bluuebunny/crossref_metadata_2025 huggingface dataset:
MESH TO DEFECT RATIO (MDR) IN OPEN VENTRAL HERNIA REPAIR (OVHR): DOES SIZE REALLY MATTER?
Authors: Mead B S , Lorenz W R , Holland A M , Scarola G T , Heniford B T , Augenstein V A
Published: May 2024

Background

There is limited data concerning adequate mesh overlap in OVHR. Recommendations of 5 cm of mesh overlap exist primarily in the context of small-to-medium sized hernias repaired laparoscopically, yet there is little substantive information supporting this. Some consider that MDR, rather than simple overlap, may be a more physiologically appropriate approach. The goal of this study was to examine MDR in OVHR and its association with hernia recurrence.

Methods

A prospective, institutional database was queried for OVHR performed by general surgeons (GS) versus fellowship trained hernia surgeons (HS) Forty cases were propensity score matched on hernia defect size, mesh location, and procedure date by each group. The patient’s demographics, mesh size, defect size, hernia recurrence rates and composite postoperative wound complications were analyzed using standard descriptive and inferential statistical analyses.

Results

A total of 80 patients were examined, there were no significant differences in age, sex, BMI or tobacco use. There was no difference in mean hernia defect size (HS:105 cm2 vs. GS:116 cm2; p = 0.703). HS tended to use larger mesh (559 ± 434 cm2 vs. 426 ± 333 cm2; p = 0.187) with a larger MDR (13.3 ± 15.8 vs. 9.0 ± 8.1; p = 0.161), but not significantly so. At an average follow-up of 46 months, HS had a significantly lower rate of hernia recurrence (5% vs. 25%; p = 0.025) and post-operative wound complications (17.5% vs. 37.5%; p = 0.024).

Conclusions

HS had significantly lower rates of hernia recurrence and wound complications after OVHR. MDR, while not statistically significant in this small study, may play a role in reducing hernia recurrence.
ANTERIOR RECONSTRUCTION OF THE ESOPHAGEAL HIATUS: A NOVEL APPROACH FOR THE REPAIR OF LARGE DIAPHRAGMATIC HERNIAS
Authors: Messer N , Ben Yehuda A , Idan C , Mimouni I , Warnaar N , Szold A
Published: May 2024

Introduction

Paraesophageal hernias (PEH) often require surgical repair. The standard approach, primary posterior hiatal repair, has been associated with a high recurrence rate. Over the past few years, we have developed a new approach for repairing these hernias, which we believe restores the original anatomy and physiology of the esophageal hiatus. Our technique includes anterior crural reconstruction with routine anterior mesh reinforcement and fundoplication. This study aims to determine the safety and clinical success of anterior crural reconstruction with routine mesh reinforcement.

Methods

Data were collected on 178 consecutive patients who had a laparoscopic repair of a symptomatic primary or recurrent PEH between 2011 and 2021 using the above technique. The primary outcome was clinical success, secondary outcome was 30 days major complications and patient satisfaction. This was assessed by imaging tests, gastroscopies, clinical examination, and direct contact with each patient.

Results

Mean follow-up is 65 (SD 37.1) months. No intraoperative or 30-day postoperative mortality or major complications were recorded. Recurrence rate requiring a re-operation was 8.4% (15/178). Radiological and gastroenterological evidence of minor type 1 recurrence was 8.9%.

Conclusion

This novel technique is safe with satisfactory long-term results. The outcome of our study will hopefully motivate future randomized control trials.
EVALUATING THE IMPACT OF LIFTING MANDATORY SMOKING CESSATION PRIOR TO ELECTIVE ABDOMINAL WALL RECONSTRUCTION. A SINGLE-CENTER EXPERIENCE
Authors: Messer N , Melland M S , Miller B T , Krpata D M , Beffa L R A , Tu C , Petro C , Maskal S M , Ellis R C , Rosen M J , Prabhu A S
Published: May 2024

Introduction

Many studies identify active smoking as a significant risk factor for postoperative wound and mesh complications in patients undergoing abdominal wall reconstruction surgery. However, our group conducted an analysis that revealed similar rates of surgical site infection (SSI) and surgical site occurrence requiring procedural intervention (SSOPI) between active smokers and non-smokers (1). As a result, the Cleveland Clinic Center for Abdominal Core Health instituted a policy change where active smokers were no longer subject to surgical delay.

In this analysis, we compared the effect of this policy change on clinical outcomes and wound morbidity.

Methods

We identified active smoking patients who had undergone open, elective, clean ventral hernia repair (VHR) with transversus abdominis release (TAR) and permanent synthetic mesh. Propensity matching was performed to create a 1:3 ratio of "current-smokers" and "never-smokers" and compared wound complications and all 30-day morbidity.

Results

106 current-smokers and 304 never-smokers were matched. Rates of SSI (12.2% vs. 6.9%, p = .13), SSO (21.7% vs. 13.2%, p = .052), SSOPI (11.3% vs. 6.3%, p = .13), and reoperation (1.9% vs. 3.9%, p = .53) were not significantly different between active smokers and never-smokers correspondingly. The current-smokers group exhibited a significantly higher incidence of pneumonia compared to the never-smokers group (5.7% vs. 0.7%, p = .005).

Conclusion

Operating on active smokers did result in a slight increase in wound morbidity, although it did not reach statistical significance. However, we did not see any mesh infections in the smoking group during early follow-up.
EFFECTIVENESS OF TOTAL EXTRAPERITONEAL HERNIA CORRECTION FOR CLINICALLY OCCULT INGUINAL HERNIA (EFFECT-TRIAL) – A MULTICENTRE RANDOMIZED CONTROLLED TRIAL
Authors: Meuzelaar R R , Verleisdonk E J M M , den Hartog F P J , Schiphorst A H W , Tanis P J , Burgmans J P J ,   EFFECT Triallists’ Collaboration
Published: May 2024

Background

Groin pain in adults is a common complaint in surgical practice, often related to an inguinal hernia (IH). An IH is occult when it is detected on ultrasound, but the patient does not manifest any clinical signs. Current international guidelines lack specific recommendations for managing occult IH accompanied by groin pain, potentially leading to unnecessary surgical interventions and inadequate patient counselling. This multicentre randomized controlled trial aimed to determine whether watchful waiting (WW) is non-inferior to totally extraperitoneal (TEP) repair in terms of pain for this condition.

Method

The primary outcome was the difference in pain scores between baseline and 3 months of follow-up, measured at rest and during exercise, in patients with groin pain and occult IH. Total follow-up was 12 months. Secondary outcomes included quality of life, patient satisfaction and cross over.

Results

Ninety-nine patients were randomized, of which 14 participants had withdrawn before treatment. A total of 85 patients (TEP repair n = 36, WW n = 49) were included in an as-treated analysis. At three months of follow-up, the difference in pain scores at rest (p = 0.691) and during exercise (p = 0.139) were comparable between both groups. Equivalence tests were significant for the primary outcome (p < 0.001), which indicated similarity. After three months, six patients (12%) crossed over from the conservative to the operative arm. Other outcome parameters were not significantly different.

Conclusion

The EFFECT-trial suggests that WW is non-inferior to TEP repair regarding pain 3 months after the start of treatment in patients with groin pain and occult IH.
EFFICACY AND SAFETY OF BILAYERED POLYPROPYLENE MESH FOR TEMPORARY ABDOMINAL CLOSURE: A PROSPECTIVE MULTICENTRIC STUDY
Authors: Munoz-Rodriguez J M , Román García de León L , Gil Cidoncha L , Grillo Marin C , Fernández Rodríguez M , Valle de Lersundi R , Medina Pedrique M , Garcia-Urena M A , Blazquez Hernando L A , Lopez-Monclus J
Published: May 2024

Background

This study evaluates the efficacy and safety of a bilayered reticular and laminar polypropylene (PLP) mesh for temporary abdominal closure in managing open abdomen cases.

Methods

A prospective multicentric study was conducted involving consecutive patients with the open abdomen of any aetiology. Temporary abdominal closure utilized a bilayered PLP mesh, with an intraperitoneal laminar 30 × 40 cm PLP layer covering viscera and a 30 × 40 cm large pore PLP layer tailored to defect size and sutured to the fascial border. Reticular PLP plicatures were performed based on clinical evolution. Post-treatment, the mesh was explanted, and attempts were made for complete fascial closure.

Results

Thirty-four patients (vascular: 29.4%, sepsis: 29.4%, trauma: 14.7%, abdominal compartment syndrome (ACS): 14.7%, prevention of ACS: 11.8%) participated, mean age 63 years (range 19–86), 52.9% females. Ten patients died before achieving full abdominal wall closure. Twenty-four patients achieved a mean open abdomen duration of 9.12 days (range 1–53), all achieving total fascial closure with no observed adhesions between visceral and parietal peritoneum. Five patients were lost to follow-up. During mean follow-up of 14.13 months (range 2–33) for fifteen patients, one (6.6%) developed an incisional hernia.

Conclusion

Temporary abdominal closure with bilayered reticular and laminar polypropylene mesh is safe and effective, achieving 100% fascial closure. This approach shows promise in managing open abdomen cases across various etiologies, including vascular, trauma, ACS, and sepsis scenarios.
USE OF MESH REPAIR IN HIATAL HERNIAS: OUR EXPERIENCE
Authors: Navarro-Morales L , Licardie-Bolaños E , Moreno-Suero F , Morales-Conde S
Published: May 2024

Aim

The use of meshes, their composition and fixation as reinforcement in hiatal hernia (HH) is currently controversial. The aim of this study is to evaluate the safety of the use of mesh in hiatoplasty, as well as to compare the medium-term results between absorbable and non-absorbable prosthesis.

Methods

Prospective study of a series of cases of patients with hiatal hernia operated on in our center between July 2010 and December 2023. In all cases, reinforcement hiatoplasty with prosthesis. Intra-surgical and post-operative complications were recorded. Clinical and radiological recurrence was evaluated.

Results

A total of 84 patients were operated on, in 12 cases (14.3%) a APTC mesh was placed, in 38 (45.2%) a cPTFE mesh and 34 (40.5%) a P4HB mesh.

The percentage of overall clinical recurrence that we found occurred in 6 patients (7.1%). Radiological recurrence occurred in 9 patients (10.7%), of which 4 (10.5%) were treated with cPTFE mesh and another 4 (11.8%) with P4HB mesh, and 1 (8.3%) with APTC mesh. No statistically significant differences.

2 (16.7%) in the APTC group had some complication, 11 (28.9%) in the cPTFE group and 7 (20.6%) in the P4HB group.

Conclusions

No cases of serious intra- or posto-perative complications have been reported.

The main medium-term complication was dysphagia with no differences between groups.

There are no statistically significant differences in clinical or radiological recurrence between patients treated with different prosthetic materials.
RISK FACTORS FOR CHRONIC PAIN FOLLOWING LAPAROSCOPIC GROIN HERNIA REPAIR IN THE SWEDISH HERNIA REGISTRY: 1. PREOPERATIVE PREDICTORS
Authors: Novik B
Published: May 2024

Aim

This prospective cohort study aimed to identify and quantify preoperative risk factors for chronic postoperative inguinal pain (CPIP) after laparoscopic groin hernia repair.

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 as “non-ignorable pain in the operated groin anytime during the recent week”.

The survey results were analyzed with regard to conceivable preoperative risk factors for CPIP, being previously recorded in the Swedish Hernia Registry.

Multivariable logistic regression rendered adjusted odds ratios (OR), with 95% confidence intervals (CI).

Results

From 80 surgical centers, 29,109 laparoscopic repairs (78% male) were included, with patient mean age 58 years. From 20,455 (70%) questionnaire responders, 5,786 (28%) qualified as having CPIP according to this wide definition. Younger patients were less inclined to respond.

Preoperative predictors significantly associated with higher CPIP risk were:

Younger and elderly patients.

Increasing ASA.

Increasing BMI.

Female (OR 1.3, CI 1.2–1.4).

Smoking (OR 1.4, CI 1.1–1.7).

Recurrent hernia (OR 1.3, CI 1.2–1.4).

Emergency repair (OR 1.3, CI 1.03–1.7).

Each groin in a bilateral repair (OR 1.1, CI 1.05–1.2).

Femoral (OR 1.3, CI 1.1–1.6), combined latero-medial (OR 1.2, CI 1.04–1.3) vs. medial hernia.

Small vs. large defect (OR 1.2, CI 1.1–1.3).

Conclusions

The findings should be useful in planning and interpreting other studies, and for clinical counseling and decision making.

An age-dependent response rate asymmetry, which is a previously overlooked systematic selection bias issue with CPIP surveys, complicates interpretation.
SURGEON PERFORMED ABDOMINAL WALL BOTULINUM TOXIN A INJECTION IN THE OUTPATIENT SETTING MAY RESULT IN SIGNIFICANT REDUCTION OF COMPLEX LOGISTICS AND COSTS
Authors: Quintens J , Zwaans W A R , ten Have T , Lubbers T , Wevers K P
Published: May 2024

Aim

Incisional hernia is a frequent complication encountered after open abdominal surgery. Multiple techniques have been developed over the past few years, however recurrence rates remain high. New strategies to aid midline fascial closure are being developed, such as preoperative ultrasound guided Botulinum toxin A (BTA) injections in the lateral abdominal muscle layers. In most clinics, these injections are performed by radiologists or anesthesiologists. With rising ultrasound capabilities among surgeons and the already extensive anatomical knowledge in this group, a significant reduction in logistics can be achieved when these BTA injections are performed at the outpatient clinic by the surgeon.

Material and Methods

In the outpatient clinics of Maastricht University Medical Center and Máxima Medical Center Veldhoven, 22 BTA injections were perfomed from February 2022 until December 2023. Technique feasibility and pain scores were registered. Average costs from previous BTA injections performed by an anesthesiologist were compared with those for the injections performed by the surgeon in the outpatient setting.

Results

A total of 22 patients received BTA injections from February 2022 until December 2023. Patients tolerated this procedure well, with a mean numeric pain rating score of six out of ten. No post-BTA or periprocedural adverse events occurred. BTA injections by the surgeon in the outpatient clinic resulted in a cost reduction of €495 to €2185.

Conclusions

Outpatient ultrasound guided BTA injection performed by a hernia surgeon is feasible for both patient and surgeon, resulting in a significant reduction of logistics and costs in our experience. For dedicated abdominal wall surgeons with experience in ultrasound-guided injections, it seems safe to perform these procedures at their outpatient clinic.
TREATMENT OF POSTPARTAL RECTUS DIASTASIS WITH SYMPTOMATIC UMBILICAL AND/OR EPIGASTRIC HERNIA PLUS EXCESSIVE/REDUNDANT SKIN – PROCEDURE AND OUTCOME
Authors: Reiners B , Gröger C , Kundel L , Riediger H , Ostapowicz D , Köckerling F
Published: May 2024

Background

In standard treatment of epigastric and/or umbilical hernias with concominant rectus diastasis a high recurrence rate must be expected. As it is a common postpartal defect in fit female patients, linea alba repair with use of the anterior rectus sheath plus mesh reenforcement combined with abdominoplasty provide both effective reconstructive and aesthetic results for this particular patient cohort.

Methods

We present our 2 years data regarding operative approach and early outcome.

Results

Between 12/2021 until 01/2024 52 female patients underwent this specific procedure. All patients presented with primary or recurrent umbilical hernia combined with postpartal rectus diastasis as well as abdominal skin excess. Additional epigastric hernias occured in 43 patients. Mean BMI was 23 kg/m². Mean surgery duration was 171 minutes. Mean defect area was 18 × 8 cm (140 cm²). Routinely, a nonresorbable polypropylen mesh was placed for augmentation of the reconstructed abdominal wall (mean diameter 17 × 9 cm). Abdominoplasty was performed in all patients removing 658 g of fatty tissue and excessive skin. Mean hospital stay was 4,3 days. Minor postoperative complications with conservative treatment occurred in 5 patients (Clavien Dindo 1: seroma, wound healing disorder). Two patients had local revision surgery for wound complication (Clavien Dindo 3: bleeding, drainage removal).

Conclusion

Performing the abdominal wall reconstruction with use of parts of the anterior rectus sheath and mesh augmentation as well as abdominoplasty is safe and shows promising perioperative results. Long term results and Quality of Life after surgery need to be further investigated.
UTILITY OF THE CARBONELL´S RULE IN eTEP VENTRAL HERNIA REPAIR: A MULTICENTER RETROSPECTIVE STUDY
Authors: Salido S , Guevara-Martínez J , Gutiérrez E , Zapata C , Reinoso F , Georgiades A , Monje B , Fondevila C
Published: May 2024

Objectives

The study aimed to assess the applicability of the Carbonell rule as a predictive tool for the need of component separation (TAR) in extended totally extraperitoneal access (eTEP) ventral hernia repair.

Materials and Methods

A multicenter retrospective study was conducted on prospectively collected data from patients undergoing eTEP repair for midline incisional hernias (W2 and W3 size classification according to EHS) at Fundación Jiménez Díaz and La Paz hospitals in Madrid, between January 1, 2019, and January 31, 2024. Preoperative, intraoperative, and postoperative data were collected. The width of the hernia defect (DW) and the muscle bellies' width (RW) of both rectus abdominis were measured, with the Carbonell rule expressed as 2xRW:DW. CarboTAR was considered predictive of the need for TAR if the value was less than 2.

Results

One hundred eight patients were included. Statistically significant differences were not observed in the studied variables when stratifying patients with positive and negative CarboTAR except for CT-measured defect size, mesh size, and case complexity (37.5% vs. 8.9%; p < 0.001). Overall, the rule demonstrated a sensitivity of 22.73% and specificity of 39.33%. Among patients with botox: sensitivity 21.67%, specificity 78.26%, positive predictive value (PPV) 27.22%, and negative predictive value (NPV) 27.66%. Without botox: sensitivity 33.33%, specificity 78.95%, PPV 33.33%, and NPV 50%.

Conclusions

The Carbonell rule exhibited significant limitations in sensitivity and predictive value for determining TAR necessity in the eTEP technique. These findings highlight the need for alternative diagnostic and technical approaches in addressing potential TAR in eTEP ventral hernia repairs.
USE OF BOTULINUMTOXIN A IN HERNIA SURGERY – RESULTS OF A SURVEY AMONG CERTIFIED GERMAN HERNIA CENTERS
Authors: Schaaf S , Wöhler A , Gerlach P , Willms A G , Schwab R
Published: May 2024

Background

Botulinum toxin A is increasingly used in complex hernia surgery, and the growing body of evidence supports the observation of beneficial effects, such as easing fascial defect closure and reducing the need for component separation and bridging techniques. However, there is no approval for this indication, and thus the use of botulinum toxin A in hernia surgery represents an off-label use that might hamper its applicability in daily routine. The aim of this study was to elucidate the use of botulinum toxin A in certified German hernia centers.

Method

We conducted a survey that covered the indications, methods of administration, suspected effects, and the need for guidance, education, and reimbursement. As of July 2023, a total of 127 hospitals were certified as hernia centers by the German Society of General and Visceral Surgery and were asked to complete an online survey.

Results

56 (44%) centers answered the questionnaire, being level 1 and 2 hospitals in 85% (n = 48). 28 (47%) centers used botulinum toxin in hernia surgery. If it wasn't used, the main reasons were lack of experience (n = 20) and reimbursement (n = 14). The main indications were M2–M4 and all lateral hernias, with a hernia width of W2 or more. The interval to surgery was mostly 4–6 weeks (85%). 77% of the responses agreed on the need for hernia-specific courses for botulinum toxin application held by scientific societies.

Conclusion

Botulinum toxin A application in hernia surgery shows promising results; however, it is still not a standard of care, even in specialized hernia centers. There is a need for education and training held by scientific societies.
PULSED RADIOFREQUENCY OR SURGERY FOR ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME: LONG-TERM RESULTS OF A RANDOMIZED CONTROLLED TRIAL
Authors: ten Have T , van Geffen S T , Zwaans W A R , Maatman R C , Boelens O B A , Steegers M A H , Scheltinga M R M , Roumen R M H
Published: May 2024

Background

Patients with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) often require a step-up treatment strategy including abdominal wall injections, Pulsed Radiofrequency (PRF) or neurectomy. However, long-term success rates of PRF and neurectomy remain largely unknown. The aim of the current study was to report long-term treatment outcomes of PRF and neurectomy in ACNES patients who have participated in the randomized controlled PULSE-trial, which compared the short-term outcomes of both treatments.

Method

Patients who completed the PULSE-trial were contacted about pain status and additional treatments in the subsequent years. Treatment success was based on Numerical Rating Scale (NRS) and Patient Global Impression of Change (PGIC) scores.

Results

A total of 44 of the original 60 patients (73.3%) were eligible for analysis. After a median of 71.5 months, one patient (4.3%) was still pain-free after a single PRF treatment, and five additional patients (21.7%) were pain-free by repetitive PRF treatments. By contrast, 13 patients (61.9%) in the neurectomy group were still pain-free without additional treatments. At the end of follow-up, regardless of additional treatment(s), 35 patients (79.5%) had a significant improvement in pain level based on NRS, while 36 patients (83.7%) scored at least ‘much improvement’ on the PGIC.

Conclusion

Approximately one in five ACNES patients undergoing PRF treatment reports long-term success obviating the need of surgical intervention. Surgery for ACNES is long-term effective in approximately two of three operated patients. Moreover, about 80% of the ACNES patients have a significant long-term pain reduction after their treatment(s).
PROPHYLACTIC MESH-RELATED REOPERATIONS AND MESH-RELATED PROBLEMS DURING RE-LAPAROTOMY: LONG-TERM RESULTS FROM THE PRIMA TRIAL
Authors: van den Berg R , van den Dop L M , Timmermans L , van de Berg M , Pierik E G J M , Roumen R , Reim D , Buijk S , van Brussel J , Lange J F , Jeekel H J , Tanis P J
Published: May 2024

Background

Prophylactic mesh reinforcement (PMA) has proven to reduce the incidence of incisional hernia, especially in high-risk patients, but the morbidity of long-term mesh-related complications are largely unknown. This study aims to evaluate all reoperations after mesh-reinforcement 14 years since the initiation of the PRIMA-trial.

Study design

Patients receiving prophylactic onlay or sublay-mesh in the PRIMA-trial between 2009 and 2012 were included on an as-treated basis from participating centers that made reoperation notes available. Main outcomes were the incidences of abdominal wall complications requiring mesh-explantation, mesh-related ileus, and mesh-related problems during laparotomy for other diagnoses.

Results

Out of 373 patients randomized to PMA, 242 could be included: 127 with onlay and 115 with sublay mesh. Median follow-up was 69 months (IQR 30–199). Thirty-four patients underwent re-operation for any reason during entire follow-up, 22 after onlay (17.3%) and 12 after sublay mesh (10.4%). Reoperation rate for abdominal wall complications that required mesh explantation was 4/127 (3.1%) after onlay and 0% after sublay mesh. Mesh-related ileus occurred in none of the onlay group, and 3/115 (2.6%) in the sublay group. During subsequent laparotomies for other primary diagnoses, adhesions to the meshes were noted in 3/10 (33%) patients in the onlay-group and 1/5 (20%) in the sublay-group, and the mesh was removed in 10/127 (7.9%) and 7/115 (6.1%) patients, respectively.

Conclusions

In high-risk patients receiving a prophylactic mesh during midline laparotomy closure, low incidences of mesh complications requiring re-operation and mesh-related problems during unrelated subsequent laparotomies were found, both for the onlay and sublay techniques.
PREVENTION OF INCISIONAL HERNIA WITH PROPHYLACTIC ONLAY AND SUBLAY MESH REINFORCEMENT VERSUS PRIMARY SUTURE ONLY IN MIDLINE LAPAROTOMIES (PRIMA): LONG-TERM OUTCOMES OF A MULTICENTRE, DOUBLE-BLIND, RANDOMISED CONTROLLED TRIAL
Authors: van den Dop L M , Sneiders D , Yurtkap Y , Werba A , van Klaveren D , Pierik E G J M , Reim D , Timmermans L , Fortelny R , Mihaljevich A L , Kleinrensink G , Tanis P J , Lange J F , Jeekel J ,   PRIMA Trialist Group
Published: May 2024

Background

Incisional hernia occurs approximately in 40% of high-risk patients after midline laparotomy. Prophylactic mesh placement has shown promising results, but long-term outcomes are needed. The present study aimed to assess long-term incisional hernia rates from 2009 until 2022 of the previously conducted randomized controlled PRIMA trial with radiological follow-up.

Methods

In the PRIMA trial, patients with increased risk of incisional hernia formation (AAA or BMI ≥ 27 kg/m2) were randomised into primary suture, onlay mesh or sublay mesh closure in three different countries in eleven institutions. Incisional hernia during follow-up was diagnosed by any of: CT, ultrasound and physical examination, or during surgery. Assessors and patients were blinded until 2-year follow-up. Time-to-event analysis according to intention-to-treat principle was performed with the Kaplan–Meier method and Cox proportional hazard models.

Results

Between 2009 and 2012, 480 patients were randomized: 107 primary suture, 188 onlay mesh and 185 sublay mesh. Five-year incisional hernia rates were 53.4% (95% CI: 40.4–64.8), 24.7% (95% CI: 12.7–38.8), 29.8% (95% CI: 17.9–42.6), respectively. Compared to primary suture, onlay mesh (HR: 0.390, 95% CI: 0.248–0.614, p < 0.001) and sublay mesh (HR: 0.485, 95% CI: 0.309–0.761, p = 0.002) were associated with a significantly lower risk of incisional hernia development.

Conclusion

Prophylactic mesh placement remained effective in reducing incisional hernia occurrence after midline laparotomy in high-risk patients during follow-up from 2009 until 2022. Hernia rates in the primary suture group were higher than previously anticipated, with up to 62% in the AAA group.
HYBRID OPERATION TECHNIQUES ARE A PROMISING OPTION IN THE REPAIR OF VENTRAL ABDOMINAL WALL HERNIAS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Visscher L , Roovers S L , Hueting W E , Tanis P J
Published: May 2024

Background

Ventral abdominal wall hernias (VAWHs) can be repaired using a wide variety of techniques. Most techniques make use of a solely open or solely laparoscopic approach. Novel hybrid approaches intend to combine the advantages and lessen the disadvantages of both. This systematic review and meta-analysis aims to evaluate the complications of hybrid VAWH repair.

Methods

A literature search was performed in five online databases until August 31st 2023. All studies describing hybrid VAWH repair were included. Studies were screened and evaluated independently by two authors. Data on the occurrence of complications were extracted. Meta analyses were performed on studies comparing hybrid and laparoscopic techniques. The study protocol was registered in PROSPERO (CRD42023460789).

Results

A total of 25 studies, based on 22 study populations, were included. Only one randomized control trial has been conducted on this topic. Seven studies, comprising of 815 patients who underwent hybrid repair, made a comparison between hybrid and laparoscopic repair techniques. Fewer surgical site occurrences were seen in patients who underwent hybrid repair (OR 0.36; 95% CI: 0.20–0.64), but no significant difference was found in recurrence rates (OR 0.34; 95% CI: 0.10–1.18).

Conclusion

The hybrid approach appears to be a safe technique for the repair of VAWHs, as it shows fewer postoperative complications and recurrence rates seem promising. More controlled studies are necessary to be able to confirm the strengths of hybrid repair, as current studies are of moderate quality and only of a low level of evidence.
SURGICAL PRACTICES IN EMERGENCY UMBILICAL HERNIA REPAIR AND IMPLICATIONS FOR TRIAL DESIGN
Authors: Walshaw J , Kuligowska A , Smart N J , Blencowe N S , Lee M J
Published: May 2024

Background

There is variation in the investigation, management, and surgical technique of acutely symptomatic abdominal wall hernias and optimal strategies remain to be established. This survey aimed to identify key variables influencing decision-making and preferred surgical techniques in emergency umbilical hernia care to help inform trial design and understand potential challenges to trial delivery.

Methods

A survey was distributed to surgeons through social media, personal contacts, and ASGBI lists. It comprised five sections: (i) performer of repair, (ii) repair preferences, (iii) important outcomes, (iv) antibiotic use, and (v) trial design.

Results

There were 105 respondents, of which 49 (46.6%) were consultants. The median largest defect surgeons would attempt to repair with sutures alone was 2 cm (IQR 2–4cm). In the acute setting, the most common mesh preferences are preperitoneal plane placement (n = 61, 58.1%), with synthetic non-absorbable mesh (n = 72, 68.6%), in clean (n = 41, 39.0%) or clean-contaminated (n = 52, 49.5%) wounds. Respondents believed suture repair to be associated with better short-term outcomes, and mesh repair with better long-term outcomes. The trial design felt to most likely influence practice is comparing mesh and suture repair, and also comparing post-operative antibiotics versus no post-operative antibiotics. Respondents indicated that to change their practice, the median difference in surgical site infection rate and recurrence rate would both need to be 5%.

Conclusion

This survey provides insight into surgical preferences in emergency umbilical hernia management, offering guidance for a future trial design.
LAPAROSCOPIC eTEP IN ACQUIRED ABDOMINAL INTERCOSTAL HERNIA WITH PERITONEAL FLAP WITH LARGE POLYPROPELENE MESH PLACEMENT
Authors: Baste N
Published: May 2024

An 83-year-old Male patient presented with complaints of Swelling in the right lower chest, Right Hypochondrium and Right lumbar region.

H/O – Chronic Cough for 6 months. Swelling increases in size on coughing.

USG S/O – Right Lateral Ventral Hernia (L1 W2).

CT Abdomen S/O – 8x6 cm defect in right anterolateral abdominal wall.

Plan – Laparoscopic E-TEP with unilateral TAR Hernioplasty.

Port position.

Intraop Steps

Supine position under General Anesthesia.

Extended Retro-rectus space created from left side. Bottoms-up right-sided TAR done.

Opening of peritoneum found near defect.

A defect was identified between the right three lower ribs, with 1 rib being the content of the hernia. Evidence of Diaphragmatic hernia was seen. Thoracic contents visualised from the hernia defect. Hence, the diagnosis of acquired abdominal inter-coastal hernia was confirmed.

Omentum & Transverse Colon were also contents of the hernia.

The peritoneal Flap surrounding the defect raised superiorly till the Diaphragm, laterally to Gerota’s Fascia. Peritoneal Flaps were under tension, so the decision was taken to utilise the peritoneum flap of the hernial sac, and accordingly, peritoneal flaps were mobilised.

Diaphragmatic hernia defect sutured with non-absorbable barbed sutures.

Peritoneal defect approximated with absorbable barbed suture.

30 × 25 cm Polypropylene mesh placed in pre-peritoneal space.

Mesh fixed to the edge of the defect.

Pneumo pre-peritoneum deflated.

Ports sites closed and strapping done post op.

Post-operative recovery was uneventful, with a stay in the ICU for 3 days.

Discharged on 7th day post op.
LAPAROSCOPIC MANAGEMENT OF STRANGULATED RECURRENT INGUINAL HERNIA WITH TACKLING OF INTRAOP UNUSUAL DEFECT CLOSURE TROUBLESHOOTING
Authors: Baste N
Published: May 2024

65/male

Presented in casualty with pain in the abdomen, vomiting, distension, constipation, and irreducible swelling in the right inguinal region. Since 3 days.

Ultrasonography – acute intestinal obstruction. X ray of abdomen- air-fluid levels.

Plan – diagnostic laparoscopy.

Procedure – Under GA. 3 ports 1–10 mm umbilical- camera port. 2–5 mm left midclavicular line below 2 cm umbilicus. 3–5 mm right midclavicular at the level of the umbilicus.

Dilated bowel loops.

Hernia defect identified with bowel.

Loops going into defect.

Difficult to reduce bowel loop.

The decision was taken to enlarge the defect. Previously put mesh identified.

Mesh cut in neck of the sack reached with a monopolar hook. Strangulated bowel loops delivered into peritoneum.

Defect closure started with 1 number nonabsorbable barbed suture.

While suturing needle broke.

As the patient is not much afforded, we decided to go ahead with the same suture.

1 mm skin incision with stab knife on the inguinal region. Suture passer needle introduced. But the suture passer needle broke while inserting.

Next plan – prolene loop with veress needle.

Veress needle introduced from same stab incision. Barbed suture introduced into prolene loop n removed outside. Now, the same barbed suture has to go into the abdomen from the opposite side of the defect. But there is difficulty in putting barbed suture into abdomen with a prolene loop and vereses needle. 3 attempts done. Not successful. After thinking for 2–3 minutes, the decision was taken to introduce suture with a Rhoeders knot pusher. The same stab knife incision is used in the different directions. Defect closure completed with Rhoeders knot pusher.

Gangrenous bowel resection and anastomosis were done through a 4 cm laparotomy incision.
EMERGENCY LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL (TAPP) HERNIOPLASTY FOR GARANGEOT'S HERNIA: A CASE REPORT
Authors: Bravo-Salva A , Perez-Guitart M , Riba L , Juvany-Gómez M
Published: May 2024

Aims

This video presentation aims to demonstrate the successful management of a rare and challenging case of Garangeot's hernia through Emergency Laparoscopic Transabdominal Preperitoneal (TAPP) Hernioplasty. The primary objectives include highlighting the surgical technique, intraoperative findings, and postoperative outcomes in the context of this uncommon hernia presentation.

Materials and Methods

An 84-year-old female presented to the emergency department with signs of femoral hernia incarceration. Upon exploration, a Garangeot's hernia, characterized by the presence of the appendix within a femoral hernia sac, was identified. In light of the emergency and the patient's deteriorating condition, an Emergency Laparoscopic TAPP Hernioplasty was performed. The procedure involved meticulous dissection of the hernia sac, reduction of the herniated appendix and appendectomy, and subsequent mesh reinforcement of the femoral defect.

Results

The video illustrates the step-by-step approach to Emergency Laparoscopic TAPP Hernioplasty in the context of Garangeot's hernia. Intraoperative findings, including the condition of the herniated appendix and associated anatomical structures, are presented. Postoperative outcomes, including recovery, complications, and follow-up observations, are discussed to provide a comprehensive understanding of the case.

Conclusions

Emergency Laparoscopic TAPP Hernioplasty emerges as a viable and effective intervention for Garangeot's hernia, offering advantages such as reduced morbidity, quicker recovery, and minimal surgical trauma. This video contributes valuable insights into the management of this rare hernia presentation, emphasizing the role of minimally invasive techniques in achieving successful outcomes.
THE NEW ERA OF ROBOTIC SURGERY: FIRST CASE IN SPAIN OF RIGHT HEMICOLECTOMY ON HUGO RAS™ SURGICAL PLATFORM
Authors: Caruso R , Ferri V , Vicente E , Quijano Y , Duran H , Diaz E , Fabra I , Malave L , Ruiz P
Published: May 2024

Background

Robotic surgery has gained worldwide acceptance over the past decade, with several studies showing that this technique is safe and feasible.

Method

We describe the first robot-assisted right hemicolectomy performed with the new HugoTM RAS (Robotic assisted surgery) (Medtronic®, Minneapolis, MN, USA) in Spain.

Results

The surgical procedures were completed without conversion. No intraoperative complications or technical failures of the system were recorded. The operative time was 200 minutes, the docking time was five minutes, and the length of hospital stay was eight days.

Conclusion

Right hemicolectomy with the HugoTM RAS system is safe and feasible. This experience provides relevant data that may assist early adopters of this surgical platform.
PREAPONEUROTIC ENDOSCOPIC REPAIR (REPA) OF RECTUS DIASTASIS AND VENTRAL HERNIA
Authors: Chanci R , Ocampo A , Martinez J
Published: May 2024

Background

Through this video we want to present the experience in the laparoscopic management of patients with rectus diastasis and concomitant ventral hernia in the city of Medellin (Colombia).

Method

39-year-old male with surgical history of epigastric and umbilical hernia repair in 2021. Clinical complaint of abdominal pain and functional limitation. Abdominal CT with epigastric hernia M3W1, umbilical hernia M3W1 and rectus diastasis T1D2H1. Laparoscopic surgery staff decided preaponeurotic endoscopic repair of rectus diastasis and lightweight microporous polypropylene prophylactic mesh.

Results

In the outpatient follow-up, correction of the abdominal wall defect was evidenced by the physical examination. Furthermore, the patient reported the disappearance of symptoms.

Conclusion

Exploring the minimally invasive route in selected patients, associated with the use of meshes in concomitant ventral hernias larger than 1 cm or multiple hernias will allow us to develop our casuistry and thus develop clinical studies that allow to contribute to the limited evidence that currently exists.
LAPAROSCOPIC REPAIR OF RECURRENT CASES AFTER LAPAROSCOPIC HERNIA SURGERY; MESH REMOVAL AND RE-MESH REPAIR
Authors: Ertem M , Babur T
Published: May 2024

Problems related to mesh and fixation may continue after hernia surgery. In particular, mesh shrinkage and sliding are among the main recurrence problems. The shrinking and meshoma can cause significant pain problems as well as recurrence. The necessity of removing the mesh from deep planes can cause catastrophic consequences. Laparoscopic hernia treatment should be done one time with the correct technique.

In the EHS Guidelines, it is recommended that re-laparoscopic repair (posterior approach) should be performed by experienced surgeons for recurrences that occur after laparoscopic repair.

In this video, three male cases are presented. All three cases were presented as recurrence and also had pain and were repaired with the laparoscopic technique. Recurrence had occurred after the TEP technique in two of three cases and in one case recurrence occurred after two anterior repairs and one posterior TEP repair.

We performed the repair with the TAPP approach in 2 cases and the TEP approach in one case. In all cases, the posterior meshes that formed meshoma were removed. We used one or two Pro Tack for the Cooper’s Ligaments and glue for mesh fixation.

Patients were discharged without complications and pain after a one-day hospitalisation.

Dynamesh 3D visible 10 × 15 cm.

Liquiband FIX8 Glue.

Pro Tack.
NUCK CYSTS; THREE CASES TREATED WITH THE TEP TECHNIQUE
Authors: Ertem M , Babur T
Published: May 2024

The first noted case defect in the Canal of Nuck dates back to 1691 by Anton Nuck. The failure of the canal to close after birth or within the first year of life in female infants can lead to the formation of hydrocele or herniation of intra-abdominal structures through the patent Canal of Nuck. The cysts of the Canal of Nuck are also known as female hydroceles.

In this video presentation, three cases are presented. The diagnosis was made based on the patient's history and clinical examination. The diagnosis was supported by ultrasound. The patient was exhibiting painful swelling in the inguinal region or even in the labia majora.

Surgical intervention was approached with the TEP technique in all cases. Two cases had cysts on the left side and one patient had cysts on the right side. The cysts were dissected from the round ligament and were completely excised. Because of the annulus inguinalis frofundus was wide, the defect closed with mesh. The mesh is fixed with glue. In one of the cases, the peritoneal tear that occurred iatrogenic was also closed with glue. Considering that the patients were young and nulliparous, the round ligament was preserved in three patients.

Dynamesh3D visible 10 × 15 cm.

Liquiband FIX8 Glue.
ENDOSCOPIC DRAINAGE FOR THE MANAGEMENT OF INFECTED SUBCUTANEOUS COLLECTIONS FOLLOWING DIEP FLAP RECONSTRUCTION TECHNIQUE: A CASE REPORT
Authors: Fernández Rodriguez M , Muñoz Rodríguez J M , Román García de Leon L , Grillo Marín C , Gil Cidoncha L , Martin Rodrigo P , Torguet Muñoz M E , Lopez Monclus J
Published: May 2024

Aim

The deep inferior epigastric perforator (DIEP) flap procedure is a widely accepted method for immediate breast reconstruction following skin-sparing mastectomy in breast cancer patients. While complications are infrequent, challenges may arise, including surgical wound infection, skin necrosis, seroma, or hematoma.

Methods

We present the case of a 68-year-old woman with multifocal infiltrating carcinoma of the right breast (T1cN0M0) who underwent DIEP flap breast reconstruction one month before presenting to the emergency room. Her symptoms included a fever of 38°C, abdominal filling in the DIEP scar region, an elevated leukocyte count (23.01 × 10E3/microL), and a C-reactive protein level of 470 mg/L. Abdominal CT revealed a collection in the infraumbilical anterior abdominal wall extending through the subcutaneous cellular tissue of both iliac fossae. The patient underwent surgical intervention, including endoscopic drainage with lavage and drain placement under direct visualization.

Results

Following surgery, the patient responded positively to intravenous Meropenem, with the resolution of fever and improvement in local cellulitis. She was discharged on the 6th postoperative day with both drains, removed 10 and 15 days after surgery in an outpatient setting.

Conclusions

In cases where immediate percutaneous drainage is not feasible, endoscopic drainage emerges as an effective strategy for managing extensive infectious collections. This technique, involving lavage, debridement, and drain placement under direct vision, eliminates the need to reopen substantial surgical wounds. Notably, this approach aids early recovery in patients undergoing active chemotherapy, preventing delays in chemotherapy administration.
FINDING OF CHYLOUS ASCITES SECONDARY TO MESENTERIC COMPRESSION DUE TO GIANT INGUINAL HERNIA: TAPP APPROACH
Authors: Fernández Rodriguez M , Muñoz Rodríguez J M , Román García de Leon L , Grillo Marín C , Gil Cidoncha L , Martin Rodrigo P , Torguet Muñoz M E , Lopez Monclus J
Published: May 2024

Aim

Chylous ascites is an infrequent pathology with an incidence of less than 1%.

We present the case of a patient with chylous ascites in the context of mesenteric compression due to a giant right inguinal hernia.

Material and Methods

We present the case of a 74-year-old woman with a personal history of a heart transplant in 2004 due to cardiomyopathy and a right inguinal hernia that had been going on for years. A CT scan identifies “Right inguinal hernia containing sigmoid and distal ileum”.

Results

During the surgical intervention, a giant right inguinal hernia was reduced with abundant chylous ascites, probably secondary to mesenteric compression.

The patient was discharged on the 1st postoperative day without complications, with dietary recommendations.

In the 1st month review, no signs of recurrence or seroma were identified.

Conclussions

Chylous ascites is defined as the presence of more than 200 mg/dl of triglycerides in the ascitic fluid.

In adults, the most frequent causes are due to cirrhosis and malignant diseases. Another less common cause is post-surgical and traumatic, such as the case we describe, where we relate mesenteric compression and torsion to the development of chylous ascites.

The gold standard imaging test is lymphoscintigraphy. The definitive diagnosis is obtained through evacuative paracentesis.

Management is based on the combination of a diet rich in protein and low in fat, with medium chain triglycerides. In refractory cases, drugs such as Octreotide and Somatostatin can be used. Surgery should be used as a last measure.
ROBOTIC RIVES-STOPPA eTEP LOWER APPROACH FOR THE TREATMENT OF MULTIPLE VENTRAL INCISIONAL HERNIAS IN OBESE PATIENTS
Authors: Friedova P , Acosta Rodríguez A , Rodríguez Valenzuela N , Sánchez González J , Pérez Saborido B
Published: May 2024

Objectives

To demonstrate the benefit of robotic extraperitoneal endoscopic approach for the treatment of ventral incisional hernia in obese patients.

Materials and Methods

Descriptive video of the eTEP endoscopic technique using a lower approach for the treatment of multiple incisional hernias in obese patients. Utilizing a PLP mesh with silver ions.

Results

The postoperative period without complications, discharge 24 hours after surgery, first follow-up at 10 days post-intervention; the patient only required continuous analgesia for the first 72 hours. Three months after surgery, the patient reported no pain, physical examination showed no recurrence and excellent aesthetic results.

Conclusions

The repair of Ventral incisional hernia using the robotic Rives-Stoppa eTEP preperitoneal endoscopic eTEP Rives-Stoppa technique is a feasible and reproducible technique approach. It meets the same criteria as open surgery (broad sublay mesh and tension-free closure) and is safe for obese patients. Additionally, it offers advantages such as less postoperative pain, reduced need for analgesia, promotes rapid recovery, early resumption of work and daily activities and daily in safe manner, and excellent aesthetic result.
ROBOTIC TRANSABDOMINAL PREPERITONEAL DIAPHRAGMATIC HERNIA REPAIR (MORGAGNI HERNIA)
Authors: Gröger C , Kundel L , Adam U , Köckerling F , Riediger H
Published: May 2024

Background

Morgagni hernia is a rare form of diaphragmatic hernia with a low incidence. Robotic surgery offers an interesting technique for sac reduction and extraperitoneal mesh placement.

Method

We present a case of a symptomatic Morgagni hernia, which was repaired utilizing the robotic transabdominal preperitoneal repair (rTAPP) approach.

Results

A 62-year-old female patient (157 cm, 80 kg, BMI 33 kg/m) presented with a symptomatic diaphragmatic hernia (Morgagni hernia). The defect size was 7 to 3 cm with a transverse colon inside the hernia sac and consecutive mediastinal shift. The hernia was repaired by using a robotic assisted minimal invasive approach. After preperitoneal dissection, using the monopolar scissor starting at the falciform ligament the hernia sac was reduced step by step. The defect was closed using barbed sutures. An uncoated 15 × 10 cm polypropylene mesh was placed in the preperitoneal space. Finally, the peritoneal incision was closed with a barbed suture. Posterior defects were closed conscientiously. Operation time was 138 min. Hospital stay was 4 days. There were no complications.

Conclusion

Robotic transabdominal preperitoneal repair (rTAPP) offers an excellent option for repairing of Morgagni hernia. The advantages of the use of a robotic system is the easy-to-manage dissection and the consecutive extraperitoneal/preperitoneal mesh placement without extensive fixation.