bluuebunny/crossref_metadata_2025 huggingface dataset:
V-006 SIMULTANEOUS TREATMENT OF VENTRAL HERNIAS & GROIN HERNIA & RECTUS ABDOMINIS DIASTASIS BY LAPAROSCOPIC E-TEP REPAIR
Authors: Trujillo Díaz J , Jezieniecki Fernandez C , Gomez Lopez J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C
Published: October 2022

Aims

Ventral hernias are a frequent pathology in general surgery.Its association with rectus abdominis diastasis and groin hernias is not uncommon.Currently, the minimally invasive approach of these pathologies is becoming more frequent.We present the usefulness of the e-TEP-approach to treat different types of hernias and diastasis at the same surgical-procedure.

Methods

Video-case presentation.

Results

73-year-old-man,surgical-histories:umbilical-hernioplasty with onlay-mesh and lap-sigmoidectomy. Physical-examination:midline ventral-hernia(M2–3W2:8cm),diastasis(6cm) and right groin hernia. CT-scan: midline ventral-hernia with small-bowel into the hernial-sac and small defect(15mm) in the right flank(L2).We decided to perform a laparoscopic-extraperitoneal-technique(eTEP).

We use 4 ports(2×12mm, 2×5mm).The surgery begins dissecting the left and right retromuscular space using a dissector balloon.We continue with the supraumbilical cross-over transecting the left posterior-sheath and then the right posterior-sheath and complete the dissection of the other retromuscular space.The dissection continues down to the pubis, dissecting the right groin space.We continue with the right-TAR,at this area we observe the lateral defect and continue the dissection on the preperitoneal-space.After that we continue with the closure of the posterior-sheath using 2–0 V-lock and the anterior-sheath using Monomax-loop-1.We placed a 3D-PVDF-mesh for right groin-hernia and 30×40cm-PVDF-mesh fixed with glue and left a drainage.The patient had a satisfactory evolution and was discharged in 2°POD.

Conclusions

The enhanced view totally-extraperitoneal approach (eTEP) is an effective and safe option in cases of ventral hernias associate with groin hernias and rectus abdominis diastasis,as in the case presented.Posterior component separation-techniques(TAR) allow us to achieve a correct and tension-free closure of the abdominal wall and place a wide mesh covering all hernial-defects.
V-010 LAPAROSCOPIC TAPP APPROACH OF A GRYNFELLT HERNIA
Authors: Medina Pedrique M , Aviles Oliveros A , Perez-Flecha Gonzalez M , De Robin Valle De Lersundi A , Cruz Cidoncha A , Rial Justo X , Guijarro Moreno C , García-Ureña M Á
Published: October 2022

Aim

To describe our laparoscopic transabdominal preperitoneal approach of a Grynfellt hernia.

Material & Methods

A female patient 69 years of age with no previous medical history came to our consultation with a chronic right lumbar bulge that produced local pain and discomfort. Preoperative CT scan showed a primary lumbar hernia with a defect estimated at 11cm. Laparoscopic approach seemed feasible and was accepted.

Results

The patient was placed on a left decubitus with the OR bed at a 45° angle. 3 trocars were used, one slightly lateral of the umbilicus for the camera, and for triangulation a subcostal 5mm and an 11mm trocar in the left flank. We started opening the peritoneum and performing preperitoneal space dissection. The hernia sac was identified and its contents were reduced. We closed the defect using a monofilament absorbable barbed suture with a running stitch. Once the defect was closed, we placed a medium-weight polypropylene mesh in a 3D “taco” configuration covering the defect with sufficient overlap. Both the mesh and the peritoneum closure were done using cyanoacrylate glue. No complications occurred and discharge was the next day.

Conclusions

Primary lumbar hernias are rare. Symptomatic hernias should be treated as they can lead to pain, discomfort, and a decrease in quality of life. Laparoscopic TAPP is a safe and simple way to access and repair these hernias, allowing an adequate space of dissection that permits the placement of a mesh tension-free with sufficient overlap, with a quick recovery time and minimal morbidity.
V-011 E-TEP RIVES STOPPA'S REPAIR USING ONLY 3 PORTS
Authors: Gadgil M
Published: October 2022

E-TEP RS repair has revolutionized ventral hernia surgery since the last few years.

Our modified technique uses only 3 ports (10mm, 5mm, 5mm), only one camera port, only one monitor, routinely available reusable trocars, no use of space creator balloons, only a single 10mm 30 degree telescope, no fancy energy sources; rather a novel, inexpensive autoclaveable bipolar cutter shear which not only makes it cost effective but also reproducible.
V-014 OPEN REPAIR OF PRIMARY LUMBAR HERNIA WITH PREPERITONEAL MESH
Authors: Katzen M , Sacco J , Tawkaliyar R , Colavita P , Augenstein V , Heniford B T
Published: October 2022

This video presents an open repair of a primary lumbar hernia with preperitoneal mesh performed at a high-volume hernia center. The patient was a 71-year-old female referred due to chronic pain from a primary hernia of the right superior lumbar triangle.

The patient was positioned in the left lateral decubitus position with the bed slightly flexed. A skin incision was created sharply, and electrocautery used to dissect subcutaneous tissue and superficial fascia, revealing the hernia contents.

Circumferential lysis of adhesions was performed with blunt and cautery dissection to release the hernia contents from the abdominal wall. Once the hernia contents were mobilized, they were then carefully reduced through the fascial defect. The hernia defect measured approximately 3.5×3.5 cm.

Next, the preperitoneal space was circumferentially developed. This was done primarily with blunt finger dissection, using a rolling motion to direct pressure towards the abdominal wall and sweep the peritoneum and other attachments down. Larger attachments are gently retracted and divided with electrocautery. The preperitoneal space was measured at 20×19 cm and the mesh trimmed to those dimensions. The mesh was carefully laid flat in the preperitoneal space. No mesh fixation was required.

Fascial edges were dissected free for 1–2cm surrounding the defect. Two running 1–0 PDS sutures were used to close the hernia defect. A closed-suction drain was placed superficial to the fascia to minimize seroma formation. The superficial fascia and dermis were closed in layers. The patient had a routine hospital course and was discharged on post-operative day 3.
V-015 ROBOTIC TARUP: TECHNICAL DETAILS AND INNOVATIVE METHOD OF FIXATION
Authors: Pecchini F , Esposito S , Casoni Pattacini G , Gozzo D , Trapani V , Piccoli M
Published: October 2022

Aim

With the recent evolution of minimally invasive hernia repairing techniques, robotic platform has exponentially gained consensus in the field of abdominal wall surgery, leading to the placement of retromuscolar synthetic meshes avoiding the need of extensive tissue dissection as the open approach.

Our aim was to describe the introduction of Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair (TARUP) at a referral centre for advanced mini-invasive surgery, by reporting the preliminary experience and the technical aspects of the procedure.

Material & Methods

We present a case of a 3 cm umbilical defect associated to supraumbilical diastasis in a young man undergoing TARUP with the Da Vinci Xi system. The robotic boom was placed on the patient's right side, with three trocars on the anterior axillary line. The outline for the mesh was marked by centering the hernia defect with transcutaneous needles to delineate the extent of dissection corresponding to mesh area. Intra-abdominal pressure was of 8–12 mmHg. A retromuscolar plane was created starting from the incision of the ipsilateral posterior rectus sheat. The hernia content was reduced. The junction between the anterior and posterior rectus fascia was incised to cross-over the linea alba and continue the dissection controlaterally. A 15×15 cm polypropylene mesh was positioned in the retrorectus space and fixed with cyanoacrylic glue tack.

Results

Intervention lenght was of 100 minutes. No intra- or post-operative complications occurred.

At present, no early recurrences were observed.

Conclusions

Robotic TARUP represents a safe and reproducible alternative in selected cases where retromuscolar mesh is preferred.
V-016 PARAHIATAL HERNIA: A RARE CASE OF DIAPHRAGMATIC HERNIA ROBOTICALLY REPAIRED
Authors: Pecchini F , Trapani V , Francescato A , Esposito S , Casoni Pattacini G , Gozzo D , Piccoli M
Published: October 2022

Aim

Parahiatal hernia is a rare type of diaphragmatic hernia, consisting in a adjacent but separated defect, lateral to the oesophageal hiatus and crus. It's not so familiar for surgeons, preoperative diagnosis is unlikely to be confirmed, and it is mostly found incidentally during intervention, leading to a complex and difficult repair.

We present a case of parahiatal hernia robotically treated with the aim of emphasizing how robotic system can successfully help surgeons in performing even unexpected confusing and challenging anatomic dissections and procedures.

Material and Methods

A 65-year-old woman underwent robotic parahiatal hernia repair at our Institution. Four robotic trocars were positioned along the transverse umbilical line with the additional Air-seal port at the periumbilical left side for assistant's use.

Dissection and isolation of both parahiatal defect and crural musculature were performed; the defect was closed with not absorbable barbed suture, conventional iatoplasty was also performed and a biosynthetic mesh was placed and fixed as a reinforcement.

Results

The duration of the intervention was of 100 minutes. No. intr- or post-operative complications occurred. Blood loss were inferior than 100 millilitres. The patient started oral intake at the second post-operative day and after discharged.

At six months no recurrences were detected.

Conclusions

Parahiatal hernia are rare entities of which surgeons should be aware. Robotic treatment is safe and feasible and it represents a good tool for a successful management.
V-022 HYBRID APPROACH E-TEP AND OPEN FOR COMBINED LUMBAR AND MIDLINE HERNIAS
Authors: Román García De León L , Polaino Moreno V , Muñoz Rodríguez J M , Serrano González J , Iglesias García E , Suárez Sánchez M , Gil Cidoncha L , López Monclús J
Published: October 2022

Aim

To present the case of a 61-year-old woman with a recurrent lumbar incisional hernia L4W3R (EHS Classification) associated with a primary midline hernia, as well as a proposed treatment by combined e-TEP and open approach.

Material and Methods

This is a 61-year-old woman with a personal history of obesity, with an open right nephrectomy and later onlay hernia repair.

She had a large lumbar eventration with an 11 cm defect (L4W3) associated with a primary midline hernia with rectus diasasis.

We performed a hybrid e-TEP approach for the midline hernia associated with lumbar open approach to perform a complete repair by reverse-TAR technique.

Results

The treatment of combined lateral and midline hernias remains controversial. In patients in whom the lateral hernia is the primary hernia, one of the proposed approaches would be to perform a posterior component separation from the lateral defect. This involves performing a reverse transverse abdominis release (reverse-TAR), opening the rectus sheath from the lateral preperitoneal plane.

In obese patients and with large defects, performing this step can be highly complicated due to the difficulty for correct visualization of the area.

Conclusions

We propose this combined approach, performing a minimally invasive surgery for the dissection of the midline defect, which allows us to perform in a simpler way later the approach from the side, as well as a better exposure and visualization of the area; thus allowing, despite the technical difficulty, the correct placement of a large mesh, which widely covers all the defects.
V-026 UTILITY OF THE LAPAROSCOPIC APPROACH IN INCARCERATED GROIN HERNIAS: A VIDEO-CASE REPORT
Authors: Jezieniecki Fernández C , Trujillo Díaz J , Herreros Rodríguez J , Ruiz Soriano M , Gómez Sanz T , Cabezudo Molleda G , Montes Manrique M , Beltran De Heredia Renteria J
Published: October 2022

Aims

Groin hernias are one of the most frequent pathologies in general surgery.Open repair remains the most widely used method.However,currently the minimally invasive approach is increasing, but the criteria or indications to use this approach in emergency surgery are still not entirely clear.

Methods

Video-case presentation.

Results

62-year-old-man,who came to the emergency-room for abdominal pain, nausea and vomiting, associated with a small painful lump in the right groin.Physical examination:abdominal distension and a painful lump in the lower region of the right inguinal-ligament, non-reducible,CT-scan:small bowel obstruction due to incarcerated femoral-hernia.We decide to perform an urgent surgical-intervention using a minimally-invasive-approach(Lap-TAPP).

A laparoscopic-TAPP-approach is performed with 3ports(1×12 and 2×5mm).An incarcerated small bowel is observed in the right-femoral-region with signs of distress and causes retrograde dilation of the small bowel loops,with meticulous pulling maneuvers reduction of the incarcerated small bowel is achieved.Peritoneal opening is performed and the Retzius and Bogros-space is dissected, subsequently the cord is dissected and the round ligament is sectioned,a 10×14cm PPL-mesh is placed.The peritoneum is closed with a 3/0V-Lock.Finally,we reviewed the small bowel and performed an invaginating suture on the incarcerated antimesenteric border.The patient presented a satisfactory evolution and was discharged the 1°POD.

Conclusion

Incarcerated inguino-crural hernia has a high risk of morbidity and mortality.The surgeon on call must have different technical resources to deal with this pathology.The Lap-TAPP approach allow us to check the viability of the incarcerated small bowel.In selected cases,experienced surgeons can perform laparoscopic small bowel resection and anastomosis in patients with necrosis or perforation.
V-029 TOTALLY ENDOSCOPIC SUBLAY (TES) REPAIR FOR L2-L3 INCISIONAL HERNIA
Authors: Munoz-Rodriguez J , Lopez-Monclus J , Roman L , Robin A , Blazquez Hernando L , Garcia-Urena M A
Published: October 2022

Aim

Endoscopic lateral incisional hernia (IH) repair provides advantages in terms of low infection rates and hospital stay when compared with open repair.

Material and Methods

62 years old men with a history of HTA and an open radical right nephrectomy for a renal tumor, developed a symptomatic iliac IH. L2–3 W2 according to the European Hernia Society (EHS) classification was clinically diagnosed and confirmed with a CT scan.

Full endoscopic abdominal wall repair with defect closure was proposed.

3 trocars in right retrorectus space were placed. Once the lateral edge of the rectus sheath is reached, the posterior rectus sheath is incised, access to the preperitoneal lateral plane. During hernia sac dissection, an opening of the hernia sac occurs. The posterior layer is closed by a barbed suture, an accessory trocar placement was necessary for the closure. Subsequently, the internal oblique and transversus abdominis muscles that formed the defect were approximated with a barbed suture.

During dissection, a right inguinal hernia was identified and repaired.

A trimmed 20 x15 cm polipropilene mesh is placed in the preperitoneal space without fixation.

Results

The patient was discharged on the 3rd postoperative day without complications. Follow-up in the outpatient clinic at 6 months did not show any signs of recurrence.

Conclusion

Endoscopic abdominal wall reconstruction with posterior component separation is an alternative to the open procedure for lateral IH, providing a complete abdominal wall repair. The mesh is placed extraperitoneal with the advantages in terms of less adhesions and postoperative pain.
V-030 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR OF A RIGHT SPIGELIAN HERNIA USING BIOSYNTHETIC (N-BUTYL CYANOACRYLATE) GLUE FOR MESH FIXATION AND PERITONEAL FLAP CLOSURE
Authors: Chatzimavroudis G , Kyriakidou D , Hadjichristou E , Tsompanis D , Atmatzidis S , Raptis D , Kiroplastis K , Papaziogas V
Published: October 2022

Spigelian hernia consists one of the most uncommon anterolateral abdominal wall hernias (<1%). The defect occurs at the spigelian fascia which is located lateral to rectus abdominis muscle along the linea semilunaris and is comprised of the transversus abdominis and internal oblique aponeuroses. Most commonly the defect is located at or below the level of arcuate line. Its diagnosis may be challenging because the aponeurosis of external oblique remains intact, leading to an intraparietal hernia, with no obvious bulge on inspection or even palpation of the abdominal wall in many cases. Computed tomography (CT) is the most reliable imaging method to diagnose a spigelian hernia. Due to the high risk of strangulation, surgery should be advised to all patients with spigelian hernia. Surgery can be performed either by open or by minimally invasive techniques.

In this video we present the case of a 54-year-old female patient suffering from a symptomatic right spigelian hernia. The diagnosis was suspected during clinical examination and was confirmed with CT. The patient underwent a laparoscopic transabdominal preperitoneal repair. During the procedure, a peritoneal flap was created; the content of the hernia sac, composed from preperitoneal fat, was completely reduced; the defect was closed with 2/0 PDS sutures; a PVDF mesh, measuring 14 cm by 12 cm, was placed in the preperitoneal area and fixed with N-butyl cyanoacrylate glue; the peritoneal flap was closed also with glue.

The patient had an unremarkable postoperative period and was discharged on the first postoperative day in good clinical condition.
V-031 VICRYL MESH WITH ATRAUMATIC FIXATION AS A TECHNICAL RESOURCE FOR DIFFICULT POSTERIOR CLOSURE IN E-TEP APPROACH
Authors: Román García De León L , Muñoz Rodríguez J M , Lucena De La Poza J L , Serrano González J , Artés Caselles M , Martin Rodrigo P , Iglesias García E , López Monclús J
Published: October 2022

Aim

To present a technical resource as a possible solution to the posterior defect that does not allow primary closure in the e-TEP approach for ventral hernias, and which may represent an alternative to transverse abdominis release.

Material and Methods

This is a 44-year-old woman with obesity and previous hysterectomy via infraumbilical median laparotomy. She presented with an M3W1 in incisional hernia with a 4 cm defect containing the transverse colon.

Results

After performing a retromuscular dissection according to the Rives-Stoppa technique, it was found that there was a continuous tear in the most cranial area of the posterior layer, which was not corrected with the primary suture.

It was therefore decided to place an absorbable vicryl mesh to cover the defect, fixed atraumatically with cyanoacrylate.

Conclusion

During a minimally invasive ventral hernia repair, closure of the peritoneal sac can be technically complex. This leads to exposure of the retromuscular polypropylene mesh, which would come into contact with the visceral bundle, and possible herniation of intestinal contents through the posterior defect.

In these cases, one of the most proposed option is the release of the transverse abdominal muscle, but it could increase the technical difficulty and surgical time.

As an alternative to this, we propose the placement of an absorbable vicryl mesh, covering the defect, fixed atraumatically with cyanoacrylate. This, as shown in this case, ensures posterior coverage of the mesh and does not hinder subsequent extension of the mesh.
V-033 LATERAL INCISIONAL HERNIA. IPSILATERAL ENDOSCOPIC TRANSVERSUS ABDOMINAL RELEASE AND PREPERITONEAL REPAIR
Authors: Zárate Gómez J , Álvarez De Sierra Hernández P , Fernández Luengas D , Supelano Eslait G , Peinado Iríbar B , Conde Someso S , Gil López J M , Merello Godino J
Published: October 2022

We present the clinical case of a 58 year old patient with a left subcostal incisional hernia, years after an emergent aortic thrombectomy and aortobifemoral bypass.

The physical examination revealed a lateral subcostal bulge near the anterior axillary line. CT findings showed a left lateral 5 cm defect without significant muscular atrophy.

An endoscopic ipsilateral transversus abdominal release (TAR) and preperitoneal mesh repair was successfully performed.

1: Port placement.

We used one 10 mm port and two 5 mm ports in a left near-midline position.

2: Retrorectal and Bogros space dissection.

Locating the arcuate line and opening the posterior rectus sheath we then proceeded with the left transversus abdominal release (in a down to up direction).

3: Hernia dissection.

After the hernial sac is identified we opened it to explore the peritoneal cavity and release the possible adhesions if encountered.

4: Full space dissection.

Once the defect dissection is finished, we fully completed the TAR in order to achieve a satisfactory space for the mesh placement.

5: Defect closure.

We performed a two-plane resorbable continuous barbed suture.

6: Mesh placement.

We measured the surgical space in order to insert a tailored mesh and lay it without fixation or drain.

Clinical outcome: The patient is discharged on postoperative day 1 and took acetaminophen 3 times daily for 48 hours, due to good pain control. On the first postoperative followup (10 days) the patient had resumed usual activities, driving and was already back to work. He was advised to avoid heavy efforts.
V-035 EXTERNAL OBLIQUE MUSCLE´S RETROFASCIAL APPROACH: IS THAT AN OPTION?
Authors: Osorio Capitán M , Novo Sukia I , Rufo Crespo E , Arruabarrena Oyarbide A , Clemares De La Lama M , Aramendia García I , Busto Vicente M J , Erro Azcarate J M
Published: October 2022

Background

The evolution of Abdominal Wall Surgery has led to increased knowledge of the abdominal wall anatomy and new dissection spaces. New surgical resources have promoted a scenario that advocates the individualization of the patient and the surgical technique. We present a new technique based on a dissection of the anterior rectus muscle´s retrofascial space and the space between oblique muscles from an anterior anatomical approach.

Material & Methods

We present you a case of a 80 years old patient with a reherniation of a right Spiegel hernia and a possible right groin hernia. The patient had a surgical history of both Retzius and right Bogros space intervened. We decided to performe a modified surgical approach dissecting anterior rectus muscle´s retrofascial space and the space between oblique muscles.

Results

The immediate postoperative period was favorable and the patient was discharged after 24 hours of the surgery. The successive reviewes were satisfactory.

Conclusion

Through this video we present an interesting case in which a modified new surgical approach has been performed. Waiting for further results, the External Oblique Muscle´s Retrofascial Approach could be a surgical resource that would facilitate hernia repair when other spaces have been previously intervened.
V-036 LAPAROSCOPIC MANAGEMENT OF ATYPICAL PRESENTATION OF PRIMARY GRYNFELTT HERNIA
Authors: Sarvani M , Lokendra Venkata Prasad M , Kalyan Chakravati K
Published: October 2022

The rarest posterior abdominal wall defect with retro and intra peritoneal contents through the upper lumbar posterolateral wall associated with weakening of the triangle is grynfeltt -lesshaft hernia. Lumbar hernia is initially small and asymptomatic and expands over time and may lead to mild symptoms gradually leading definitely grave complications. Grenynfeltt –lesshaft triangle is quite often missed due to unfamiliar nature . Correcting surgically is the only treatment option. Performing early elective management preferred to avoid grave complications. Lumbar hernia presentations are very limited in number and its laparoscopic hernioplasty was shown in very minimal series. Laparoscopic lumbar hernioplasty with principle similarity to inguinal hernioplasty is undoubtedly the best treatment modality with minimal complications.

Presentation of case

A 50 yrs healthy male without any past surgical history and nil comorbidities presented with a swelling in the right loin region gradually progressive swelling and is more prominent on the cough. Diagnosis confirmed by ultrasonography. The hernia was repaired by laparoscopic Trans abdominal pre-peritoneal approach. It was successfully completed laparoscopically and no conventional method was used. On follow up patient doing well without any signs of infection or any seroma formation noted.

Discussion

Laparoscopic approach is far more advanced and superior to the open approach with adequate long-term results.
V-037 PARASTOMAL MESH INFECTIONS WITH INTESTINAL FISTULA: 2 RARE SURGICAL CASES AND HOW WE FIXED THEM
Authors: Bertoglio C L , Quagli O , Grimaldi S , Alampi B , Morini L , Ferrari G
Published: October 2022

Parastomal hernias (PSH) occur in 50–80% after stoma formation and its treatment is considered a real challenge. According to the recent literature, the use of prophylactic mesh at the time of primary stoma should decrease the odds of hernia formation. The most common occurrences after PSH surgery are: recurrence, seroma and wound complications.

In this video, we report 2 cases of mesh infection with fistula necessitated removal after 10 and 4 years of mesh placement.

The first patient was a 66 years-old male.

In 2007 he underwent radical prostatectomy and pelvic lymphadenectomy following radiotherapy. He underwent a radical cystectomy and Bricker's cutaneous uretero-ileostomy for stenosis of the vesicourethral anastomosis. In 2012 for PSH he underwent laparo-alloplasty with a placement of an intraperitoneal mesh. In February 2022, with fever and dyspnoea, at the CT-scan of the abdomen we found air bubbles near the mesh and a suspected sigmoid-to-mesh fistula.

The second patient was a 66 years old male.

In 2018 the patient underwent neoadjuvant radiotherapy, then Miles’ procedure and prophylactic 3D intraperitoneal mesh, subsequent adjuvant therapy. During the oncological follow-up an abdominal CT-scan showed air bubbles around the stoma and suspicion of fistula on the adjacent intestinal loops.

In both cases there was an infection of the area around the stoma due to a fistula between the mesh and the intestine. We proceeded, in laparoscopy, to remove the infected mesh. We converted in open surgery with the resection of the fistulized intestine tract and we did a new ostomy.
V-039 EXPANDED INDICATION FOR LAPAROSCOPIC INTRACORPOREAL RECTUS MUSCLE APONEUROPLASTY (LIRA) IN PARASTOMAL HERNIA
Authors: Navarro-Morales L , Licardie E , Gómez-Menchero J , Suárez-Grau J , Bellido J , Morales-Conde S
Published: October 2022

Aims

Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) is a minimally invasive technique for the repair of incisional hernias from M2 to M4, but using the basic concepts of the technique, it allows an extended indication for other types of hernias such as suprapubic, lateral, or as in our case, the parastomal.

The aim is to present step by step the larparoscopic aponeuroplasty technique as an alternative for parastomal hernia repair, as a modification of the original LIRA-technique.

Material & Methods

We present a 56-year-old patient with a history of abdominoperineal resection in 2012, who presented a symptomatic parastomal hernia. Clinical examination and computed tomography (CT) showed a partially reducible type I parastomal hernia, 8×11cm.

Results

We begin by releasing adhesions and reducing the hernial sac, always with control of the vascular axis, avoiding ischemic events. We opened the peritoneum and the transversus muscle 1–2 cm from the edge of the defect. We closed the defect using the transversus muscle as well as the posterior rectus sheath. We reduce the pneumoperitoneum to adapt the mesh and fix it using non-absorbable tackers and fibrin glue coating.

Conclusions

The LIRA technique guarantees a reconstruction of the midline, reinforcing this area without tension in ventral hernias. Based on this condition, we apply the concepts in a parastomal hernia, the original technique being equally reproducible, providing the advantages of laparoscopic surgery in terms of less pain. and morbidity, and betting on the minimization of tension compared to primary closure, as well as less appearance of seroma.
V-041 ENTEROCUTANEOUS FISTULA TAKEDOWN AND VENTRAL HERNIA REPAIR WITH PREPERITONEAL MESH
Authors: Wilson H , Sacco J , Tawkaliyar R , Augenstein V
Published: October 2022

In this video, we present a 48-year-old otherwise healthy man with a history of perforated appendicitis status post exploratory laparotomy and appendectomy, complicated by an intraabdominal abscess requiring re-exploration and subsequent midline wound dehiscence, incisional ventral hernia, and enterocutaneous fistula managed with a drain. Plastic surgery performed a split thickness skin graft of his midline wound, and his drain was kept in place until surgery. The patient was taken to the operating room for a takedown of his enterocutaneous fistula and an open repair of his incisional ventral hernia. We entered the abdomen in the midline, far away from the fistula. After lysing omental and bowel adhesions, we identified the patient's drain entering the small bowel and exiting about 10 cm distally. We removed the drain from the small bowel and performed a small bowel resection, including the entry and exit points of the drain, and a stapled side-to-side antiperistaltic anastomosis. Preperitoneal planes were developed bilaterally, and the peritoneum was rearranged over the bowel and partially closed to the omentum. We placed a biologic mesh into the preperitoneal plane and secured it in place with transfascial sutures. We then performed a multilayer closure of the fascia and dermis and an incisional negative pressure dressing was placed over the wound. The patient was discharged on postoperative day 4 after tolerating a regular diet and having full return of bowel function. In summary, this video demonstrates several important operative techniques in our approach to this complex case.
V-047 LAPAROSCOPIC TEP- RECURRENT MASSIVE REDUCICLE COMPLETE SCROTAL HERNIA
Authors: Bhowate P
Published: October 2022

The patient was 67 yrs old gentlemen. Swelling over the Left groin for the last one and half year with recent onset discomfort. He was operated on same side 2 years back with open suregry. On clinical examination - large scrotal reducile hernia was observed, another reducible herinia primary was obseved on right side. He was also having symptoms of bladder outlet obstruction for which tablet. silodosin was started. A complete workup was done and patiemt was told about need for folys post operative. He underwent surgery for same under general anesthesia. (video enclosed). The post operative period was eneventful and on follow up of 8 months there is no recurrence. Why laparoscopy - Hernia was reducible, recurrence was on medial aspect. Less tone of abdominal was musculature. Challaanges in laparoscopy - Hernia sac reduction. Opening of sac may happen loss of TEP space, Management of sac, Large mesh covering all defects, post operative seroma, Mesh fixation mutiple places and surggical mangement of contrallaetral hernia in same setting.
V-048 EXPANDING INDICATION OF LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA) TO SUPRAPUBIC AREA: LIRA & TAPE
Authors: Licardie E , Jerí-Mcfarlane S , Navarro L , Bellido J , Gómez-Menchero J , Morales-Conde S
Published: October 2022

Aim

LIRA-technique is a minimally invasive technique described to repair M2–M4 primary and incisional hernias. Defects below this area (M5 –Suprapubic area) could be treated using the concept associated to LIRA, expanding the indication of this technique in combination with a transabdominal partially extraperitoneal (TAPE) repair. The aim of this video is to show the surgical steps combining LIRA & TAPE for M2–M5 ventral hernias.

Material & Methods

75-years-old-female patient with clinical examination and CT-scan showed a 9 cm width incisional hernia(W2), including the supraumbilical(M3), infraumbilical(M4) and suprapubic area(M5) with a total longitudinal length of 18 cm.

Results

The first step of the procedure is to open the peritoneum and posterior rectus sheath at 1–2 cm from the edge of the defect over the arcuate line. This flap allows following the dissection below arcuate line. At the suprapubic area, a bilateral peritoneal flap was done as indicated during the TAPE-repair until both Cooper ligaments are identified. Loop sutures were used for closing the defect, using the rectus muscle below the arcuate line, as well as the posterior rectus sheath above this line. A double-layer mesh is used in this case, being placed intraperitoneally.

Conclusions

The combination of LIRA & TAPE techniques provides an extension of the indication of concept associated to the LIRA for the repair of M5/W2 hernias, which could not be achieved using a conventional technique. Our initial experience with this technique, expanding the concept of LIRA to the suprapubic area, shows no recurrences and no postoperative morbidity.
V-055 LAPAROSCOPIC FUNDOPLICATION WITH HANDXTM HOOK AND NEEDLE HOLDER
Authors: Szold A , Ortenzi M
Published: October 2022

Aim

HandX™ is a handheld, powered laparoscopic device with interchanging single-patient fully articulating instruments. It is electromechanically controlled, and, as the manual interface is handled by the surgeon, beside the patient's bed, the movements of the surgeon's wrist and fingers are translated to the instrument-articulating tip.This report is to show the feasibility and safety of this technology implemented with a monopolar dissecting hook in a complex abdominal procedure.

Materials and Methods

We report the case of the laparoscopic repair of a large hiatal hernia using HandXTM instruments.

Results

The index case was a 69-year-old female with symptomatic large paraesophageal hiatal hernia. Three 5 mm trocars were used: 1 in the left midclavicular line, 1 in on the right of the midline close to the costal arch and 1 assistant on the right midclavicular line, one 11 mm umbilical. The sac was dissected with the HandXTM monopolar hook and the stomach was fully reduced into the abdomen with the hernia sac. The hiatus was closed with three separated stiches handled with the articulating needle holder. A Nissen funduplication was performed. Three separated stiches were used to secure the wrap, using the HandX needle holder. At the end of the operation a mesh was used to reinforce the hiatus. The operative time was 80 minutes, no blood loss nor intraoperative or post-operative complications were recorded

Conclusions

The report showed how the HandX technology could be safely adopted to obtain both a safe dissection and an ergonomically advantageous suture in laparoscopic Nissen fundoplication.
V-056 LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH GORE SINECOR INTRAPERITONEAL BIOMATERIAL: OUR CENTER EXPERIENCE
Authors: Monti E , Latham L , Gianazza S , Zullo A , Odeh M , Colombo E M , Marzorati A , Fanelli M , Costa J , Inversini D , Ietto G , Carcano G
Published: October 2022

Aim

Ventral hernias including incisional ones are very common in our population. Mesh reinforcement options for ventral/incisional hernia repair continue to evolve with advances in polymer science and better understanding of the extracellular matrix. Consensus on the safety and efficacy of these various types of synthetic and biologic mesh has yet to be reached.

Intraperitoneal onlay mesh (IPOM) is the laparoscopic technique most frequently used in our center to treat umbilical and abdominal ventral defects sized 3 cm to 8 cm. Our equipe built an expertise with Gore DualMesh prosthesis (2% recurrence ratio in our center); we used the Gore Sinecor Intraperitoneal Biomaterial for the first time here.

Methods

Symptomatic supraumbilical incisional hernia in a 74 years old man; parietal defect sized 7×8 cm. We performed an Ipom repair procedure using a 20×25 cm Gore Sinecor Intraperitoneal Biomaterial, trimmed to 18×20 cm. Follow-up at one and six months from surgery.

Results

The patient was discharged the day after surgery. He did not complain severe pain in the first week after surgery and he only use Paracetamolo 1g die as antalgic therapy. After seven days he resumed his daily activities.

He did not experience any short-term sieroma nor long-term complication at follow up.

Conclusions

The Gore Sinecor Intraperitoneal Biomaterial, while maintaining a firm peritoneal adhesivity, has a better handling and feels lighter than the Gore DualMesh we routinely use. The transparency makes it possible to visualize the overlying abdominal wall, allowing a safer tacs positioning.
V-057 INTRAPERITONEAL ONLAY MESH (IPOM) TECHNIQUE FOR THE LAPAROSCOPIC TREATMENT OF INGUINAL HERNIA
Authors: Bellino R , Giaccone M , Sandrucci S
Published: October 2022

Laparoscopic treatment of inguinal hernia is a widely accepted technique, especially in the case of bilateral or recurrent inguinal hernias. The evolution of materials has led to the successful use of double layer prostheses for the intraperitoneal treatment of wall defects, significantly reducing the mesh-related complications.

In this regard, the literature data and the availability of non-absorbable, transparent, light surgical prostheses in polypropylene, composed of a macroporous monofilament mesh and a transparent film, have led to the re-proposal of the IPOM technique also for the treatment of primary inguinal hernias.

After the laparoscopic access in the abdomen using a 10 mm trocar in the umbilical region and two 5 mm trocars operating in the Iliac fossae, the hernia is reduced by returning the hernial contents to their original compartments and the hernial sac is closed with the possible lipoma using purse-string suture. Subsequently, a polypropylene composite prosthesis is then inserted into the abdomen, centered on the defect and fixed to the wall by tack and chemical glue.

To date we have performed 10 procedures on 6 patients (4 with bilateral hernia). The longest follow-up is one year. The patients were all discharged the day after the surgery, reporting a mean postoperative pain score (assessed with EHS QoL scale) equal to 2 (range: 0–4), and the work resumption after a week in average.

This technique, which is easy to perform and reproducible, can significantly reduce operating times and minimize complications related to the preparation of the peritoneal pocket.
Teaching Social Work Practice Skills: A Collaborative Autoethnography Identifying Key Practice Skills and Modes of Delivery in the Art of Social Work Practice
Authors: Turner George W , Round Rohena , Chhetry Dibya Shree
Published: October 2022

Social work students must advance their social work skills gaining practice competencies. And, whilst practice learning takes place in field education placements, social work students often also enrol in a dedicated unit/ course whereby the teaching of practice skills is facilitated in class. A practice skills class is another learning space to imbue practice wisdom. Adjunct teaching staff are often employed on short-term university contracts to teach social work students in the area of practice skills. Whilst these practitioners can bring a wealth of experience and expertise to the under-graduate classroom, it cannot be assumed that adjunct teaching staff have formal training in curricula development nor pedagogical delivery. The goal of this article is to identify the critical elements of teaching practice skills and to examine the ways in which teaching content is delivered. This article presents the ‘teaching the teacher’ experience of three social work educators at an Australian university. A collaborative autoethnography identified three themes from the inductive analysis: (i) teaching best practices, (ii) teaching role and (iii) teaching practice skills. Finally, implications for social work are discussed and recommendations shared.
Parallel in-depth analysis of repeat expansions in ataxia patients by long-read sequencing
Authors: Erdmann Hannes , Schöberl Florian , Giurgiu Mădălina , Leal Silva Rafaela Magalhaes , Scholz Veronika , Scharf Florentine , Wendlandt Martin , Kleinle Stephanie , Deschauer Marcus , Nübling Georg , Heide Wolfgang , Babacan Sait Seymen , Schneider Christine , Neuhann Teresa , Hahn Katrin , Schoser Benedikt , Holinski-Feder Elke , Wolf Dieter A , Abicht Angela
Published: October 2022

Instability of simple DNA repeats has been known as a common cause of hereditary ataxias for over 20 years. Routine genetic diagnostics of these phenotypically similar diseases still rely on an iterative workflow for quantification of repeat units by PCR-based methods of limited precision.

We established and validated clinical nanopore Cas9-targeted sequencing, an amplification-free method for simultaneous analysis of 10 repeat loci associated with clinically overlapping hereditary ataxias. The method combines target enrichment by CRISPR–Cas9, Oxford Nanopore long-read sequencing and a bioinformatics pipeline using the tools STRique and Megalodon for parallel detection of length, sequence, methylation and composition of the repeat loci.

Clinical nanopore Cas9-targeted sequencing allowed for the precise and parallel analysis of 10 repeat loci associated with adult-onset ataxia and revealed additional parameter such as FMR1 promotor methylation and repeat sequence required for diagnosis at the same time. Using clinical nanopore Cas9-targeted sequencing we analysed 100 clinical samples of undiagnosed ataxia patients and identified causative repeat expansions in 28 patients. Parallel repeat analysis enabled a molecular diagnosis of ataxias independent of preconceptions on the basis of clinical presentation. Biallelic expansions within RFC1 were identified as the most frequent cause of ataxia. We characterized the RFC1 repeat composition of all patients and identified a novel repeat motif, AGGGG.

Our results highlight the power of clinical nanopore Cas9-targeted sequencing as a readily expandable workflow for the in-depth analysis and diagnosis of phenotypically overlapping repeat expansion disorders.
Mutant huntingtin messenger RNA forms neuronal nuclear clusters in rodent and human brains
Authors: Ly Socheata , Didiot Marie-Cécile , Ferguson Chantal M , Coles Andrew H , Miller Rachael , Chase Kathryn , Echeverria Dimas , Wang Feng , Sadri-Vakili Ghazaleh , Aronin Neil , Khvorova Anastasia
Published: October 2022

Mutant mRNA and protein contribute to the clinical manifestation of many repeat-associated neurological disorders, with the presence of nuclear RNA clusters being a common pathological feature. Yet, investigations into Huntington's disease – caused by a CAG repeat expansion in exon 1 of the huntingtin (HTT) gene – have primarily focused on toxic protein gain-of-function as the primary disease-causing feature. To date, mutant HTT mRNA has not been identified as an in vivo hallmark of Huntington’s disease. Here, we report that, in two Huntington’s disease mouse models (YAC128 and BACHD-97Q-ΔN17), mutant HTT mRNA is retained in the nucleus. Widespread formation of large mRNA clusters (∼0.6 to 5 µm3) occurred in 50-75% of striatal and cortical neurons. Cluster formation was independent of age and driven by expanded repeats. Clusters associate with chromosomal transcriptional sites and quantitatively co-localize with the aberrantly-processed N-terminal exon 1-intron 1 mRNA isoform, HTT1a. HTT1a mRNA clusters are observed in a subset of neurons from human Huntington’s disease post-mortem brain and are likely caused by somatic expansion of repeats. In YAC128 mice, clusters, but not individual HTT mRNA, are resistant to antisense oligonucleotide treatment. Our findings identify mutant HTT/HTT1a mRNA clustering as an early, robust molecular signature of Huntington’s disease, providing in vivo evidence that Huntington’s disease is a repeat expansion disease with mRNA involvement.
Brain structure in autoimmune Addison’s disease
Authors: van’t Westeinde Annelies , Padilla Nelly , Siqueiros Sanchez Monica , Fletcher-Sandersjöö Sara , Kämpe Olle , Bensing Sophie , Lajic Svetlana
Published: October 2022

Long-term disturbances in cortisol levels might affect brain structure in individuals with autoimmune Addison’s disease (AAD). This study investigated gray and white matter brain structure in a cohort of young adults with AAD. T1- and diffusion-weighted images were acquired for 52 individuals with AAD and 70 healthy controls, aged 19–43 years, using magnetic resonance imaging. Groups were compared on cortical thickness, surface area, cortical gray matter volume, subcortical volume (FreeSurfer), and white matter microstructure (FSL tract-based spatial statistics). Individuals with AAD had 4.3% smaller total brain volume. Correcting for head size, we did not find any regional structural differences, apart from reduced volume of the right superior parietal cortex in males with AAD. Within the patient group, a higher glucocorticoid (GC) replacement dose was associated with smaller total brain volume and smaller volume of the left lingual gyrus, left rostral anterior cingulate cortex, and right supramarginal gyrus. With the exception of smaller total brain volume and potential sensitivity of the parietal cortex to GC disturbances in men, brain structure seems relatively unaffected in young adults with AAD. However, the association between GC replacement dose and reduced brain volume may be reason for concern and requires follow-up study.
Anorectal Testing for Mpox Virus Infection in Men Who Have Sex With Men With and Without Proctitis
Authors: Meyerowitz Eric A , Gendlina Inessa , Desai Vimi J , Grossberg Robert , Nair Singh R , Pujar Beendu , Riska Paul F , Root Heather B , Toro Justin , Torres Julian A , Pirofski Liise-anne , Zingman Barry S
Published: October 2022

We performed anorectal testing in 18 cis-gender men who have sex with men with symptoms consistent with mpox virus (MPXV) infection. We found rectal MPXV DNA in 9/9 with and 7/9 without proctitis. Future study of anorectal testing is needed and may inform the diagnosis and pathogenesis of MPXV disease.
MALDI–TOF–MS for Rapid Screening and Typing of β-Globin Variant and β-Thalassemia through Direct Measurements of Intact Globin Chains
Authors: Zhang Qianqian , Wang Ge , Sun Dehui , Lin Wanying , Yan Tizhen , Wu Yuanjun , Wu Meiying , Chen Jianhong , Zou Shaomin , Xie Wenchun , Zhou Yuqiu , Wang Yuxi , He Linlin , Liu Yanhui , Qiu Zhenxiong , Hu Lingling , Lin Bin , Zhou Xiaoguang , Li Yan , Xu Xiangmin
Published: October 2022

Background

Traditional phenotype-based screening for β-globin variant and β-thalassemia using hematological parameters is time-consuming with low-resolution detection. Development of a MALDI–TOF–MS assay using alternative markers is needed.

Methods

We constructed a MALDI–TOF–MS-based approach for identifying various β-globin disorders and classifying thalassemia major (TM) and thalassemia intermedia (TI) patients using 901 training samples with known HBB/HBA genotypes. We then validated the accuracy of population screening and clinical classification in 2 separate cohorts consisting of 16 172 participants and 201 β-thalassemia patients. Traditional methods were used as controls. Genetic tests were considered the gold standard for testing positive specimens.

Results

We established a prediction model for identifying different forms of β-globin disorders in a single MALDI–TOF–MS test based on δ- to β-globin, γ- to α-globin, γ- to β-globin ratios, and/or the abnormal globin-chain patterns. Our validation study yielded comparable results of clinical specificity (99.89% vs 99.71%), and accuracy (99.78% vs 99.16%) between the new assay and traditional methods but higher clinical sensitivity for the new method (97.52% vs 88.01%). The new assay identified 22 additional abnormal hemoglobins in 69 individuals including 9 novel ones, and accurately screened for 9 carriers of deletional hereditary persistence of fetal hemoglobin or δβ-thalassemia. TM and TI were well classified in 178 samples out of 201 β-thalassemia patients.

Conclusions

MALDI–TOF–MS is a highly accurate, predictive tool that could be suitable for large-scale screening and clinical classification of β-globin disorders.