bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPARISON OF LAPAROSCOPIC VERSUS ROBOTIC HERNIA REPAIR OUTCOMES
Authors: Hayward R , Alhadad Z , Smith J J , Muirhead L J , Warren O J
Published: May 2024

Background

Use of robotics in hernia surgery is increasing. Comparison of outcomes between traditional laparoscopic and novel robotic procedures is vital to determine safety and inform cost-benefit decisions.

Method

Prospective data capture on patients undergoing inguinal hernia repair during one surgeon’s transition from an exclusively laparoscopic practice to one incorporating robotics.

Results

28 robotic transabdominal preperitoneal and 79 laparoscopic totally extraperitoneal inguinal hernia repairs were performed in the calendar year 2023.

In the robotic arm, median age was greater (69 vs. 58 years, p <0.001) and more patients had history of abdominopelvic surgery (robotic n = 20 (71%), laparoscopic n = 28 (35%), p = 0.001).

There were no blood transfusions, mesh infections or removals. There was one conversion to open (robotic arm). One robotic patient was readmitted, returned to theatre and sadly died within 60 days with pathology unrelated to his groin hernias.

Recovery was complication-free for 24 (86%) robotic and 78 (99%) laparoscopic procedures (p = 0.004). There was one superficial infection (laparoscopic). Complications in the robotic arm included urinary retention (n=3) and persisting numbness (n = 1).

17 (61%) robotic procedures were day-case versus 67 (85%) laparoscopic (p = 0.008). A robotic learning curve was demonstrated through decreased operative time between the first and second half of operations (49 vs. 37 minutes, p <0.001).

Conclusion

Transition to robotic practice has a significant learning curve requiring comprehensive training. Patients selected for robotic repair were significantly older and more complex, increasing perioperative complication risk. Nonetheless, length of stay, complications, re-admission and recurrence rates are within acceptable parameters, supporting the feasibility of this approach.
LAPAROSCOPIC TOTALLY EXTRAPERITONEAL HERNIA REPAIR IN PATIENTS WITH A HISTORY OF PREVIOUS ABDOMINOPELVIC SURGERY
Authors: Hayward R , Smith J J , Qiu S , Muirhead L J , Warren O J
Published: May 2024

Background

A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic (AP) surgery, to determine the feasibility of totally extra-peritoneal (TEP) repair within this population.

Method

All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals were retrospectively analysed to assess perioperative outcomes.

Results

308 patients were operated on between 2017 and 2024; 86% male, median age 58 years. 110 patients (36%) had a history of previous AP surgery.

298 patients (97%) achieved complication-free recovery. Superficial infection requiring antibiotics occurred in 4 cases (1.3%), all in the non-AP arm (p = 0.113). 2 patients (0.6%), one from each arm, reported ongoing post-operative pain. Recurrence occurred in 4 cases (1.3%) (1.8% in the AP vs. 1.0% in the non-AP arm, p = 0.548). 247 patients (80%) underwent day-case surgery (77% in the AP vs. 82% in the non-AP arm, p = 0.338).

There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to the testicle, or persisting numbness. There were no requirements for blood transfusion, or returns to theatre. There was one conversion to open. One patient was readmitted within 30 days and sadly died.

Conclusion

In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low complication rates, thus should be considered as standard for patients regardless of a history of AP surgery.
ESTABLISHMENT OF LAPAROSCOPIC INGUINAL REPAIR AT A SWEDISH TERTIARY CENTER: PERI-OPERATIVE DATA, RECURRENCE AND PATIENT-REPORTED OUTCOME BETWEEN 2015 AND 2020
Authors: Hedlund F , Norgren A , Cengiz Y
Published: May 2024

Background

TAPP was introduced in Sundsvall County Hospital, Sweden in late 2014. The results of either open tension-free mesh technique or TAPP consecutively performed between 2015 and 2020 was studied.

Methods

650 consecutive patients were studied retrospectively with prospectively collected data from Swedish Hernia Registry. Patient demographics, peri-operative data, recurrence and patient reported outcome were studied.

Results

231 TAPP and 419 open procedures were performed for 588 (90,5%) primary hernias and 62 (9,5%) recurrent hernias. 598 (92,0%) repairs were elective and 555 (85,4%) were treated in day care. Mean operation time for a TAPP was 48,7 minutes (SD 21,7) and for open repair 75,8 minutes (SD 27,8), p <0.05. Repair of recurrent- and bilateral hernia were more common with a TAPP (p <0.001). Of 219 operations performed by residents, 204 (93,2%) were open repairs and 15 (6,8%) TAPP (p <0.001). Postoperative complications occurred in 29 (4,5%) cases, of which 21 after open repair (p >0.05). Surgeon's competence was not associated with postoperative complications. Recurrence occurred in 2 (0,9%) TAPP and in 5 (1,2%) open repairs, the differences not significant.

Conclusion

Despite reflecting results from the department´s learning curve, TAPP was faster and produced comparable low rates of complications and recurrence as those from open repair. More than half of the inguinal hernia repairs were performed by specialists in surgery.
COMPARISON OF COSTS BETWEEN ROBOTIC VERSUS LAPAROSCOPIC APPROACH TO INGUINAL HERNIA. IS IT SUSTAINABLE?
Authors: Hinojosa-Ramirez F , Martinez-Nuñez S , Tallon-Aguilar L , Tinoco-Gonzalez J , Arteaga-Sanchez A , Morales-Conde S
Published: May 2024

Aim

There has been a rapid growth in the robotic approach to inguinal hernia. This is because it has demonstrated similar results to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in Spanish National Health System.

Materials and Methods

A retrospective single-center comparative study of cost on inguinal hernia repair using a robotic approach versus laparoscopic approach.

Results

98 patients who underwent inguinal hernia repair were analyzed between October 2021 and July 2023. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p <0.001), an extended hospital stay (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p <0.007), as well as higher procedural costs (2810.15€ ± 218.10€ vs. 725.81€ ± 158.91€, p <0.001) and total hospitalitation costs (3792.49€ ± 326.06€ vs. 1497.20€ ± 375.68 €, p <0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias.

Conclusions

The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.
EFFECTS OF OBESITY ON OUTCOMES OF LAPAROSCOPIC TAPP INGUINAL HERNIA REPAIRS: A RETROSPECTIVE ANALYSIS
Authors: Janik M , Sroczyński P , Jędras K
Published: May 2024

Background

This study investigates the impact of obesity on surgical outcomes of laparoscopic Transabdominal Preperitoneal Patchplasty (TAPP) inguinal hernia repair.

Method

A retrospective analysis was conducted on patients who underwent TAPP inguinal hernia repair from January 2022 to March 2023. Patients were divided into two groups based on their BMI: those with obesity (BMI ≥30 kg/m², n = 20) and a control group (BMI <30 kg/m², n = 176). The study focused on surgical duration, hospitalization length, hernia recurrence, and postoperative complications.

Results

Patients with obesity had a significantly higher body mass (mean 101.05 kg) and BMI (mean 33.22 kg/m²) compared to the control group (mean body mass 78.87 kg, mean BMI 25.43 kg/m²). However, there were no significant differences in surgical duration (mean 52.06 vs. 45.06 minutes) and hospitalization length (mean 3.23 vs. 3.244 days) between the two groups. Both groups experienced primarily Class I complications according to the Clavien-Dindo classification, with no significant differences in surgical site infection rates. Hernia recurrence at 6 months post-surgery was slightly higher in the obesity group (5%) compared to the control group (0.3%), but this was not statistically significant.

Conclusion

This study suggests that obesity does not significantly impact the short-term outcomes of laparoscopic TAPP hernia repair, with similar operative times, hospital stay lengths, and complication rates observed in both obese and non-obese patients. These findings support the safety and efficacy of TAPP hernia repair in obese patients, although further research with larger sample sizes and longer follow-up is needed for comprehensive conclusions.
PNEUMOMEDIASTINUM AS A SEQUELA OF PRE-OPERATIVE PROGRESSIVE PNEUMOPERITONEUM — A RARE PHENOMENON
Authors: Jha A K , Kumar M , Priyadarshi R , Badani A
Published: May 2024

Surgeons typically use pre-operative progressive pneumoperitoneum (PPP) in cases of complex incisional hernias. With the advent of preoperative botulinum toxin and component separation techniques, rarely preoperative progressive pneumoperitoneum is required to facilitate midline closure. Subcutneous emphysema and pneumothorax can happen after PPP. However, pneumomediastinum as a sequela of PPP is an extremely rare phenomenon.

We herein describe a case of a 42-year-old gentleman, who presented with recurrent c incisional hernia with loss of domain. A CECT abdomen revealed a midline defect of 20 × 20 cm along with a loss of domain. In view of the large hernial defect with loss of domain, an injection of botulinum toxin A was given in the lateral abdominal wall muscle to facilitate midline closure. However, even after botulinum toxin A injection, the desired lengthening of the lateral could not be achieved. Therefore, we had to switch to pre-operative progressive pneumoperitoneum to enable midline closure. We used to instill 800 to 900 ml of air daily for 8 days. However, on the eighth day, the patient started experiencing mild chest pain, and the chest x-ray revealed pneumomediastinum. In addition, the CECT chest was also performed and it was suggestive of pneumomediastinum. Thereafter, we stopped further insufflation of air, and the pigtail catheter was left open to decompress the abdomen. We waited for approximately one week, and a repeat chest x-ray confirmed the resolution of the pneumomediastinum. Thereafter, a successful hernia repair was performed.

This case highlights the fact that pneumomediastinum can occur during preoperative progressive pneumoperitoneum, and a high index of suspicion is required to detect it early. In most cases, it resolves spontaneously.
DEVELOPMENT OF A REGIONAL AUTOMATED HERNIA REGISTRY: FIRST RESULTS
Authors: Kravchenko A , Kakotkin V , Agapov M
Published: May 2024

Background

In recent years, the concept of Learning Health Systems (LHS) has continued to develop. The existing hernia registries do not fully meet the requirements of the LHS. The aim of the study was to develop an automated hernia registry.

Method

The study is a prospective register-based (clinicaltrials.gov ID is NCT05920200). To maintain data quality, structured data entry forms have been developed and integrated into Medical Information System of Kaliningrad region (preoperative examinations, perioperative data, treatment results). Postoperative complications, recurrences, quality of life (EuraHS Qol Score) and pain levels (IPQ) scale were monitored. The approach to the work with the register was based on the principles of Big Data.

Results

During the first year, 43009 records from 995 patients diagnosed with ICD-10 K40-K43 were included. There were 327 (32.8%) females, 668 (67.2%) males. The emergency surgeries rate – 26.8%. The frequency of application of MIT was 9.74%. Intraoperative complications rate – 0.9%. Postoperative complications rate – 2.7%. Pain in 24 hours after surgery (VAS) – 3[1; 5], pain in 48 hours after surgery – 2 [0; 6]. Quality of life at 2 months after surgery: Pain – 2 [0; 8], Restriction of activities – 3 [0; 20], Esthetical discomfort – 3 [0; 9].

Conclusion

The automatic registry made it possible to evaluate the results of treatment of 100% of patients in public hospitals. Postoperative complications rate does not exceed that of HerniaMed. The level of quality of life corresponds to the data of publications. The automated registry is an effective tool for evaluating healthcare technologies in hernia surgery.
PERINEAL HERNIA REPAIR: MULTICENTRE COMPARATIVE ANALYSIS OF SYNTHETIC MESH VERSUS MESH COMBINED WITH TISSUE FLAP
Authors: Kreisel S I , de Jong D L C , Burger P J W A , Hompes R , Nienhuijs S W , Verhoef C , Musters G D , Tanis P J
Published: May 2024

Aim

Surgical techniques for perineal hernia repair have evolved over time. Presently, synthetic mesh repair is the preferred technique, but recurrence rates are high. This study aimed to compare the outcomes of adding a tissue flap to the mesh with mesh-only repair.

Method

Between 2006 and 2022, patients who underwent perineal hernia repair with synthetic mesh or mesh combined with tissue flap were retrospectively identified from three referral centres. Primary endpoint was recurrent perineal hernia.

Results

Seventy-nine patients were included, of which 65 patients underwent mesh-only repair and 14 patients mesh with flap repair. Postoperative perineal wound complications occurred in 23% in the mesh-only group and in 21% in the mesh with flap group. Meshes were solely explanted within the mesh-only group (n = 3). There were no flap failures in the mesh with flap group. During a median follow-up of 54 months, recurrent perineal hernia occured in 27/65 (42%) after mesh-only and in 2/14 (14%) after mesh with flap repair (p = 0.06). Time to recurrent hernia was median 14 months. Failed mesh only repair was successfully treated by crossover to mesh with flap in 4/4 patients.

Conclusion

Mesh combined with tissue flap repair of a perineal hernia seems more effective than synthetic mesh-only repair. These findings have to be confirmed in larger series.
LAPAROSCOPIC VENTRAL HERNIA REPAIRS IPOM 35 CONSECUTIVE CASES WITH BIOSYNTHETIC MACROPOROUS PTFE MESH: OUR INITIAL EXPERIENCE
Authors: Latham L , Soldini G , Casali A , Antonini I , Intelisano A , Musolino C , Scalambra S M
Published: May 2024

Introduction

The laparoscopic intraperitoneal onlay mesh (IPOM) technique for the repair of incisional and parastomal hernias has increasingly gained popularity since its first description in 1993. The main advantage in comparison with the open approach is the reduced incidence of wound complications and the lower recurrence rate.

Meshes used for laparoscopic approaches must induce strong and rapid incorporation on the parietal side and they should also prevent adhesions on the visceral side.

Biosynthetic macroporous ptfe meshes are innovative solutions for advanced reconstruction in the repair of hernias and abdominal wall soft tissue deficiencies that may require the addition of a non-absorbable reinforcing or bridging material.

These meshes offer 4 main solutions in the wall hernia repairs: they facilitate wound healing, support rapid vascularization, minimize need for removal and enable single-stage repair.

Materials and Methods

In our center from 15th of January 2023 till 31st of December 2023 we performed 35 laparoscopic abdominal wall hernia repairs with laparoscopic intraperitoneal onlay mesh (IPOM) using biosynthetic macroporous ptfe mesh, 21 for incisional hernia and 14 for primitive hernia. 31 were ventral defects (17 M3, 10 M2, 4 multiple hernia defects) and 2 were subxyphoidal (M1), 1 lateral iliac defect (L3) and 1 suprapubic (M5), 20 women and 15 men.

The median age of the patients was 58 yrs old, the median size of the defect was 3.5 cm length × 3 width cm, the median size of the meshes was 15 cm lenght × 15 cm width, the median operating time was 60 minutes.

All the meshes were positioned with a double crown of tacks: the inner crown with absorbable tacks and the outer crown with non absorbable tacks.

Results

No intraoperative complications were detected, post operative complications were: a trocar hernia with small bowel incarceration that lead the patient to surgery, no prolonged pain or discomfort was detected.

The median time of hospitalization was 1 day.

Discussion

The new biosynthetic macroporous ptfe mesh shows to be more flexible with good memory that enable an easy unrolling, facilitating its placement and, most of all, seems to positively impact on the post operative quality of life.
USE OF CYANOACRYLATE GLUE AS AN ALTERNATIVE FOR PERITONEAL DEFECT CLOSURE IN MINIMALLY INVASIVE INGUINAL HERNIA REPAIR BY TEP APPROACH
Authors: Licardie E , Navarro-Morales L , Moreno-Suero F , Suárez-Grau J M , Morales-Conde S
Published: May 2024

Aims

Laparoscopic approach to inguinal hernia has a great future as a gold standard' procedure given its advantages over the open approach. Regarding the TEP approach, one of the biggest 'fears' is repairing an accidental opening of the peritoneum in the surgery. An Endoloop can be used for closure, however, if the defect is too large it forces us to suture it. We present an alternative for closure of such holes.

Methods

A male patient with diagnosis of bilateral inguinal hernia who underwent repair by TEP approach. In the first surgical technique introducing the balloon to dissect the pre-peritoneal space in order to be able to approach the inguinal spaces, a very firm adherence of the peritoneum to the area of the vas deferens is observed, which when the balloon dissection is performed produces a laceration of the peritoneum and an important defect that must be repaired.

Results

Continued by dissecting and identifying the anatomical landmarks to determine the area of dissection and their location with respect to the hernial defect. The anatomical spaces are dissected and the hernial sac is freed from the rest of the structures and placed the mesh. Before going to the contralateral side, the orifice is closed with cyanoacrylate glue. It is not necessary to use sutures for this closure, checking its tightness and security in order to continue.

Conclusions

We believe that the use of cyanoacrylates for the closure of holes in the peritoneum during the TEP-approach can be a useful and efficient resource.
INCISIONAL VENTRAL HERNIA REPAIR TRENDS IN THE LAST DECADE: AN ACHQC NATIONWIDE DATABASE ANALYSIS
Authors: Lima D L , Kasakewitch J P G , Nogueira R , Keisling S , Phillips S , Sreeramoju P
Published: May 2024

Aim

This study evaluates the trends in incisional ventral hernia repair (IVHR) techniques and their outcomes over ten years in the United States.

Material and Methods

A retrospective review of IVHR from the Abdominal Core Health Quality Collaborative (ACHQC) database (a US Nationwide hernia registry) was conducted from January 2013 to December 2022. Adult patients who underwent incisional ventral hernia repair using different techniques and with 30-day follow-ups were included.

Results

22,434 patients were included after applying inclusion and exclusion criteria. The use of the robotic approach increased from 8.0% (2013–2015) to 36.4% (2019–2022), while the open technique decreased from 69.9% to 55.9%. Median Mesh/hernia width increased over time from 2.5 (IQR 1.9–3.4) to 2.7 (IQR 2–3.7) (p <0.001), along with median mesh width from 17 cm (IQR 13–17) to 19 cm (IQR 12-30) (p <0.001). There is a decreasing trend of biologic mesh use from 4.98% to 2.6%. Regarding mesh positioning, retromuscular repair increased from 52.2% to 63.1%, preperitoneal decreased from 12.6% to 11.6% and intraperitoneal decreased from 34.4% to 23.9% (p <0.001). 30-Day readmission, recurrence, SSI (Surgical Site Infection) and reoperation across groups were the same. There was a decrease in SSO (Surgical Site Occurrence) over time from 15% to 10% (p <0.001).

Conclusion

This study highlights a significant trend toward MIS techniques in IVHR over the last decade. This shift is accompanied by consistently minimal intraoperative complications using bigger meshes in larger defects. There is a decrease in SSO rates and biologic mesh usage.
ROBOTIC SURGERY AS A TOOL FOR INCREASED DEXTERITY IN MINIMALLY INVASIVE HERNIA SURGERY – AN ANALYSIS OF TRENDS AND BASELINE COMPARISON OF 10 YEARS OF MIS VENTRAL HERNIA REPAIRS IN THE UNITED STATES USING THE ACHQC DATABASE
Authors: Lima D L , Nogueira R , Kasakewich J , Balthazar da Silveira C A , Dias Rasador A C , Malcher F
Published: May 2024

Aim

To evaluate the dexterity in Minimally invasive ventral hernia repair (VHR) in the last 10 years in the United States utilizing the Abdominal Core Health Quality Collaborative (ACHQC) database.

Materials and Methods

A retrospective review of prospectively collected data from the ACHQC database was performed to include all adult patients that underwent laparoscopic and robotic VHR in the last 10 years. Univariate analysis was performed to compare outcomes from laparoscopic and robotic-assisted approaches across preoperative, intraoperative and postoperative outcomes in two different periods in time.

Results

ACHQC database identified 15,437 patients that underwent VHR. Patients were divided into four groups: Laparoscopic 2013–2017 (Lap1) (n = 2,535), Robotic 2013–2017 (n = 1,806) (Robot1), Laparoscopic 2018–2022 (n = 2,063) (Lap2), and Robotic 2018–2022 (n = 9,033) (Robot2). Median Hernia width was higher in the Robot2 (4 cm IQR 2–6) when compared to the lap2 group (3 cm IQR 2–5) (p <0.001). Retromuscular repair was higher in the Robot2 group when compared to Lap2 group (n = 3201; 37.6% versus n = 68; 4.2%) and to the Robot1 group (n = 419; 24.7%) (p <0.001). Fascial closure was higher in the Robot2 group when compared to Lap2 group (n = 8649; 96.5% vs. n = 1359; 67.3%) and to the Robot1 group (n = 1736; 96.1%) (p <0.001). There was no difference in SSI between groups and SSO/I was lower in the Robot2 group when compared to Lap2 and Robot1 groups. Readmission rate was lower in the Robot2 group when compared to Robot1 (2.6% vs. 2.9%, p = 0.009).

Conclusions

Robotic approach was associated with more technically challenging repairs with lower complication rates over time.
PSEUDO HERNIA A RARE PRESENTATION OF A SKELETAL FLUOROSIS
Authors: Lodha M
Published: May 2024

Pseudo hernia is a bulge of the abdominal wall due to weakness of the muscle of the abdominal wall, the main differential diagnosis of the pseudo hernia is the hernia, which differ from the hernia is that there is diffuse swelling and bulge and such there is no defect to palpate, it can happen after spinal trauma, nerve injury to abdominal wall and pressure on the nerve.

Our case presented as a bulge on the lumber reason with obvious no past history of any surgery, on CT scan we found that there is sclerosis of the bone of the vertebral region, which was suspected probably as a skeletal sclerosis leading to the nerve pressure and muscle weakness.

In our region skeletal fluorosis is quite common in past, we conduced nerve conduction study also which did not reveal any anomaly although.
HYBRID LAPAROSCOPIC REPAIR OF COMPLEX ABDOMINAL WALL HERNIAS WITH TRANSABDOMINAL PARTIALLY EXTRA-PERITONEAL (TAPE) MESH FIXATION: PRELIMINARY RESULTS
Authors: Mahmood S , Moollan Y , Badiani S S , Rajkomar K , Berney C R
Published: May 2024

Background

There are two conventional approaches to abdominal wall hernia repairs which aim to achieve anatomical restoration. Open approaches have the advantage of complete hernial sac excision and more freedom with mesh placement. In comparison, laparoscopic approaches benefit by shorter hospital stays, less post-operative pain and fewer post-operative complications. Recently a hybrid approach which combines the two techniques has gained popularity.

Our aim was to validate if such hybrid approach can still achieve the same benefits, irrespective of hernia size, age, and BMI, with acceptable low complication and recurrence rates.

Method

The medical record of all patients who underwent hybrid laparoscopic hernia repair (HLHR) from 2017 to 2023 was retrieved from a prospectively maintained institutional database and retrospectively analysed. Intra- and post-operative complications, as well as hernia recurrence at 6 months were assessed.

Results

There were 37 patients (21 females: 56.8%) with a mean age of 66 years and BMI of 34.2 kg/m2 who underwent hybrid hernia repair. Thirty-four (91.9%) were incisional hernias, of which 50% were recurrent. Mean hernia size was 96.8 cm2. Twelve (32.4%) patients had preoperative chemical component separation with botulinum toxin A (BTA); this group had a significantly higher BMI and hernia size compared to no BTA (37.7 vs. 32.5; P=0.048; 174.5 cm2 vs. 59.5 cm2; P=0.0002). There was no intra-operative, but eight (21.6%) minor postoperative complications. There was no hernia recurrence at 6 months follow-up.

Conclusions

HLHR with TAPE mesh fixation is safe with satisfactory outcome, irrespective of hernia size and BMI.
ABDOMINAL SKIN NECROSIS FOLLOWING RIVES AND ANTERIOR COMPONENT SEPARATION TECHNIQUE
Authors: Martínez Alegre J , Sánchez López J D , Ferrero Celemin E , Vaquero Pérez M A , García-Sancho Téllez L , Picardo Nieto A L
Published: May 2024

Aim

Skin necrosis is a complication that we can find after abdominal wall surgery. In this paper we show how we treated this complication.

Material and Methods

Male 69 years with M2-4W3 abdominal wall hernia. Preoperatively we applied botulinum toxin in both sides. We perform Rives eventroplasty closing posterior fascia with monofilament 2/0 small bites and reticular mesh 20 × 15 cm. Due a high tension we perform an anterior component separation only in left side to get free tension close.

After 72 hours our patient present dyspnea, abdominal pain and transfer to intensive care. After 48 hours we could see skin necrosis at the right side of laparotomy, paradoxically where we didn´t anterior component separation.

Results

After stabilization by intensive care we perform surgical debridement of all necrotic tissue and applied a negative pressure wound therapy on this side. One month later, in collaboration with plastic surgeon, we could close skin defect.

Conclusion

Skin necrosis is a severe complication in abdominal wall repair surgery. Negative pressure wound therapy and multidisciplinary treatment were necessary for successful management.
OUTCOMES OF CONCURRENT PANNICULECTOMY AND HERNIA REPAIR IN A SINGLE SURGEON’S ABDOMINAL WALL RECONSTRUCTION PRACTICE
Authors: Mead B , Holland A , Lorenz W , Scarola G , Ku D , Hollingsworth R , Augenstein V
Published: May 2024

Background

Concurrent panniculectomy (CP) with hernia repair allows patients to have removal of their redundant skin and excess overlying fat in addition to herniorrhaphy. While providing excellent cosmesis and patient satisfaction, concerns have historically included longer operative times, higher rates of wound complications and infection. This study analyzed the rates of postoperative complications in patients undergoing CP with abdominal wall reconstruction (AWR).

Methods

A prospectively maintained institutional database was queried for patients who underwent both hernia repair and CP. All patients had the same fellowship trained surgeon, between 2017 and 2023. Primary outcomes included wound complications and hernia recurrence rates.

Results

A total of 149 patients were identified; 75.8% were female, mean age was 57.3 ± 12.2 years, median BMI was 32.2 kg/m2 (IQR:28.4, 36.5), 30.9% had diabetes, 14.8% were immunosuppressed, and 5.4% were smoking. Prehabilitation resulted in a median preoperative weight loss of 11.7 lbs (IQR:21.7, 1.0). Median hernia size was 216.0 cm2 (IQR:150.0, 300.0), and 97.3% were ventral hernias. Median mesh size was 900.0 cm2 (IQR:471.2, 1050.0), 57.7% were biologic, and 98.7% of all repairs had preperitoneal mesh placement. Intraoperatively, 83.2% of cases were clean or clean-contaminated. Median operative time was 134.5 minutes (IQR:110.0, 176.0). Postoperative wound complications included seroma requiring intervention (11.4%), cellulitis (7.4%), wound infection (6.0%), intraabdominal abscess (6.0%), wound breakdown (3.4%), hematoma requiring intervention (3.4%), and mesh infection (1.3%). Hernia recurrence rate was 2.0% over a median follow-up time of 16.4 months (IQR:5.7, 41.1).

Conclusion

CP with AWR does not compromise wound morbidity or hernia recurrence. Despite significant patient comorbidities, rates of postoperative wound morbidity were low.
RECURRENCE AFTER IMPLEMENTATION OF AN UPDATED INTRAOPERATIVE PROTOCOL FOR TOTALLY EXTRAPERITONEAL (TEP) INGUINAL HERNIA REPAIR IN A HIGH-VOLUME CLINIC – A RETROSPECTIVE COHORT STUDY
Authors: Meuzelaar R R , de Vries J J , Burgmans J P J , Schiphorst A H W
Published: May 2024

Background

Recurrence rate after inguinal hernia (IH) repair is low, however, it remains an important postoperative outcome due to its adverse impact on quality of life. Therefore, modifiable risk factors should be explored and adjusted to reduce recurrence rate. Consequently, recommendations to the intraoperative protocol for totally extraperitoneal (TEP) repair were implemented in a high-volume hernia clinic. The present, retrospective cohort study assessed reoperation for recurrence-like complaints after the adoption of this protocol, which recommended fixating mesh in large, direct defects and thoroughly reducing lipomas.

Method

All patients receiving IH repair between January 1, 2013 and October 25, 2023 were studied retrospectively. Only elective TEP repairs in adult individuals were included. Subsequently, the cohort was divided into two groups, depending on when their TEP repair had been performed, pre- or post-implementation. The primary outcome was reoperation for recurrence-like complaints after initial TEP repair. Secondary outcomes were mesh fixation and lipoma reduction.

Results

In total, 14.536 IH repairs were performed in the studied period, of which 12.878 TEP repairs in 12.507 patients were included. Pre-implementation, 0.97% of the patients were reoperated, compared to 0.65% in the post-implementation group (p = 0.70). A significant increase of mesh fixation was observed (p <0.001) post-implementation. Lipoma reduction was similar between both groups (p = 0.32).

Conclusion

The adoption of the updated intraoperative protocol for TEP repair demonstrated a declining trend of reoperations for recurrence-like complaints, which was not statistically significant. Additionally, this study illustrates how internal quality analysis may be used to enhance surgical care.
LAPAROSCOPIC TOTALLY EXTRAPERITONEAL REPAIR OF INGUINAL HERNIAS IN FEMALE PATIENTS: DOES OLDER AGE INFLUENCE INCIDENTAL FINDINGS AND QUALITY-OF-LIFE?
Authors: Moollan Y , Badiani S S , Tsakanov S , Rajkomar K , Berney C R
Published: May 2024

Aim

To investigate the age-related incidence of incidental perioperative findings and differences in postoperative Quality-of-Life using the Carolinas Comfort Scale (CCS), in all female patients undergoing laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

Material and Methods

The clinical data of all female patients who underwent elective TEP repair between September 2009 and December 2023 was retrieved from a prospectively maintained institutional database. The data was divided into two groups (age ≤50 years vs. >50 years old) and analyzed retrospectively.

Results

There were 143 female patients who underwent TEP repair of 176 inguinal hernias with no conversion to open. Forty-one femoral and 33 obturator hernias were incidentally found in 58 patients (40.6%). Patients aged ≤50 years had the same frequency of incidental femoral hernias than those >50 years, but there was a trend towards increased incidence of obturator hernias found in older age group (P = 0.06).

At 2-weeks post-surgery, the average CCS score ratio was 0.14 +/- 0.15 in the younger age group, compared to 0.08 +/- 0.11 in >50 years (P = 0.008). When looking at the eight different domains of the CCS score, younger patients (age ≤50 years) were experiencing significantly more pain when performing activities of daily living (P = 0.017), walking, or standing (P = 0.05), or taking stairs (P = 0.02).

Conclusions

TEP inguinal hernia in older female patients increases the chance of finding an associated obturator hernia. At 2-weeks post-surgery younger patients are experiencing more residual groin pain when performing activities of daily living, walking, or standing, or taking stairs.
TRUE INCIDENCE AND CLINICAL SIGNIFICANCE OF PATENT PROCESSUS VAGINALIS IN MALE ADULTS DURING LAPAROSCOPIC INGUINAL HERNIA REPAIR
Authors: Moollan Y , Badiani S S , Tsakanov S , Rajkomar K , Berney C R
Published: May 2024

Aim

The exact incidence and clinical significance of patent processus vaginalis (PPV) in adult males is unclear. Perception is that PPVs rarely cause symptoms, but there is very limited data regarding its impact on Quality-of-Life (QoL). Our aim was to estimate the occurence of PPV in all adult male and to assess its influence on QoL using the Carolinas Comfort Scale (CCS).

Material and Methods

The medical record of all patients who underwent primary laparoscopic TEP inguinal hernia repair between August 2009 and December 2023 was retrieved from a prospectively maintained institutional database and retrospectively analysed. Data was divided into two groups (PPV vs. no-PPV). Recurrent hernia repairs were excluded.

Results

There were 929 male patients (mean age of 51.9 years) who underwent 1280 inguinal hernia repairs. No intraoperative complications and no conversion to open were encountered. Those with no PPV had significantly more chance of having an associated direct hernia (P <0.0001). After exclusion of all direct hernia repairs in the no-PPV group, the incidence of PPVs was 17.9%.

Preoperative modified CCS (MCCS) was completed in 740 patients. After exclusion of all those treated for a direct hernia, PPV patients were experiencing significantly less pain when laying down (P = 0.007) or exercising (P = 0.001). QoL at 2- and 6-weeks postoperative was comparable between both groups.

Conclusions

The true incidence of PPVs is estimated at 17.9% and seems to prevent the risk of developing an associated direct defect. Patients treated for PPV are less likely to experience pre-operative pain when laying down or exercising.
ROBOTIC-ASSISTED LATERAL VENTRAL HERNIA REPAIR—EXPERIENCE FROM THE FIRST 50 CONSECUTIVE OPERATIONS WITH PREPERITONEAL AND RETROMUSCULAR MESH PLACEMENT
Authors: Mück B , Vogel R , Heinzelmann F , Büchler P
Published: May 2024

Background

Due to the proximity to bony structures and the complex anatomy of the three-layered lateral abdominal wall, the surgical treatment of lateral ventral hernias is technically demanding. With this we demonstrate how lateral abdominal wall hernias can be treated using new robotic surgical techniques with extraperitoneal mesh placement.

Objectives

The purpose of this study is to demonstrate that robotic management of lateral abdominal wall hernias is safe and efficient.

Materials and Methods

A retrospective analysis of all robotically operated patients on lateral ventral hernia from June 2019 to December 2023 was performed.

Results

A total of 50 ventral hernias were operated robotically because of a lateral hernia in the study period. 90 per cent of the patients had an incisional hernia, 10 per cent had a primary spighelian hernia. 27 patients had only lateral findings, 23 patients had combined hernias with lateral and medial hernial defects. 18 patients were treated with a preperitoneal mesh (r-vTAPP). 31 patients were treated by TAR with a retromuscular mesh (24 extraperitonel approach r-eTAR/7 transperitonel approach r-TAR). One patient had to be converted intraoperatively from a planned preperitoneal mesh to an intraperitoneal mesh repair (r-IPOM).

The median hernia defect area was 71 cm² (3–375 cm²). The median mesh size was 600 cm² (150–1290 cm²). The median mesh defect ratio (MDR) was 10 (2,33–133,33). Three postoperative complications were encountered (6%) out of which two required reoperations (4%).

Conclusion

With the use of new robotic surgical techniques, even complex lateral hernias that previously caused difficulties in surgical care can be treated safely with promising results in the early postoperative course.

Keywords

lateral ventral hernia, robotic eTEP, retromuscular mesh placement, robotic ventral TAPP, robotic transversus abdominis releaseGesamtAnzahl50vTAPP1836%eTAR2448%TAR714%rIPOM12%Alter (Median)67,00(23–85)Männlich2754,00%Weiblich2346,00%ASA (Median)2(1–3)Größe m (Median)1,72(1,50–1,90)Gewicht kg (Median)82,5(54–125)BMI (Median)28(19–39)Zeit min (Median)214(53–525)Komplikationen36,00%Interventionen00,00%Reoperationen12,00%Aufenthalt3(1–16)Narbenhernien4590,00%primäre Hernien (Spieghel)510,00%simultane Leistenhernien2 Leistenhernien1 PatientenNetzgröße600(150–1225)Netzgröße gesamt600(150–1290)Bruchpforte71(3–375)MDR10(2,33–133,33)kombinier mediale-laterale Bruchpforte2346,00%laterale Bruchpforte2754,00%
CASE REPORT: OUR MISTAKES IN THE eMILOS TECHNIQUE LEADING TO THE NEED FOR REOPERATION
Authors: Musilova Z , Handl V
Published: May 2024

The Endoscopic MILOS (Mini- or Less-Open Sublay) technique has demonstrably fewer complications, favorable healing, a better cosmetic effect. Adherence to the precise procedure is necessary for a successful operation and patient satisfaction. This case report presents our mistakes that led to the reoperation and could have been avoided.

The patient underwent eMILOS hernioplasty in 2019 for an umbilical hernia with a symptomatic wide diastasis extending to the xiphoid. Mesh was implanted retromusculary with fixation to the xiphoid. The wound healed primarily, however, on the 13th postoperative day, patient felt a burst beneath the xiphoid without any complications. In 2023, the patient presented with year-lasting subxiphoidal pain. A palpable resistance was found in the abdominal wall in the epigastric region. A CT scan revealed a hyperdense infiltrate at the site of the mesh. During the reoperation, a retromuscular calcified hematoma (14 × 6 cm) was found wrapped in a folded mesh. The hematoma with a portion of the mesh was removed.

The likely cause of the formation of the calcified hematoma was a torn fixation suture of the mesh to the xiphoid. The resulting hematoma leaked into the folds of the mesh, did not absorb, and calcified. The mesh was likely extremely wide, leading to its wrinkling.

In conclusion, we would like to emphasize that fixation of the mesh is not necessary in eMILOS, and the accurate size of the implanted mesh is crucial. The patient could have avoided painful laparotomy, and the cosmetic effect would have been more favourable.
INITIAL EXPERIENCE ON EMERGING MULTIMODULAR ROBOTIC PLATFORM: CASE SERIES OF BILATERAL INGUINAL AND VENTRAL HERNIA REPAIR
Authors: Nicastro V , Marin J N , Morini L , Alampi B , Grimaldi S , Ferrari G
Published: May 2024

Background

Robot-assisted approach in abdominal wall hernia repair (AWHR) is constantly spreading, increasing minimally invasive procedures and sublay or extraperitoneal mesh placement. Few evidences about robotassisted approaches are available in literature, especially looking at new emerging robotic platforms. The aim of this study is to prospectively report our initial monocentric experience of robotic AWHR performed with a multimodular robotic platform.

Method

All consecutive patients, undergoing robotic AWHR with a multimodular robotic platform, between February 2023 and September 2023, were considered. Data of patients were retrieved from a prospectively collected database. Clinical and demographic characteristics, short and long term outcomes were analyzed.

Results

Thirty patients underwent robotic AWHR. Eighteen underwent bilateral inguinal hernia repair with transperitoneal approach (TAPP). Twelve patients underwent robotic transabdominal retromuscular umbilical prosthetic repair (TARUP) for umbilical hernia combined with symptomatic diastasis recti. Mean operating time was 174,28 min. Three intervention were concluded laparoscopically due to arms conflicts. No major intra- and post-operative surgical complications were observed. The mean post-operative hospital stay was 1.14 days. All patients received a follow-up at one week, 1, 3 and 6 months from surgery

Conclusion

The role of robotic surgery for AWHR is being defined. We can conclude that robotic AWHR for inguinal and ventral hernia is feasible and safe in term of surgical outcomes. In fact, sublay ventral hernia repair is encouraged by robotic approach, rather than intraperitoneal onlay mesh placement.
COMPLEX ABDOMINAL WALL HERNIAS: A MULTICENTER COHORT STUDY
Authors: Nieto Martos R , Blázquez Hernando L , Martos Meléndez S , Andrés Andrade Yagual A , López Monclús J , Robín Valle de Lersundi A , Muñoz Rodríguez J , Porrero Guerrero B , Román García de Leon L , Manuel Molina Villar J , María Fernández Cebrian J , Ángel García Ureña M
Published: May 2024

Introduction

The TAR description has revolutionized complex abdominal wall surgery, providing solutions to previously challenging issues. We acknowledge its associated morbidity, low recurrence rates, and short-term improvement in quality of life. However, its long-term impact on patients' quality of life remains unknown.

Material and Methods

prospective study of consecutive patients undergoing transverse abdominis release (TAR) for complex abdominal hernias between 2014 and 2017 in four different centers with a minimum of 5-year follow-up. Demographics, operative and postoperative variables were analyzed. Preoperative quality of life assessments (EuraHS QoL) was conducted, along with follow-ups at one and two years postoperatively. A fourth assessment was performed more than five years after the intervention, incorporating the use of the Carolina's Comfort Scale on this occasion.

Results

A total of 60 patients undergoing TAR were included. The mean follow-up was 82 months. Of them, 59,6% were men and 40,4% women. The mean age was 61 (52–69) years. The EuraHS QoL score significantly improved compared to the preoperative score in terms of pain, aesthetic perception and physical functioning (p <0,0001). The Carolina’s Comfort Scale after 5 years showed a low incidence of mesh sensation, pain related to mesh and limitation for movements or physical exercise.

Conclusions

The TAR technique for complex abdominal wall hernias improves long-term quality of life after surgery with a low incidence of postoperative chronic pain and functional impairment.
RISK FACTORS FOR CHRONIC PAIN FOLLOWING LAPAROSCOPIC GROIN HERNIA REPAIR IN THE SWEDISH HERNIA REGISTRY: 2. MESH AND FIXATION COMBINATIONS
Authors: Novik B
Published: May 2024

Background

A recent Swedish Hernia Registry (SHR) study associated standard, aka “heavyweight”, polypropylene flat mesh (StdPPM) without fixation, and lightweight polypropylene or polyester based flat mesh (LWM) with fibrin glue, with the lowest reoperation risks (Novik, et al. J Am Coll Surg 2022).

Aim

The present prospective cohort study aimed at correlating mesh/fixation combinations with chronic postoperative inguinal pain (CPIP) risk.

Material and Methods

Virtually all patients ≥15 years, operated with TEP or TAPP in Sweden during September 2012—December 2018, were routinely sent a CPIP questionnaire at 1 year postoperatively. This study defined CPIP widely, as “non-ignorable pain in the operated groin anytime during the recent week”.

A. Mesh alternatives:

StdPPM

LWM

Anatomically (“3D”) shaped polypropylene mesh, standard or lightweight.

Non-characterized polyester mesh.

B. Fixation alternatives:

Non-fixation

Tacks

Fibrin glue

Progrip® self-gripping absorbable micro-hooks (only with LWM).

Thirteen mesh/fixation combinations were analyzed with multivariable logistic regression, rendering adjusted odds ratios with 95% confidence intervals.

Effect modifiers adjusted for were sex, age, ASA, body mass index, smoking, recurrent hernia, emergency repair, bilateral vs. unilateral, and anatomical type and defect size of hernia.

Results

Eighty surgical centers contributed 29,109 laparoscopic repairs (78% male). Patient mean age was 58 years. From 20,455 (70%) questionnaire responders, 5,786 (28%) qualified as having CPIP.

With non-fixated StdPPM as reference, some mesh/fixation combinations were associated with a significantly higher CPIP risk, while no alternative combinations correlated with a lower risk.

Conclusions

Of the mesh/fixation combinations associated with the lowest CPIP rates, non-fixated StdPPM is the least expensive, and can therefore be recommended.
STRANGULATED SPIGELIAN HERNIA: A RARE CASE REPORT AND DIAGNOSTIC DILEMMA
Authors: Pal A K , Kumar Agrawal M , Singh H , Karnik A , Kumar A
Published: May 2024

Background

Spigelian hernia, is a rare abdominal wall anomaly with an incidence of 0.1–2%, was initially documented by Josef Klinkosh in 1764. This hernia protrudes through the Spigelian aponeurosis, a continuation of the transversus abdominis muscle's aponeurosis situated between the rectus abdominis muscle's lateral border and the linea semilunaris. They primarily occur within the spigelian hernia belt, a region below the umbilicus delineated by the anterior superior iliac spines. These are often misdiagnosed as lateral incisional hernias (eg, port site hernia).There’s no clear sex predilection, and most patients are diagnosed in the fifth or sixth decade of life.

Case Presentation

A 56-year-old woman presented with acute onset and severe abdominal pain persisting for four days, accompanied by bilious vomiting. She had history of intermittent pain and swelling in left abdomen for more than 20 years and had undergone Hysterectomy with bilateral salpingo-oophorectomy 11 years earlier. Clinical examination revealed a palpable 5 × 5 cm lump in the left iliac fossa, with tenderness and mild erythema of overlying skin. Non-contrast abdominal CT confirmed a bowel loop protruding through an abdominal wall defect. Exploratory laparotomy revealed a gangrenous ileal segment of about 10 cm and segmental resection followed by anastomosis by single layer interrupted technique was done. The patient recovered well during a 5-day hospital stay and continued follow-up without complications.

Conclusion

This case report emphasizes the importance of diagnosing spigelian hernia with increased risk of strangulation in patients with prior abdominal surgery. A high index of suspicion is needed for early diagnosis resulting in better outcomes.