bluuebunny/crossref_metadata_2025 huggingface dataset:
EXTENDED TOTALLY EXTRAPERITONEAL (eTEP) ASSOCIATED TO TRANSVERSUS ABDOMINIS RELEASE (TAR) IN THE MULTI-RECURRENCE VENTRAL HERNIA
Authors: Gómez Menchero J , Aguilar A , Lara Y , Navarro L , Licardie E , Bellido J , Moreno F , Garcia Moreno J
Published: May 2024

Aim

Minimal invasive surgery of the abdominal wall has evolved in the last years. Endoscopic extraperitoneal approach shows a good vision in the reparation of ventral hernias. Complex hernias can be repaired in this way with a low rate of recurrence and postoperative pain. Our objective is to show the advantages of this endoscopic approach to solve the multi-recurrence ventral hernia.

Methods

A male 58 years old who underwent 3 prior surgeries of a umbilicus hernia (herniorraphy, hernioplasty with polipropilene (PPL) onlay mesh, onphalectomy and new hernioplasty with PPL mesh) is examinated for a new recurrence M2 M3 M4 W3 (following EHS Classification) and a diastasis associated. A Computerized Tomography (CT) is performed to plan the procedure showing a 10 cm width defect. Botuline toxin were applied (Ibarra´s technique) 30 days before planning a totally endoscopic approach (eTEP). We used three ports in the left side of the abdomen (optic 12 mm and BTT 11 mm and 5 mm in the border of the left rectus muscle. A Spacemaker is used to dissect the retrorectus space. Cross over is performed to dissect the contralateral retrorectus space. Three ports are positioned in the right side. A TAR is performed in both sides (Down to up).

Posterior fascia was sutured using a 3.0 barbed suture. Anterior fascia was sutured using a barbed suture 0 to close the defect.

A PVDF mesh (40 × 30 cm) was positioned using an autramatic fixation with cianocrilate.

Conclusion

eTEP is a safe procedure with good results in middle line hernias, even in those cases with large defects. It is possible to associate this technique to prehabilitation using Toxine to get a higher overlap mesh/defect ratio with the mesh. More studies are needed to reach more conclusions.
ROBOTIC-ASSISTED SINGLE DOCKING TAR
Authors: Grimaldi S , Alampi B D A , Morini L , Nicastro V , Marin J N , Ferrari G
Published: May 2024

Background

Transversus abdominis release (TAR) was introduced in 2012 and has emerged as a preferred method for addressing wide and complex ventral hernias. In recent years, it has been explored the role of minimally invasive approach in retromuscular repairs, to permit a minimally invasive anatomical reconstruction and placement of the mesh in an extraperitoneal location.

Advancements in robotic surgery have led to increase the utilization of robotic approach to repair complex ventral hernias, combining the benefits of minimally invasive techniques with TAR. Our aim is to describe our surgical technique of a robotic-assisted single-docking TAR.

Method

Supine patient, we induced pneumoperitoneum with the Veress needle and inserted three 8 mm robotic trocars on the left side. Upon exploration of the abdominal cavity, we found a border incisional hernia in the right flank/iliac fossa (EHS classification: L2-3W7L8) with extensive adhesions. Sectorial TAR extended to the right quadrants. Preparation of the Rives plane on the left, crossover of the midline, and access to the Rives plane on the right. Suturing the defect with barbed long absorbable suture. Placement of a 20 × 30 PVDF mesh fixed with cyanoacrylate glue. Placement of aspirative drainage in the preprosthetic plane.

Results

The patient was discharged on the fifth postoperative day with no complications. Aspirative drainage was removed on the fourth postoperative day.

Conclusions

A robotic-assisted TAR is feasible and safe, helps to perform extensive adhesiolysis, allows for reducing output from drains and therefore earlier discharge, favoring release compared to resection of transverse muscle fibers.
ROBOTIC REPAIR OF A MULTIPLY RECURRENT INGUINAL HERNIA
Authors: Holland A , Lorenz W , Augenstein V
Published: May 2024

Background

This is a 62-year-old male with bilateral inguinal hernias (IH), the left being multiply recurrent after an open, anterior tissue-based approach 30 years ago and recently a robotic Transabdominal Preperitoneal Repair. He recurred within a year and was referred to our hernia center.

Methods

The patient underwent preoperative counselling, and we particularly discussed the risk of converting to an open approach if we could not safely carry out the dissection robotically.

Results

Upon entry, a recurrent left IH and primary right IH were noted. We incised the peritoneum across the abdominal wall and dissected medially, down to the pubis. Although this was a reoperative case, we successfully accessed the preperitoneal plane. On the left, we encountered the prior mesh, which appeared rotated medially and densely adhered to the inferior epigastric vessels, so the decision was made to leave it in place. The lateral preperitoneal dissection was completed, and the cord structures were dissected off the hernia sac.

We repaired the contralateral defect following the same steps. The critical view of the myopectineal orifice was obtained bilaterally, and two pieces of mesh were introduced. Our mesh spanned two centimeters below the pubic tubercle and sat flush without the edges rolling. The mesh was secured at the pubic tubercle, Cooper’s ligament, medially, and at the lateral edge of the preperitoneal flap, protecting the neurovascular structures in the area. The preperitoneal flap was closed with a running absorbable barbed suture.

Conclusions

The patient was discharged postoperatively and is doing well on follow-up.
DUAL MESH, DUAL APPROACH: RUPTURE OF EVENTRATION OF DIAPHRAGM
Authors: Kalikar V
Published: May 2024

Ruptured eventration of diaphragm is a rare entity, with only 3 cases reported in adults till date, all on left side. Surgery is mandatory which consists of returning the affected organs back in place by Adhesiolysis followed by closing the diaphragmatic opening, strengthening the diaphragm by plication and mesh placement. We present the case of a 78-year-old gentleman, sudden onset breathlessness for 2 days. On imaging there was a rupture of the right hemidiaphragm with herniation of intrabdominal contents into the right hemithorax. We managed this patient by a combined thoraco-laparoscopic way reinforcing the defect with a dual mesh.
ADJUVANT TECHNIQUES FOR MINIMALLY INVASIVE INGUINAL HERNIA REPAIR
Authors: Marques-Antunes J , Correia P , Rodrigues E , Magalhães J , Guimarães M , Nora M , Pereira A
Published: May 2024

Background

The characterization of complexity in inguinal hernia lacks precision, yet loss of domain (LOD) serves as a well-defined criterion. Similar to other ventral hernias, treatment efficacy hinges on a pliable abdominal wall and an abdominal cavity capable of accommodating herniated content. Adjuvant techniques employed to attain these objectives are also applicable to inguinal hernias with LOD. Authors present, in video format, the perioperative approach to a case of a large bilateral inguinal hernia repair with loss of domain.

Method

A 58-year-old male presented with a longstanding bilateral inguinal hernia with LOD (Sabbagh > 20%). Preoperative optimization involved cardiorespiratory rehabilitation and adjuvancy, with botulinum toxin A injection and progressive pneumoperitoneum (PPP). Transabdominal pre-peritoneal approach using a single 30 × 10 macroporous polypropylene mesh was performed for bilateral repair.

Results

During preoperative hospitalization for the PPP, patient developed a paroxysmal atrial fibrillation and started anticoagulation. No complications were reported after surgery, with the exception for a bilateral local seroma, and patient was discharged at 4th postoperative day. 6 months later, there was no evidence of complications or recurrence.

Conclusion

Adjuvant techniques play a major role in optimizing patients with complex hernias of the abdominal wall. While the benefits of minimally invasive surgery in inguinal hernias are known, concerns about technical difficulties in large hernias may compromise safety and lead to recurrence. Tailored adjuvant strategies for patient and hernia optimization are essential for effective treatment with long-term successful results.
LAPAROSCOPIC UNILATERAL ETEP WITH PARTIAL TAR
Authors: Shaik N , Shrivastava R
Published: May 2024

Introduction and Aim

Laparoscopic ETEP is an approach that is emerging as an effective management for ventral and incisional hernias. Lateral abdominal wall hernias, although less common than ventral hernias, can progress to a large size and cause significant morbidity. We present a case of lateral abdominal wall incisional hernia managed with a laparoscopic unilateral eTEP (Extended totally extra-peritoneal repair) with partial TAR (Transversus abdominis release).

Case

We present a case of a 52-year-old gentleman who had an incisional hernia at a previous appendicectomy scar, for which an onlay mesh repair was done 5 years ago. He then later developed an incisional hernia. He presented with a bulge on the scar associated with pain since the past 1 year. His CT scan was suggestive of a recurrent incisional hernia -L3W2R1 according to EHS classification.

A laparoscopic unilateral eTEP with partial TAR hernia repair was performed for the patient. He showed satisfactory recovery in the post-operative period with minimal surgical site pain and has been asymptomatic without any recurrences on follow-up for the past 2 years.

Conclusion

Laparoscopic unilateral eTEP with partial TAR maybe a safe and feasible approach for the treatment of lateral abdominal wall hernias.
ROBOTIC MORGAGNI HERNIA REPAIR IN AN INFANT
Authors: Sinha A
Published: May 2024

A nine month old child presented with a history of recurrent respiratory distress and infections and repeated admissions to the hospital. The x-ray of the child demonstrated fluid-filled bowel loops in the thorax. Computed tomography of the chest demonstrated. bowel loops in the anterior mediastinum anterior to the heart. A diagnosis of Morgagni hernia was made. The child was operated via Robot Assisted Repair of the defect. Reduction of contents, excision of the sac and a simple closure of the diaphragm with the anterior abdominal wall was done. A transcutaneous suture was passed from the abdominal skin and through all the abdominal wall layers to anchor the diaphragm to the wall to ensure a secure closure. The suture was buried in the skin. The child recovered uneventfully and is well on follow-up after a year.
RECURRENT COMPLEX INGUINAL HERNIA: ROBOTIC TAPP
Authors: Villalobos R , Maestre Y , Barranquero A G , Gas C , Semeraro C , Escartin A
Published: May 2024

Background

Inguinal hernia is a prevalent pathology that the only definitive treatment is a surgical approach. Many techniques were described but minimally invasive surgery (MIS) is the most recommended. Despite this recommendation, patients that present a recurrent inguinal hernia become very complex to approach with MIS. A robotic approach has emerged as an ideal option to perform this type of case. We present a video of a recurrent complex left inguinal hernia using a Da Vinci robotic approach. This patient had a previous Nyhus approach and a second surgical revision because of a great postoperative hematoma.

Method

A Veress needle was used to create the neumoperitoneum. After that, an 8 mm robotic trocar was introduced just above the belly bottom, then 2 equidistant 8 mm trocars on the right and another one on the left were placed. The trocars were numbered 1, 2, 3 and 4 from the left to the right. The number 4 was used to pull the tissue and to expose the defect. Number 1 was used for the bipolar fenestrated, number 2 for the camera and number 3 for the scissors and needle driver.

Results

After a partial dissection of the hernial sac, a big defect was found. The remaining sac was sutured to decrease the cavity. A 15 × 20 cm Dynamesh IPOM was placed and fixed in Cooper´s ligament and the rectus muscle. Finally, the peritoneum was closed using a 2–0 barbed suture.

Conclusion

MIS using a robotic platform is feasible, ergonomic and it allows to reconstruct and repair very complex inguinal hernias.
NAVIGATING RECURRENT PARASTOMAL HERNIA: A LAPAROSCOPIC SUGARBAKER APPROACH
Authors: Wannberg M , Hansske B
Published: May 2024

Aim

To highlight challenges and adverse outcomes in parastomal hernia patients.

Material and Methods

A 62-year-old woman with recurrent parastomal hernia underwent 8 laparotomies and 5 parastomal hernia procedures. Complications from a fundoplication resulted in a gastric bypass and jejunostomy. Chronic diarrhea led to a sigmoid stoma. Emergency surgeries included incisional hernia repair, laparotomies with mesh removal, and stoma revision. Referral to a specialist center resulted in a Rives-Stoppa and sublay procedure. Subsequent recurrence led to our center. A history of adhesions prompted an onlay approach with an elastic funnel mesh. A CT scan later diagnosed another recurrent parastomal hernia.

Results

Employing a laparoscopic approach, abdominal access was gained from the right flank using a 5-millimeter optic access port. Dissection of multiple adhesions preceded stoma visualization. The small bowel was mobilized, and hernia defect approximation was done with slowly resorbable continuous sutures. A Sugarbaker procedure with a 15 × 15 cm mesh and absorbable tackers was performed. The patient was discharged one-day post-surgery, with no evidence of recurrence at the three-month follow-up.

Conclusions

A laparoscopic approach, even in an adherent abdomen, proved feasible. Lateralization of the stoma during the initial surgery is preferable, and centralization of parastomal hernia patients in specialized centres is crucial for optimal management. Multidisciplinary treatment conferences should be considered for these complex cases to ensure comprehensive care. This case emphasizes the importance of a systematic approach and the potential effectiveness of the Sugarbaker technique in managing recurrent parastomal hernias.
ADDRESSING CHRONIC PAIN AFTER LAPAROSCOPIC IPOM REPAIR: A CASE OF SUCCESSFUL TACKS AND MESH EXCISION WITH RIVES-STOPPA RECONSTRUCTION
Authors: Barranquero A G , Maestre González Y , Gas Ruiz C , Raich M S , García-González L , Codina-Corrons L , Olsina Kissler J J , Villalobos Mori R
Published: May 2024

Introduction

Chronic pain following laparoscopic intraperitoneal onlay mesh (IPOM) repair with permanent tack fixation affects up to 13.8% of patients (Asaf Kahn et al. [2018]). In our case, this was addressed through the excision of the mesh and tacks, followed by abdominal wall reconstruction using a Rives-Stoppa repair.

Case Presentation

A 61-year-old woman presented with chronic abdominal pain following laparoscopic IPOM with permanent tack fixation in October 2021. Her EuraHS QoL score was 46/80 (excluding restrictions during sports), with a notable 21/30 "pain at the site of the hernia.” A CT scan revealed no evidence of hernia recurrence, 41 metallic tacks in the abdominal wall, and bilateral inguinal hernia.

The surgical intervention commenced with a midline laparotomy through the previous 20 × 30 cm mesh, which was excised en-bloc with the tacks. Subsequently, a bilateral retrorectus dissection was performed, addressing both inguinal hernias. The posterior layer was progressively closed, leaving a 9 × 9 cm defect that was bridged with a 9 × 15 cm biosynthetic polyglycolic acid/trimethylene carbonate mesh. Later, a 20 × 45 cm polyvinylidene fluoride (PVDF) retromuscular mesh was placed, and the anterior layer was completely closed.

The postoperative period was uneventful. At the one-month follow-up, the patient exhibited significant improvement in "pain at the site of the hernia" with a 9/30 score, still somewhat limited by postoperative pain, resulting in a EuraHS QoL score of 37/80.

Conclusion

Permanent tacks can contribute to chronic pain. An optimal repair requires the complete excision of the tacks and proper abdominal wall reconstruction.
SHOULD WE REPAIR DIASTASIS WHEN IS ASSOCIATED TO PRIMARY VENTRAL HERNIA?
Authors: Bosch G , Bravo A , Pérez M , Juvany M , Riba L , Carrancho A , Galindo J , Pereira J A
Published: May 2024

There is low consensus about rectal diastasis concomitant with a primary ventral hernia. However, the new EHS guidelines recommend joint repair in one time. In our group, in cases of asymptomatic diastasis D1–D2 associated with ventral hernia, only the hernia is repaired. The aim of this study is to analyze the impact of concomitant diastasis on preperitoneal ventral hernioplasties.

Methods

An observational single-center retrospective analysis was performed. We analyzed primary ventral hernia preperitoneal repairs in our hospital from 2017 to 2022. Two groups were compared according to the presence of concomitant diastasis recti or not. We performed a descriptive analysis; comparative univariate analysis for complication and recurrence and risk factors analysis.

Results

From 743 ventral hernia repairs a total of 663 (89,2%) preperitoneal open hernia repairs were performed. 57 (8,6%) patients had diastasis. The diastasis recti group had no statistically significative difference with the control group except more global comorbidity 215 (35.5%) vs. 32 (56.1%); p = 0,002 and more previous hernia repair 22 (3.6%) vs. 7 (12.3%) p = 0,008. There were 2 reoperations (0.3%), 7 readmissions (1.05%), and 1 death (0.15%). There were no differences in terms of global complications 92 (15,2%) vs. 10 (17,5%) p = 0,37 and recurrence was also similar in both groups. In the multivariate analysis any factor risk was found.

Conclusions

In our series, diastasis associated to ventral hernia repair seem not to impact in hernia repair outcomes and recurrence. So, diastasis repair should carefully take into account when repairing an associated ventral hernia in order to not increase complications.
COMPLEX CASE OF OPEN ABDOMEN CLOSURE WITH MESH MEDIATED FASCIAL TRACTION TECHNIQUE AND RECONSTRUCTION OF THE ABDOMINAL WALL IN CASE OF LOSS OF SUBSTANCE
Authors: Capoccia Giovannini S , Stabilini C , Rubartelli A , Carlini F , Longo G , Morelli N , Minuto M , Varaldo E , Ansaldo G , Bruno A , Drago B , Fanti F , Patania G , Mkrtchyan M , Frascio M , Camerini G
Published: May 2024

Aim

Our aim is to present the clinical case of an Open abdomen delayed closure with Mesh Mediated Fascial Traction (MMFT) and complex abdominal wall reconstruction.

Material and Methods

We report a case in which was combined the MMFT with a complex abdominal wall reconstruction due to loss of substance.

Results

A 34 years old male after suicide attempt was submitted to an emergency laparotomy for retroperitoneal hematoma determining colonic perforation and disruption of the insertion of rectus abdominis muscles (RAM) to the pubic bone resulting in a loss of substance in the lower part of the abdomen. A sigmoidectomy, a lateral ileostomy and open abdomen was performed. After 9 days was planned the closure. There was a divarication of RAM of 14 cm in width, loss of substance above the arcuate line, exposure of inguinal ligaments bilaterally and a massive adhesion syndrome of small bowel.

The massive soft tissue edema and stiffness of abdominal wall made impossible the closure of the skin. A MMFT technique was used for the medialization of the RAM. 3 cm was gained for each revision, every 48 hours and in 6 procedures the abdomen was closed. For the reconstruction of the lower part of the abdomen a biosynthetic mesh 9 × 15 cm was placed intraperitoneally and over it was implanted a macroporous mesh secured with the onlay mesh placed over the RAM.

Conclusions

Closure of open abdomen with MMFT technique is useful but availability of materials and expertise are required for complex cases.
PECULIARITIES OF MESH FIXATION DURING TAPP IN PATIENTS WITH INCARCERATED INGUINAL HERNIA
Authors: Feleshtynskyi Y , Onyshko M , Vatamaniuk V
Published: May 2024

Background

Aim of the study is to increase the effectiveness of TAPP in incarcerated inguinal hernias by fixing the mesh with glue combined with an antiseptic. Experimental study.

Method

Analysis of surgical treatment of incarcerated inguinal hernias with TAPP was carried out in 92 patients, aged from 30 to 75 years, average age 50 + 1.2 years. Only males were included. In the first group, 47 patients polypropylene mesh was fixated using an adhesive composition of polyurethane glue with the antiseptic decamethoxin. The peculiarity of mesh fixation was that glue was applied to the entire surface of the mesh. In the second group of 45 patients, mesh fixation was performed with the absorbable tacks.

Results

In the early postoperative period, among the patients of the first group, seroma was observed in 3 (6.3%) patients, infection of the wounds was not observed, chronic postoperative pain was diagnosed in 1 (2.1%) patient. Among the patients of second group seroma of the implantation site occurred in 14 (31.1%), infection in 4 (8.8%). Long-term results were studied from 1 to 36 months in 40 patients of group I and 41 patients of group II. Recurrences were found only in 4 (9.7%) patients of the 2nd group, which was due to infection of the area of the mesh implant, which was removed.

Conclusion

Mesh fixation with an adhesive composite during TAPP in patients with pinched hernias, compared to traditional fixation by tacks, reduces the likelihood of seroma, infection.
HERNIA RECURRENCE, CHRONIC PAIN AND INFECTION IN PATIENTS UNDERGOING OPEN REPAIR OF VENTRAL HERNIA OR DIVARICATION OF RECTUS ABDOMINUS WITH MONOFILAMENT POLY-4-HYDROXYBUTYRATE MESH: A RETROSPECTIVE, PATIENT-REPORT CASE SERIES
Authors: Field M , Molesworth C , Kaplan E
Published: May 2024

Aim

To report rates of patient-reported hernia recurrence, chronic pain and re-operation for surgical site infection (SSI) in patients who underwent open repair of ventral hernia or divarication of rectus abdominus using monofilament Poly-4-hydroxybutyrate (P4HB) mesh.

Method

Multi-centre, retrospective case series using prospectively collected anonymous patient-reported outcomes. Inclusion criteria: diagnosis of Spigelian, incisional or umbilical hernia or divarication of rectus abdominus; open repair using resorbable P4HB monofilament mesh.

Primary outcome: recurrence rate using Ventral Hernia Recurrence Inventory (VHRI). Secondary outcomes: (1) chronic pain using a modified item from Ventral Hernia Pain Questionnaire (VHPQ); (2) rate of re-operation for SSI.

Results

Twenty-four of 42 (57%) eligible patients participated: 54% of participants were female and 75% were aged ≥50 years.

On VHRI, 13% of participants reported their hernia had come back, 25% felt or saw a bulge, 46% reported physical symptoms or pain at the site. On the VHPQ modified item, 79% of participants reported either no pain or pain that can easily be ignored, the remaining 21% reporting higher levels of pain. Three participants (13%) reported having a follow-up procedure for SSI.

Female participants reported higher rates of pain or symptoms at the site, levels of pain and follow-up procedures for SSI.

Conclusions

Recurrence rates for patients with ventral hernia or rectus abdominus who underwent open repair with P4HB mesh were broadly similar to previously published ventral hernia recurrence rates. Female participants experienced higher rates and levels of pain, and more frequent follow up procedures for SSI.
POLY4 HYDROXYBUTYRATE MESH: LONG-TERM RESULTS FROM A SINGLE INSTITUTION
Authors: Fra D , García Galocha J L , Peña M J , López Antoñanzas L , Charef L , del Campo M , Torres A
Published: May 2024

Aim

The aim of this retrospective review is to analyze long term results with Poly 4 hidroxibutirate (P4HB) mesh in our institution. The main end point was recidive and its factors asociated.

Material and Methods

During the period between May 2015 and December 2021, 93 patients with abdominal wall complex defects were operated on, using P4HB mesh at our third-level institution in Spain. Several variables were analyzed to identify any factors related to recurrence. Multivariate statistical analysis was employed to identify independent factors.

Results

Out of the total cases, 26 were excluded due to insufficient follow-up time. The majority of patients were women (54%) with a mean age of 65. Midline incisional hernias were predominant (80.2%), and 80.6% were elective procedures. The most frequently used surgical technique was supra-aponeurotic repair (84.78%). Postoperative wound infection was 12.9%, and the hernia recurrence rate was 11.94%. Significant independent risk factors for recurrence included concurrent malignant neoplasm, para-stomal hernia, and postoperative complications.

Conclusions

P4HB is a long-term absorbable biosynthetic material. One of the possible adverse effects is a higher recurrence incidence. In our study, we observed an 11% recurrence rate, which is similar to when we use other materials. In particular, concurrent malignancy, para-stomal hernia, and postoperative complications emerged as statistically significant factors contributing to recurrence. As a result, we might say that P4HB meshes would be a useful tool in these situations in which leaving a permanent mesh could be a problem because of the high risks of complications related to them.
ROBOTIC-ASSISTED INGUINAL HERNIA REPAIR WITH A NEW ROBOTIC SYSTEM: A PROSPECTIVE MULTICENTRE CLINICAL INVESTIGATION
Authors: Gantner L , Mignot H , Pochhammer J , Grieder F , Breitenstein S
Published: May 2024

Aim

Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP) is established as safe and feasible with various robotic platforms. This prospective clinical study (NCT05873582) evaluated a new robotic system, consisting of an open platform with a sterile surgeon’s console, two robotic instrument arms, and one robotic endoscope arm.

Material and Methods

Three centres in France, Germany and Switzerland participated in the study. Safety and clinical performance data were collected perioperatively up to 30 days for both unilateral and bilateral inguinal hernia repair.

Results

Fifty patients underwent rTAPP for inguinal hernia (33 unilateral, 17 bilateral). Mean age was 60 years (±15) and BMI 25.7 kg/cm2 (±3.3). All surgeries were successfully completed with robotic assistance, with one conversion to laparoscopy due to trocar positioning. No intra-operative complications, device deficiency, or adverse events of Clavien-Dindo Grade III to V occurred. The mean skin-to-skin operative times were 55 min (±14) for unilateral, 95 min (±22) for bilateral hernia. The mean docking time was 4 min (±2). Robotic console time were 34 min (±12) for unilateral, 68 min (±21) for bilateral hernia. Patients were discharged within 1 day, while 26 discharged on the day of the procedure. The mean duration to return to normal activities was 8.1 days.

Conclusions

Our rTAPP experience with this new robotic system confirms feasibility and safety. The performance was similar to comparative devices on the market, positioning this new robotic system as an advantageous tool in inguinal hernia repair.
HERNIA MESH EXPLANTATION FOR MESH INGUINODYNIA AND ALLODYNIA. WHY IS HERNIA MESH SO PAINFUL?
Authors: Garvey J F W , Atmore B
Published: May 2024

Introduction

Chronic pain after mesh repair for abdominal wall hernia is an indication for the removal of mesh and reconstruction by a non-mesh technique.

Materials and Methods

In a consecutive series over 19 years, 128 patients had mesh removed to relieve chronic pain. This open method of mesh removal relies on confirming normal anatomical landmarks. The superior and inferior leaf of the External oblique aponeurosis are raised, the spermatic cord is identified and retracted. The mesh is gently dissected off the Internal oblique from lateral to medial, taking care in preserving the vas, and accompanying vessels. Adherent ilio-inguinal, iliohypogastric and genitofemoral nerves are removed with the mesh. The resultant recurrent hernia is repaired by Moloney darn, a tension-free tissue repair.

Results

128 consecutive patients have been treated by mesh explantation and immediate reconstruction on average 6 years after implantation. Resolution of symptoms was experienced very shortly after the mesh removed. Preperitoneal mesh particularly Kugel patch has been the most difficult to remove. Meshes have been submitted for histological examination and the findings are usually chronic granulomatous foreign body reaction. Few complications have been encountered with a follow-up period ranging from 6 months to 15 years, the most common being the failure of explantation to alleviate inguinal pain in the long-term.

Conclusion

All hernia patients should be afforded informed consent including discussing the potential long-term consequences of chronic groin and abdominal pain.
THE SAFE INTRODUCTION OF ROBOTIC SURGERY INTO A BUSY HERNIA PRACTICE; PATIENT OUTCOMES AND LEARNING CURVE
Authors: Hayward R , Alhadad Z , Smith J J , Muirhead L J , Qiu S , Warren O J
Published: May 2024

Background

The use of robotics in hernia surgery is increasing. Continuous, real-time outcome analysis is vital to inform and protect patients, and enable cost-benefit decisions.

Method

Prospective data capture on patients undergoing robotic hernia repair during one surgeon’s introduction of robotics into their high-volume practice.

Results

In the year 2023, 60 hernia repairs were performed robotically: 29 ventral (transabdominal retromuscular umbilical prosthetic n = 12, parastomal Sugarbaker n = 5, transabdominal preperitoneal (TAPP) n = 4, extended totally extraperitoneal n = 4, component separation/transversus abdominis release n = 3, intraperitoneal onlay mesh n = 1); 28 inguinal (TAPP); 3 combined inguinal/ventral. 45 patients (76%) were male, median age 67.

Median blood loss was 10 ml, with no blood transfusions. 3 operations (5%) were converted to open. 23 operations (38%) were day-case. There were 2 readmissions; 1 patient returned to theatre and sadly died with pathology unrelated to his hernias.

52 patients (87%) had complication-free recovery. 4 complications were Clavien-Dindo (CD) grade I (urinary retention n = 3, persistent numbness n=1). 2 complications were CDII (pneumonia n = 1; superficial infection n = 1). 2 patients had infections requiring drainage (CDIII). There were no mesh explanations or early recurrences (median follow-up 3 months).

Overall median console time was 52 minutes (IQR 38–71). For the first 14 inguinal repairs, median console time was 49 minutes. This decreased to 37 minutes for the following 14 repairs (p < 0.001).

Conclusion

Length of stay, complications, re-admission and recurrence rates are within acceptable parameters, supporting the feasibility of introducing robotic hernia surgery into practice. A learning curve is demonstrated, with rapid significant improvement in operative duration.
EQUAL PROCEDURAL COST OF ROBOT-ASSISTED AND LAPAROSCOPIC VENTRAL AND INCISIONAL HERNIA REPAIR. A NATIONWIDE DATABASE STUDY
Authors: Henriksen N A , Christoffersen M W , Marckmann M , Jensen K K
Published: May 2024

Background

The use of the robotic platform for ventral hernia repair has increased in the last decades, however, it has been criticized for being too expensive. The aim of this was study was to compare the procedure-specific cost of robot-assisted and laparoscopic ventral and incisional hernia repair including cost of procedure-related readmissions and reoperations within 90 days postoperatively.

Methods

This was a nationwide database study including 554 robot-assisted ventral and incisional hernia repairs matched 1:1 on hernia type and defect size with laparoscopic repairs.

The primary outcome was the total cost per procedure in Euros including the cost of a robotic approach, extra ports, mesh, tackers, length of stay, length of readmission, and operative reintervention.

Results

For a robot-assisted approach, the mesh was most often placed in the retromuscular position 75.6% (419/554), whereas the mesh was placed in the intraperitoneal position 76.9% (426/554), P <0.001. Likewise, a self-fixating mesh was used significantly more in the robotic group 68.1% (337/554) compared with fixation with tackers in the laparoscopic group 67.3% (373/554), P <0.001. The length of stay was significantly shorter and readmission rate significantly lower for robot-assisted repairs (0.5 days and 7.0%) compared with laparoscopic repairs (1.2 days and 12.5%), P <0.001. The mean total cost of all robot-assisted ventral and incisional hernia repairs was 1,342 euro compared with 1,519 euro for laparoscopic repairs, P = 0.594.

Conclusion

The procedural cost of a robot-assisted ventral and incisional hernia repair is comparable to the cost of a laparoscopic approach.
A SPECIALIZED HERNIA SURGEON, BENEFITS FOR PATIENTS
Authors: Latham L , Casali A , Soldini G , Antonini I , Intelisano A , Musolino C , Callipari R , Scalambra S M
Published: May 2024

Introduction

Hernia surgery has become more and more complex over the last 30 years due to new surgical approaches, new techniques and innovation of the standardized techniques.

Therefore surgical teams need well trained surgeons dedicated to the abdominal wall hernias repairs. Nowadays it’s not acceptable to perform a hernia repair offering only one traditional technique.

Patients need to be evaluated by an open-minded surgeon that has more than one weapon in his cartridge.

Our team is a newborn team, we started our collaboration in this hospital only 9 months ago putting together different surgeons from different realities and with different know-hows.

Two of the new surgeons have wide experience in laparoscopic hernia treatments.

We started with a modern approach to the abdominal wall surgery either for ventral or inguinal hernias with the possibility to guarantee the patients traditional and laparoscopic approaches.

Materials and Methods

As concerns the inguinal hernia surgery, from the 15th of January till now we performed 100 inguinal hernia laparoscopic repairs, 55 for bilateral inguinal hernia and 45 for monolateral hernia, 64 TAPP technique, 2 with fixation of the mesh and 62 without fixation, and 36 TEP technique 9 with mesh fixation and 27 without fixation.

In the TAPP population in 2 cases a laparoscopic cholecistectomy has been performed before the hernia repair.

Results

The median operating time was 45 minutes for monolateral hernia with TEP technique vs. 49 minutes with TAPP, 53 minutes for bilateral hernia with TEP technique vs. 67 minutes with TAPP. The intra-operative complications were 1 mild bleeding, 1 lesion of the bladder treated with direct suture and positioning of the urinary catheter.

Post-operative complications were 1 seroma and 1 rectus hematoma treated laparoscopically.

No hernia recurrence and only 1 case of moderate postoperative pain was detected after 6 months of follow-up.

Discussion

In conclusion hernia surgeons are mandatory for a modern approach to the abdominal wall hernia surgery in order to guarantee a wide spectrum of techniques for each single patient and to achieve good results with low rate of hernia recurrence and good postoperative quality of life.
THE IMPORTANCE OF HORIZONTAL MESH OVERLAP IN OPEN RETROMUSCULAR MIDLINE INCISIONAL HERNIA REPAIR: NATIONWIDE ANALYSIS WITH LONG-TERM FOLLOW-UP
Authors: Marckmann M , Henriksen N A , Jensen K K
Published: May 2024

Aim

Recurrence after open incisional hernia repair remains an issue with long-term rates ranging from 11 to 29%. In open hernia repair it is preferred to place the mesh in the sublay position rather than underlay, however, it is unclear what the optimal mesh overlap is. We sought to determine the importance of this matter.

Material and Methods

This study was based on a nationwide hernia register allowing for a 100% follow-up from 2007 to 2022. Eligibility criteria were elective incisional hernia surgery, vertical incision, retromuscular mesh placement, and linea alba reconstruction. The 5-year cumulative incidence of reoperation for hernia recurrence was determined. Potential confounders were included in multivariate regression analyses.

Results

A total of 1539 patients were included. Mean (sd) age was 61.2 (12.4) years and 46.2% were females. The mean horizontal defect size was 8.4 (4.2) cm. Seventy-two (4.7%) patients underwent operative reintervention within 90 days postoperatively, and 112 (7.3%) developed recurrence during a median follow-up of 3.8 (IQR 1.8–6.1) years. Cox regression analysis showed that a mesh width of 10–15 cm significantly decreased the risk of recurrence development compared to both narrower and wider sizes (HR 0.38, CI 0.16–0.90, P = 0.029). Interestingly, in adjusted analysis the fascial defect width was not associated with risk of recurrence.

Conclusions

For patients undergoing elective open midline retromuscular incisional hernia repair, the size of mesh overlap is important as a golden mean reduces the risk of subsequent hernia recurrence and is more appropriate than both “too little” and “as much as possible”.
COMPLEX INCISIONAL HERNIA AND STOMA REVERSAL: SYNCHRONOUS OR TWO-STAGE APPROACH
Authors: Marques-Antunes J , Correia P , Osório C , Magalhães J , Guimarães M , Nora M , Pereira A
Published: May 2024

Background

Parastomal hernia (PH) is a common complication post stoma creation, often coexisting with incisional hernias. Stoma closure is the primary treatment for PH, with options including simultaneous repair (stoma closure and abdominal wall reconstruction – AWR) or a deferred two-stage approach. The optimal approach remains undetermined. The study aimed to assess outcomes following AWR and stoma closure in both simultaneous and deferred approaches, focusing on complications and hernia recurrence.

Method

Four cases were presented, with two undergoing one-stage treatment and the others with a deferred approach.

Results

In the one-stage approach, patients aged 58 and 78 with a history of Hartman's operation developed Type IV PH. Both received botulinum toxin type A (BTA), and one had progressive pneumoperitoneum. The deferred approach involved patients aged 45 and 46. One, with a colostomy post-traumatic severe pancreatitis, developed an incisional midline complex hernia. The other had an ileostomy post-intestinal occlusion for endometriosis. Both received BTA, and AWR was deferred due to intraoperative technical difficulties. Negative pressure therapy with mesh-mediated traction served as a bridging technique for one patient. Both were reoperated after 6 days, with one using intraoperative dynamic fascial traction. No short-term complications or recurrence were observed.

Conclusion

The decision to simultaneously treat the abdominal wall with stoma closure should consider the patient's functional capacity. Surgeons should prioritize patient selection, preoperative preparation, and maintain a low threshold to defer AWR, thereby avoiding complications associated with extensive operations.
SURGICAL TREATMENT OF COMPLEX ABDOMINAL WALL HERNIA IN OBESE PATIENTS
Authors: Marques-Antunes J , Correia P , Osorio C , Magalhães J , Guimarães M , Nora M , Pereira A
Published: May 2024

Background

Obesity is considered a factor contributing to the complexity of abdominal wall hernias due to an increased risk of surgical wound complications, intra-abdominal pressure and recurrence. The risks associated with obesity significantly escalate when the body mass index (BMI) is greater than 30 kg/m2. The optimal approach for managing these patients remains unclear. Our objective is to assess outcomes in the surgical treatment of complex abdominal wall hernias in obese patients.

Method

Retrospective analysis of 13 patients who underwent surgery for complex abdominal wall hernias after participating in a pre-operative program for both surgical and non-surgical weight loss. Patients with a BMI >35 were included.

Results

The average initial BMI was 40 kg/m2 (39–47), and the preoperative BMI was 30 kg/m2 (21–36). Among the patients, six underwent bariatric surgery for the first time (four vertical gastrectomies, one Roux Y Gastric Bypass, and one SADI-S). For those included in the non-surgical weight loss protocol, all were supervised by a nutritionist and endocrinologist, and three of them underwent intragastric balloon placement. The complication rate was 23%, with two cases of wound dehiscence without infection and one case of hemorrhage requiring percutaneous embolization.

Conclusions

Primary surgical treatment of obesity is favored when indicated. Non-surgical weight loss program (including diet, medications, or intragastric balloon) with synchronous bariatric surgery should be reserved for patients unable to undergo primary surgery or those requiring rapid correction of abdominal wall defects. The pre-operative preparation process is gradual, and currently, numerous individuals are in the preparatory phase.
ENHANCED-VIEW TOTALLY EXTRAPERITONEAL RIVES STOPPA (eTEP-RS) TECHNIQUE VERSUS LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA) FOR VENTRAL HERNIA REPAIR: A COMPARATIVE ANALYSIS
Authors: Marrero Marrero P , Fernández Hernández L , Mon Martín F , González de Vera O , Lorenzo Rocha N , Delgado Plasencia L J
Published: May 2024

Background

The purpose of this study is to compare the postoperative outcomes of the enhanced-view totally extraperitoneal Rives Stoppa (eTEP-RS) technique to the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) for primary (PVH) and incisional (IVH) ventral hernia repair, in terms of the quality of life (QoL), postoperative complications and hernia recurrence rate at the six month follow-up.

Method

A comparative retrospective review of a prospectively maintained database of all patients undergoing eTEP-RS and LIRA from December 2022 to June 2023. Data retrieved included demographics, clinical and operative variables. Computed tomography scan was performed before and 6 months after surgery. QoL was assessed using the EuraHS-QoL scale prior to-and following eTEP-RS and LIRA. Pain was evaluated using the visual analogue scale.

Results

Ten and seventeen consecutive patients underwent eTEP-RS and LIRA, respectively. No significant differences were found in baseline characteristics between the two groups. PVH was the most common pathology (n = 19; 70,3%). Pre-operative and post-operative EuraHS-QoL questionnaire scores were available for the 100% of the patients and showed at the six postoperative month no significant differences in either pain (0.70 eTEP-RS vs. 1.41 LIRA; p = 0.556) or restrictions (0.50 eTEP-RS vs. 1.35 LIRA; p = 0.477) or cosmetics appearance (1.60 vs. 2.82; p = 0.588). Postoperatively, six (60%, Clavien-Dindo I) and five early complications (29,4%, Clavien-Dindo I) occurred in the eTEP-RS and in the LIRA group, respectively (p = 0.278). No hernia recurrence was found.

Conclusion

No significant differences were found between eTEP-RS and LIRA at the six month follow-up. So far, this is the first published study where QoL is evaluated and compared in patients undergoing these two techniques.
INCISIONAL HERNIA SURGERY: WHEN YOU NEED BACKUP
Authors: Melo Pinto D , Costa Farias L , Quintela Silva C , Saraiva P , Correia J
Published: May 2024

Background

Synchronous surgery to cure complex abdominal wall hernia and stoma reversal is associated with more morbidity, especially in cases in which a posterior component separation technique is performed.

Method

We present a case of a 64 years old man with BMI 27.8 kg/m2 with history of perfurated acuted diverticulitis with a previous Hartmann procedure.

Results

He presents with an incisional hernia M2M5W3 VHWG 3 with a median width of 15 cm. We performed a multi-step preparation for this surgery with botulinic toxin application four weeks before surgery. Intraoperatie we performed a stomal reversion surgery (terminoterminal anastomosis) and correction by Rives-Stoppa-Wantz technique with myofascial flap of rectus muscle. We used a myofascial traction system, which was tightened every 2 minutes. With this system we were able to reduce the defect from 15 to 3 cm and close the abdominal wall without the need for posterior component separation technique. Patient was discharged by the 5th day.

Conclusion

Myofascial relaxation and traction appears to contribute to a tension-free closure of the abdominal wall leading to slower morbidity rates.
CORRELATION BETWEEN CARBONELL’S RATIO AND EXPERT OPINION IN COMPLEX ABDOMINAL WALL HERNIAS
Authors: Mesquita Guimarães C , Melo Pinto D , Saraiva P , Correia J
Published: May 2024

Background

Complex abdominal wall hernias are still challenging. These patients require an extensive preoperative preparation, and, sometimes, the use of adjuvant techniques. Although some ratios (like Carbonell) are objectively estimate the surgical technique and the need of adjuvants preoperatively, Surgeon’s judgement is crucial for decision-making.

Method

This study aimed to evaluate a group of patients submitted to complex abdominal wall hernias correction after botulinum toxin administration (BTA) between 2012–2022, in order to evaluate a correlation between the choice of surgeon and Carbonell ratio.

Results

During this period, 38 patients were submitted to surgery (after BTA). BTA decision was used based on domain loss, wall rigidity and the size of the defect. Retrospectively, we applied the Carbonell ratio, and divided them in 3 groups. The first group (ratio <1) was composed by 23 patients, 19 did a bilateral component separation (BCS), 3 did a Rives-Stoppa with unilateral component separation (RS+UCS) and 1 patient did a Rives-Stoppa (RS). The second group (ratio 1–2), was composed by 13 patients, 6 did a BCS, 2 did a RS + UCS and 5 patients did a RS. The third group (ratio >2) had only 2 patients, 1 did BCS and the other RS. The recurrence rate was evaluated at two years both by clinical examination and image. We observed recurrence in 3 patients, 2 of them after BCS.

Conclusion

Based on this analysis, we can affirm that the use of objective measures might help the surgeons decide the best surgical approach and patient selection for adjuvant techniques.
OUTCOMES OF THE ABDOMINAL WALL RECONSTRUCTION IN A DISTRICT GENERAL HOSPITAL
Authors: Mohamedahmed A Y , Ramasamy S , Agrawal D , Muras Z , Marzook H
Published: May 2024

Background

The aim of this study was to explore the outcomes of abdominal wall reconstruction surgery by assessing postoperative complications and recurrence.

Methods

This is a retrospective case series. All patients who underwent abdominal wall reconstruction between 2018 and 2023 were included and followed up for complications and recurrence till January 2024. Patient demographics, operative parameters and postoperative complications were extracted in an Excel sheet, and data analysis was performed with SPSS 27 software.

Results

Forty-two patients were included in this study with a median age of 61.5 (34–83) and 1.2: 1 female: male gender distribution. Moreover, 41% of the included patients had a BMI >35, and 47.6% were smokers. The type of hernia was incisional in 50% and recurrent hernia in 31%, and the defect size was >10 centimetres in 48% of the included cohort. The type of operation was as follows: Rives-Stoppa (50%), TAR (24%), and combined procedure (26%). additionally, only 18% had their operation laparoscopically, and the position of mesh was retro-rectus in 88% of the cases. Post-operative complications were SSI (11.9%), seroma (28.6%), haematoma (7.1%), re-operation (9.5%), entero-cutaneous fistula (2.4%), and Hernia recurrence (4.7%) at a median follow-up of 42.5 months. Length of hospital stay was <5 days in 48% of patients.

Conclusion

The Component separation technique is an excellent approach to repairing complex incisional hernia with excellent results (<5% recurrence rate). Abdominal reconstruction is feasible in district general hospital settings.