a CTDH. The diaphragm should be meticulously assessed in the pre-operative CT scan of obese patients with multiple hernias.
MODIFIED PORT POSITION FOR BILATERAL INGUINAL TAPP CREATING UNILATERAL PERITONEAL FLAP
Authors: Khetan M
Published: May 2024

Introduction

Usually, the TAPP approach for bilateral inguinal hernia requires bilateral port placement and two separate peritoneal flaps to facilitate dissection and mesh placement. Our technique with modified port placement allows bilateral repair through unilateral flap with equal ease and feasibility and thus not only reduces the efforts of two flap suturing but also mimics TEP approach for hernia contralateral to ports.

Material and Method

During a period from February 2015 to December 2022 we have managed 48 patients with this approach. Patients with bilateral, primary, reducible inguinal hernias were managed, all of them do not have any history of previous surgery. With experience even complete irreducible hernias were managed in the same manner. Ports were placed on the side of the symptomatic or bigger hernia in triangular fashion for better ergonomics.

Results

In all patient’s adequate dissection of myopectineal orifice was achieved on either side through single flap. In few patients there were accidental small peritoneal rents on contralateral side which required single suture to close them. Medium weight PP mesh of size 15 × 12 cm was used in all except few, in which either 3D meshes or self-adhesive Progrip mesh was placed. No post-operative complications were seen in the form of recurrence or seroma and chronic pain in all patients.

Discussion and conclusion

Our technique of single peritoneal flap requires small unilateral flap to be raised to deal with bilateral defects without compromising on the steps of the procedure. Modification in port placement for the approach allows better ergonomics and ease of contralateral dissection and mesh placement along with easy closure of small peritoneal flap.
ABDOMINAL WALL RECONSTRUCTION AFTER POST-RIVES INJURY OF LINEA SEMILUNARIS
Authors: Lopez-Monclus J , Munoz-Rodriguez J M , García de León L R , Grillo Marin C , Rodriguez Fernandez M , Gil Cidoncha L , Blazquez Hernando L A , Valle de Lersundi A R , Medina Pedrique M , Garcia-Urena M A
Published: May 2024

Aim

Recurrences after retromuscular repairs of abdominal wall defects are a surgical challenge. Posterior Component separation techniques have allowed abdominal wall surgeons to solve this situation.

Material and Methods

68-year-old female patient. Obesity (BMI 38), dislipemia, arterial hypertension. Previous open hysterectomy in 2016, open rives repair of an incisional hernia back in 2018 (wound infection in the postoperative period). Early lateral recurrence due to left semilunaris line injury. Planned open posterior component separation after preoperative optimization. Important weight loss (dropped BMI to 32) and Ipsilateral botox injection 4 weeks prior surgery. Approach throughout a transverse incision to add a functional dermolipectomy. Dissection of the lateral preperitoneal space reaching the posterior axillary line, cranial dissection pulling down the fascia diaphragmatica, caudal dissection overpassing Cooper ligament and medial dissection performing a reverse transversus abdominis release and reverse Rives to the contralateral retrorectus space. Reconstruction with a double mesh technique (combination of an absorbable biological scaffold and a 50 × 50 cm polypropylene mesh) with reimplantation of the lateral abdominal musculature and reconstruction of the linea semilunaris.

Results

No immediate postoperative complications. Discharged in the sixth postoperative day. Subcutaneous seroma which required fine needle aspiration in the outpatient clinic. No recurrence after 18-month follow-up.

Conclusion

Posterior component separation technique allows the abdominal wall surgeon to deal with complex situation as recurrences after previous retromuscular repairs. Preoperative optimization is mandatory in these complex patients.
eTEP FOR A LARGE INCARCERATED PRIMARY VENTRAL HERNIA: EXPANDING THE INDICATIONS FOR eTEP TECHNIQUE TO THE EMERGENCY SETTING
Authors: Marrero P , Fernández López L , Hernández Oramas C , Delgado Plasencia L J
Published: May 2024

Clinical case

66-year-old female patient; Medical history: BMI 34,7 kg/m², chronic smoker, diabetes mellitus type II; Diagnosed in 2022 of a large and reducible primary ventral hernia M3W2 with recti diastasis associated: 36 mm at epigastric and 68 mm at supraumbilical level, respectively. She presented at the emergency department with a 24 hours history of an umbilical painful and irreducible lump associated with nausea.

Investigation

Bloodtest: Leukocytes 8,8 × 109/l; prothrombin time 65%; C-reactive protein 190,85 mg/dl. Abdominal X-ray showed no abnormalities. Abdominal ultrasound showed a large umbilical sac, which contained epiplon with signs of suffering. No anaesthetic contraindication for an emergent endoscopic surgery.

Therapy and Outcome

An umbilical hernioplasty and recti diastasis correction was performed using the eTEP technique. Absorbable barbed suture 2–0 were used to close de defect and correct the recti diastasis. A macroporous polypropylene mesh was implanted without fixation, which covered entirely the dissected area and not just the hernia area. No drains were used. The patient had an uneventful hospital stay and was discharged at 36 hours after surgery. An umbilical subcutaneous seroma M3-type IV, according to the Morales-Conde Classification, was developed. No evidence of recurrence neither clinically nor radiologically at 6 months follow-up.

Conclusion

There is a lack of scientific evidence about the use of eTEP technique in the emergent treatment of complicated ventral hernia. eTEP approach to this type of hernia is a promising abdominal wall reconstruction technique. It is reproducible and safe, with short hospital stay, low morbidity and short-term effective.
SMALL BOWEL OBSTRUCTION AS A COMPLICATION OF TRANSABDOMINAL PREPERITONEAL HERNIA REPAIR – AN INTERNAL HERNIA CAUSED BY ADHESIONS TO A BARBED SUTURE
Authors: Meruje F , Monteiro R , Peliteiro J , Moutinho Teixeira M , Neves T , Fortes R , Barata P , Mega M , Paulino A
Published: May 2024

Background

Laparoscopic approach to inguinal hernias is advantageous as it reduces postoperative pain, length of stay and recovery time, while allowing for an easier correction of multiple hernia defects in a single operation. Laparoscopic transabdominal preperitoneal (TAPP) hernioplasty is one such technique. Bowel obstruction as a postoperative complication is rare, and can be due to inadequate peritoneal closure, herniation through disrupted peritoneum or adhesions.

Aim

We herein report on a case of postoperative small bowel obstruction caused by adhesions to a long, barbed suture.

Material and Methods

Case presentation, in video format, of a 74-year-old man admitted through the emergency department for small bowel obstruction, 7 days after laparoscopic bilateral TAPP hernioplasty and intraperitoneal underlay mesh (IPUM+) hernioplasty for correction of bilateral inguinal hernia and umbilical hernia.

Results

After examination, and an inconclusive computerised tomography scan, the patient underwent emergency laparoscopic exploration. We found a small bowel obstruction caused by adhesions to the barbed suture previously used to close the peritoneal flap on the right side. The small bowel was freed from the suture, without need for its resection. Appendicectomy was performed as well. The patient was discharged 3 days later, without further complications.

Conclusions

Adhesions after peritoneal closure may lead to postoperative small bowel obstruction. Surgeons must be aware of complications associated with any procedures performed, including the rare, since a timely diagnosis is necessary for their patients’ adequate care. Hernia surgeons can minimise this complication by improving their suture technique and avoiding bridges of exposed barbed sutures.
TOTALLY EXTRAPERITONEAL INGUINAL HERNIA REPAIR IN A PATIENT WITH CEREBRAL PALSY
Authors: Nanda A , Rao C , Gerogiannis I
Published: May 2024

Aim

Cerebral Palsy (CP) is a group of neurological disorders that affect movement, muscle tone and coordination with the appearance of muscle stiffness, weakness and involuntary movements. Although there is no direct correlation with inguinal hernia, people with CP may be at greater risk of developing hernias due to factors such as chronic constipation, frequent coughing, or physical stress. We present a video highlighting all the difficulties faced in this minimally invasive approach.

Material and Methods

A 66-year-old woman with CP, without mental but with many mobility problems, presented in outpatient clinic with right groin discomfort. On clinical examination, the inguinal hernia was difficult to identify, but it was confirmed by an ultrasound scan. The patient requested a laparoscopic approach hoping for faster recovery and less hospital stay.

After placing the patient on the operating table with special supports and the left leg flexed, through an incision in the right upper quadrant of the abdomen, the endoscope was inserted with a visiport of 10 mm in the retrorectus space. Preperitoneal space was dissected with CO2 and with the use of a 0 degree endoscope. Two additional 5 mm ports were inserted in the lower midline. The pubic symphysis and inferior epigastric vessels, due to their location and distorted anatomy in this area, were very difficult to identify initially. The hernia sac was identified and reduced. A mesh of 15 × 10 cm was placed in the preperitoneal area without fixation.

Results

The patient's postoperative course was smooth, but her discharge was delayed due to the need for extensive physiotherapy. At follow-up at 12 weeks, patient was well and free of symptoms from the groin area.

Conclusion

Laparoscopic inguinal hernia repair with the TEP technique in cases of patients with stiffness or movement disorders has several difficulties and requires advanced laparoscopic skills. Careful patient selection and accurate consent of the patient mentioning the increased likelihood of conversion to an open method are essential.
TOTAL EXTRAPERITONEAL ENDOSCOPIC DEEP INGUINAL EXPLORATION FOR LYMPH NODE BIOPSY
Authors: Zárate Gomez J , Álvarez de Sierra P , Peinado Iríbar B , Supelano Eslait G , Cano Alonso R , Salazar Palacio C , Gil López J M , Merello Godino J
Published: May 2024

Background

TEP (Totally ExtraPeritoneal) technique is used for inguinal hernia treatment. It is now considered a basic technique in minimally invasive abdominal wall surgery and the door to more complex procedures. In high volume centers this approach can be used for purposes other than reconstructive.

Method

We present the clinical case of a 44-year-old patient with a history of multiple lymph nodes located in the axilla and pelvic areas, with no pathologic histologic findings since 1992, after several surgical samplings (follicular lymphoid hyperplasia in all specimens). Bone marrow biopsy in 2020 highly suspected a non Hodgkin lymphoma, it did not correlate with periferal biopsy results, all of which rendered inconclusive results.

In 2023, in image follow-up by PET-CT scan revealed a high PDF uptake (SUV 17,9) located in a bulky node (38 × 32 mm) in the right exernal iliac area. As a highly experienced surgical group in TEP hernioplasty, an endoscopic preperitoneal exploration and lymph node biopsy was indicated to avoid open surgery.

Result

An outpatient surgery was succesfuly performed. An en-bloc sample was obtained. There were no intraoperative or postoperative complications.

Pathologic findings: Low-grade Non-Hodgkin Lymphoma IV-B IPI-2.

Conclusion

The Totally Extraperitoneal access can be used not only for inguinal hernioplasty but also for other indications such as a selective deep inguinal lymphadenectomy.
PATIENT CASE STUDY: REBUILDING A PATIENT’S LIFE NOT JUST THEIR ABDOMINAL WALL – EXPERIENCE FROM A TERTIARY HERNIA CENTRE ON THE IMPACT OF ABDOMINAL WALL RECONSTRUCTION ON QUALITY OF LIFE
Authors: Birch A , Cocciolo F , Alabbasi I
Published: May 2024

Introduction

Abdominal wall reconstruction is a transformative intervention, significantly improving the quality of life for individuals with complex defects. This paper focuses on sharing a patient's experience post-surgery.

Case Presentation

The patient presented with a complex incisional hernia following a laparotomy, Hartmann’s procedure and splenectomy for perforated diverticular disease. Their CT scan showed a 16.5 × 17.5 cm defect, with a separate component involving their colostomy and lateral displacement of their muscle complexes. The hernia significantly impacted the patient's quality of life, manifesting as daily moderate pain that hindered routine activities. They required daily dressings and antibiotics due to skin changes over the hernia. Furthermore, dissatisfaction with the cosmetic appearance of the hernia contributed to the overall burden on the patient.

Management and Outcomes

The patient underwent pre-operative botulinum toxin injections six weeks prior to their abdominal wall reconstruction. They received 200 units divided equally between internal and external obliques. During their surgery they required a left sided transversus abdominus release and an >5cm mesh overlap was achieved in all directions. A post-operative CT scan conducted ten days after the surgery revealed no complications. The patient's recovery progressed well, leading to their discharge 12 days post-surgery.

Discussion

The patient was reviewed nine months post-surgery. Expressing high satisfaction with the surgical outcome, they conveyed a profound positive impact on their quality of life. The patient's newfound confidence in the improved cosmesis of their hernia was evident. Overall, the surgery proved transformative, liberating the patient from the burdens of frequent medical appointments and instilling a renewed sense of self-assurance.
MESH FIXATION IN INGUINAL HERNIA REPAIR: ARE WE CLOSE TO A DEFINITIVE SOLUTION?
Authors: Casali A , Latham L , Soldini G , Intelisano A , Antonini I , Musolino C , Scalambra S M
Published: May 2024

Introduction

Inguinal hernia repair is the most performed surgical procedure and one of the most serious post-operative complications is still chronic pain, literature describes rates of chronic pain of 5–10%.

Laparoscopic repairs can prevent post-operative pain due to a minimally invasive approach reducing the manipulation of the layers covering nerves and vessels in the inguinal area.

The use of staples to fix the mesh could cause post-operative pain, for this reason in the last decade several studies comparing glue fixation to staples have been performed, showing better results for chronic pain and no differences in recurrence rate.

In these last years a step forward has been done, the comparison between glue fixation versus no fixation at all, granted by the tridimensional shape of some meshes in order to reduce the operating costs. These studies showed no difference between glue fixation and no fixation in the recurrence rate.

Materials and Methods

From 15th of January 2023 till now we performed 100 laparoscopic inguinal hernia repairs, 55 for bilateral inguinal hernia and 45 for monolateral hernia, median age was 58 yrs old.

36 of them were treated with TEP technique (9 with non-absorbable tacks and 27 without fixation), 64 with TAPP technique (2 with non-absorbable tacks and 62 without fixation).

The median operating time was 50 minutes, in the TAPP group 18 direct hernias were detected and the difect was closed with an absorbable running suture, in the TEP group 7 direct hernias were detected and no suture of the defect was performed.

Intraoperative complications were: in the TAPP group 1 bladder lesion treated with direct suture, in the TEP group 1 mild bleeding.

Post-operative complications were: 1 rectus hematoma treated laparoscopically and 29 cases of seroma (13 bilateral, 16 monolateral).

Results

After 6 months of follow up no recurrence was detected, 1 case of moderate post-operative pain (nociceptive pain: painscore 9) was treated with anti-inflammatory medicines.

Discussion

Laparoscopic repairs of inguinal hernia nowadays should provide an easy recovery to the normal quality of life with reduction of social costs. Our results show that no mesh fixation could be performed safely with good results concerning the percentage of recurrences.