bluuebunny/crossref_metadata_2025 huggingface dataset:
De Garengeot hernia: A case report and classification
Authors: Sutedja Barlian , Rudiman Reno , Susanto Nelly , Siswanto Ardine Yew
Published: August 2023

Laparoscopic repair of De Garengeot hernia is recommended for its association with decreased postoperative pain and faster return to normal activities. A 65-year-old female patient presented with painful right inguinal swelling, and surgery was indicated due to suspected omentum incarceration in a femoral hernia detected via computed tomography. Laparoscopic transabdominal preperitoneal repair with appendectomy was performed, with satisfactory postoperative results and no evidence of recurrence after 2 years. Placing polypropylene mesh preperitoneally provides a natural barrier against potential sources of infection, and it is recommended to improve postoperative outcomes.
Enterocutaneous fistula from a mesh eroding the small bowel after incisional hernia repair
Authors: Lorentziadis Michael L. , Nafady Hego Moustafa Mahmoud , Al Nasser Fatma
Published: August 2023

Tension-free hernia repair with mesh reinforcement has become the standard of care in hernia surgery. Mesh eroding the bowel with enterocutaneous fistula is a rare and serious complication. We present a case of a 46-year-old obese man with abdominal wall abscess who developed enterocutaneous fistula due to the erosion of the small bowel from a bioabsorbable coated mesh after incisional hernia repair. We discuss the biological response to hernia repair meshes as well as this challenging to treat, early or late complication of hernia surgery.
Current opinions in inguinal hernia emergencies: A comprehensive review of related evidences
Authors: Kulacoglu Hakan
Published: August 2023

INTRODUCTION:

Groins hernia emergencies are evaluated under two definitions: incarceration that is defined as a hernia in which its content becomes irreducible at the passage in the abdominal wall and strangulation that compromises the blood supply to the omentum and/or intestines within the hernia sac. The purpose of this paper was to determine the latest knowledge about groin hernia emergencies.

MATERIALS AND METHODS:

PubMed and Google Scholar searches were done by using combinations of “inguinal hernia” and “emergency”, and “groin hernia” and “emergency” keywords at first. More detailed searches were performed to enrich the “Surgical treatment” part of the paper by using “emergency hernia” and “mesh”, “emergency hernia,” and “laparoscopic versus open” keywords afterward.

RESULTS:

Approximately 5%–10% of all inguinal repairs are performed in emergency settings. Both lateral and medial inguinal hernias can get incarcerated or strangulated, whereas the risk for femoral hernias is higher. Manual reduction of incarcerated inguinal hernias is successful in approximately 60% of the cases. The prediction of bowel ischemia due to strangulation may be possible with some blood tests and imaging studies like ultrasound and computed tomography. It has been shown that the longer the duration of incarceration the higher the risk of bowel ischemia. Bowel resection which is more frequently necessary in patients with advanced age, female gender, and femoral hernia, is associated with an increased risk of perioperative mortality. Some surgeons still use tissue-suture repairs in an emergency setting; however, mesh repairs have been shown to be safe unless there is an overt contamination.

CONCLUSION:

Early treatment of complicated groin hernias is the key to favorable outcomes. The need for bowel resection and advanced age are the most prominent factors for morbidity and mortality. Mesh repairs are safe in most cases. Minimally invasive approaches promise good results in experienced centers.
Hernia uterine inguinale in adolescence
Authors: Samy Angeline Mary , Shanmugam Dasarathan
Published: August 2023

A 14-year-old girl presented with a swelling over the right groin for 2 years associated with amenorrhea. She also had cyclical pain over the swelling every month. On further evaluation, she had a right inguinal hernia with right ovary and uterus in the hernia sac. She underwent inguinal exploration and hernial sac was identified. She underwent hernioplasty and was discharged uneventfully. The presence of uterus in a hernial sac is a rare entity. The risk of complications and chances of untoward injury during the unprecedented surgical procedure warrants a careful evaluation before surgery.
A single-blind, randomized study comparing clinical equivalence of Trulene® polypropylene mesh to Prolene® polypropylene mesh in subjects undergoing lichtenstein open repair of primary inguinal hernia secured with sutures
Authors: Hangloo Vijay , Babu Tippana V S S Naga , Bhattacharya Sanjoy Mohan , Agarwal Nikhil , Moharana Ashok Kumar , Deepak T S
Published: August 2023

BACKGROUND:

Inguinal hernia is the most frequently diagnosed abdominal wall hernia. Lichtenstein open repair involving mesh fixation lowers the recurrence rate and risk of postoperative complications. This study compared the clinical equivalence of Trulene® polypropylene mesh (Healthium Medtech Limited) and Prolene® (Ethicon-Johnson & Johnson) polypropylene mesh with respect to recurrence rate of hernia in subjects undergoing Lichtenstein open repair of primary inguinal hernia, secured with sutures.

MATERIALS AND METHODS:

Between September 2020 and November 2022, this multicentric, randomized (1:1), single-blind, prospective, two-arm, parallel-group study (n = 120) was conducted. The primary study endpoint, proportion of subjects having recurrence of hernia within 6 and 12 months of index surgery, was assessed. The secondary endpoints, pain score, number of analgesics, postoperative complications, operative time, length of hospital stay, need for readmission, time to resume back to normal activities and return to work, other adverse events, subject satisfaction score, and quality of life (QOL) postoperatively were also recorded.

RESULTS:

During the 12-month follow-up period, no recurrence of hernia was recorded. In addition, no significant differences regarding intraoperative mesh parameters, pain score, number of analgesics, postoperative complications, operative time, length of hospital stay, readmission, time to resume normal activities and return to work, and subject satisfaction score and QOL were recorded between Trulene® and Prolene® mesh groups.

CONCLUSION:

Trulene® polypropylene mesh is clinically equivalent to Prolene® polypropylene mesh. Both meshes are safe and effective for Lichtenstein open repair of primary inguinal hernia with minimal risk of hernia recurrence and chronic pain.
A case report on late-onset congenital diaphragmatic hernia in adolescence
Authors: Sharma Pawan , Rehsi Simarjit Singh , Das Abhishek , Nair Vipin Venugopal
Published: August 2023

Congenital diaphragmatic hernia is a life-threatening anomaly with the high mortality rate in infancy. Very rarely they remain silent and manifest in the adult life. Once they manifest, the symptoms vary and are not easy to diagnose. The entity also has associated problems in the form of hypoplastic lungs and loss of domain of the abdomen. In such cases, the diagnosis is most often based on clinical suspicion and radiological confirmation. The treatment options are open abdominothoracic procedures or laparoscopic procedures. Once hernia is reduced, the defect is closed and should be reinforced with prosthetic mesh. Here we present a case of congenital diaphragmatic hernia in a teenager presenting with cardiac symptoms. The challenges faced in managing the case are discussed.
Traumatic lumbar hernias, when should I operate? A case report
Authors: Alharmoodi Fatima , Ghabra Shadin , Chebli Ali Ahmad , Alharthi Salem , Al-Bahri Shadi
Published: August 2023

Traumatic lumbar hernias are a rare subset of abdominal wall hernias encountered following blunt trauma to the abdomen. These are more commonly being found due to the increased use of advanced imaging. Three cases of traumatic lumbar hernias were identified at our institution from 2021 to 2022, one of which underwent delayed repair. The second case resulted in the resolution and healing of the defect within 6 weeks of presentation, and the third was lost to follow up. Acute repair of lumbar hernias might be indicated during the repair of other intra-abdominal injuries. Delayed repair allows for a laparoscopic approach or open repair via flank incisions. Delay in asymptomatic patients may also result in fibrosis and scarring and may resolve the defect. Fixation of mesh to adjacent bony structures may be needed, and adequate sub-lay dissection for mesh placement particularly for larger defects. Consider delaying the repair of traumatic lumbar hernias in asymptomatic to minimally symptomatic patients if no other abdominal surgery was warranted at the time of presentation.
A minimally invasive approach for the treatment of encysted hydrocele of the canal of Nuck in adult female: A case report
Authors: Bilaskar Rajeev P , Thorat Santosh D , Dhaigude Balaji D
Published: August 2023

The canal of Nuck is the female equivalent of the patent processus vaginalis in the male. Abnormality of canal of Nuck is a rare clinical condition amendable with surgical intervention. It usually presents as a swelling in the inguinal region in pediatric age group. However, their presentation in an adult women is very rare. Intraabdominal contents including intestine, uterus, fallopian tube, and ovaries are prone to herniate though the unobliterated processus vaginalis. Hydrocele of the canal of Nuck (HCN) may develop in these patients which may be misdiagnosed with the other differential diagnosis. In this case report, we emphasize on reporting minimally invasive surgical intervention of HCN by transabdominal preperitoneal approach in a of tertiary care hospital.
Obstructed inguinal hernia in an adult male
Authors: Husain Musharraf , Khan Sabina , Deshpande Sanika , Yadav Kartavya S.
Published: August 2023

Persistent Müllerian duct syndrome (PMDS) is an unusual form of internal male pseudohermaphroditism in which Müllerian duct derivatives are seen in phenotypically normal males, with 46, XY karyotype. PMDS is an outcome of defective functioning of the Müllerian inhibiting factor (MIF) or its receptor. MIF causes degeneration of the Müllerian duct in the fetus. PMDS clinically manifests as cryptorchidism or inguinal hernia, although it is mostly undetected until puberty. We report a rare case of PMDS in a 45-year-old male patient with right-sided cryptorchidism and contralateral inguinal hernia. Upon exploration of the hernial sac, it contained a uterus-like mass with attached left testis. Biopsy and subsequent histopathological examination of the mass confirmed the presence of endometrial glands.
Innovative technique for the abdominal wall reconstruction of complex enteroatmospheric fistula
Authors: Kollias Victoria , Cribb Benjamin Ian , Ganguly Timothy , Bierton Christopher , Tonkin Darren
Published: August 2023

Enteroatmospheric fistula (EAF) is a rare and devastating surgical complication with significant management challenges. Abdominal wall reconstruction (AWR) at the time of definitive repair represents the major challenge in patients with large abdominal wall defects with associated loss of abdominal domain. Herein, we describe a case of EAF with significant loss of domain for which AWR was achieved using an innovative combined approach of preoperative botulinum toxin A (BTA), extensive transversus abdominal release (TAR), and abdominal reinforcement with biosynthetic mesh. This approach achieves primary abdominal closure, providing the option of a single definitive reconstructive procedure for EAF. Further studies with long-term follow-up are required to assess the long-term durability of this approach.
Morgagni hernia presenting as constipation in the postsurgical patient
Authors: Cartwright Thomas , Charoenmins Patherica , Nelson Cole , Faustino Josiah , Akhtar Shaan Jamil
Published: August 2023

In this case report, we discuss an 83-year-old woman who presented to the emergency department with complaints of constipation and progressive abdominal pain 2 days after a right total knee arthroplasty. Chest X-ray indicated a possible hiatal hernia, but computed tomography revealed a Morgagni hernia with a portion of the transverse colon and omentum in the thoracic cavity, resulting in a large bowel obstruction. The more common presenting symptoms associated with Morgagni hernia, dyspnea, and chest pain were not present. Surgical management was pursued with a transabdominal approach, the bowel was successfully reduced and the defect was closed using sutures. This case provides an interesting insight into the many potential presentations and clinical signs of the rare Morgagni hernia.
Robot-assisted repair of incisional hernia of the abdominal wall: Which access is better—endoscopic totally extraperitoneal preperitoneal plasty (eTEP) or mini- or less-open sublay (e)(MILOS), some first considerations
Authors: Vogel Robert , Heinzelmann Frank , Büchler Peter , Mück Bjoern
Published: August 2023

Numerous metanalyses have shown that the retromuscular mesh placement is superior to other positions in terms of recurrence and complication rate. As a result, there has been a surge in novel minimally invasive retromuscular surgical techniques. We compared total extraperitoneal plasty (eTEP) and hybrid Mini/Less-open-Sublay [(e)MILOS] with respect to their adaptability to a surgical robotic system. Unfortunately, there is little to no literature regarding robotic adaptation of the (e)MILOS procedure, which made it rather difficult to juxtapose, but then again also implies that it is not commonly performed. As many benefits as the robot brings to endoscopic surgery, however, there is one major constraint when it comes to directionality. In eTEP dissection is performed in one direction and the trocars are positioned at the edge of the dissection field. The centripetal preparation of the (e)MILOS procedure is less suitable for the currently available systems and would naturally require multiple un- and re-dockings of the robot. Alternatively, the robot could only be used for a minor part of the operation. Looking at the published data concerning laparoendoscopic (e)MILOS and eTEP, there appears to be no significant difference in terms of major complications as well as reoperation and infection rates. However, a comparison to a robot-assisted eTEP cannot be done due to lack of publications. Judging from our own experience, we believe the eTEP technique to harness the advantages of the robot in addition to those of minimally invasive surgery more effectively. Within the last two decades, we have been experiencing a constant increment of endoscopic procedures in hernia surgery. This surge is nonetheless thanks to the availability of robotics in a continuously increasing number of hospitals in Europe and the United States. The combination of the advantages of minimally invasive surgery and robotic systems has been discussed and elaborated on many occasions and platforms. Hence, the goal of this analysis is to compare two broadly established minimally invasive (or less open) retromuscular methods in hernia repair surgery with regard to their adaptability to a surgical robot.
Seroma-prevention strategies in minimally invasive inguinal hernia repair
Authors: Ng Trina Priscilla , Loo Brandon Yong Kiat , Chia Clement Luck Khng
Published: August 2023

BACKGROUND:

The rise of minimally invasive inguinal hernia repair has seen both the laparoscopic and robotic approaches increase in popularity in recent years. Despite this, seroma formation remains a common complication, and the aim of this study is to evaluate the current evidence on seroma-prevention strategies in minimally invasive inguinal hernia repair.

MATERIALS AND METHODS:

Four databases (PubMed, Scopus, Embase, and Cochrane Library) were searched from inception to November 15, 2021. All studies describing the use of intraoperative adjuncts to reduce postoperative seroma formation in patients undergoing laparoscopic or robotic inguinal and inguinoscrotal hernia repair were included. Meta-analyses were performed using Review Manager (Version 5.4).

RESULTS:

2,382 articles were identified in the initial database search, and 40 articles were included in the final analysis. In this analysis, there was a significantly lower incidence of seroma formation in the drain group when compared to the no-drain group (P < 0.00001). Other strategies aimed at reducing the dead space involving the transversalis fascia (TF) and hernia sac such as TF inversion with tacking, Endoloop closure of TF, barbed suture closure of TF, distal sac fixation, and complete dissection of the sac have shown promising results as well.

CONCLUSIONS:

While there is currently insufficient evidence to recommend the routine use of any one of the interventions analyzed, the use of drains, the management of the TF, and the hernia sac have showed potential in reducing seroma formation.
Robot-assisted repair of primary uncomplicated inguinal hernia: comparisons to conventional laparoendoscopic repair
Authors: Limper Bernhard , Kamrath Lukas
Published: August 2023

BACKGROUND AND METHOD:

Robotic hernia surgery is progressing more and more, so that the robotic procedure is also used in the groin. We compared our patients who were operated on laparoscopically using the TEP technique with patients who were operated on robotically using the TAPP technique.

RESULTS:

The rTAPP can be safely performed without any problems and has many advantages, but the operating time is significantly longer than the laparoscopic TEPP.

CONCLUSION:

Inguinal hernia surgery can certainly be learned quickly and effectively as an introduction to robotics. It remains to be seen whether it will prevail in terms of surgical time and economics.
Robotic transversus abdominis release for ventral hernia repairs
Authors: Nguyen Tiffany , Kunes Kristina , Crigler Christine , Ballecer Conrad
Published: August 2023

Background:

Robotic transversus abdominis release (roboTAR) is a minimally invasive surgical approach for ventral hernia repairs that builds on the concepts developed by Rives and Stoppa. The Rives–Stoppa procedure incorporates Rives’ retromuscular repair and Stoppa’s concept of giant prosthetic reinforcement of the visceral sac (GPRVS).[1] In an effort to mitigate the limitations of the Rives–Stoppa procedure, Novitsky et al. developed the open transversus abdominis release (TAR). The TAR approach is favorable when repairing large ventral hernia defects, as it provides myofascial advancement to reconstitute linea alba, preserves the neurovascular bundles of the medial abdominal wall, and creates a large extraperitoneal space to allow for mesh reinforcement.

Methods:

The three main technical components of the roboTAR include the following: bottom-up, Novitsky method, and top-down approach. An understanding of the anatomy and technique involved in the three techniques is critical for performing roboTAR.

Results:

Within the authors’ practice, the average hernia defect size is 115 cm2. With a n = 200, approximately 1% of our patients has had a surgical site complication. Recurrences are rare and occur in very large complex hernias. The average operative time is approximately 400 min with an average length of stay being 1.2 days. This is consistent with others.

Conclusion:

Utilizing a minimally invasive approach, as seen in roboTAR, provides additional advantages, including shorter length of hospital stay, reduced wound morbidity, reduced postoperative pain, and expedited return to work and activities of daily living. This article is a comprehensive review of the pertinent anatomy, preoperative evaluation, operative technique, and the postoperative course of roboTAR.
Robot-assisted repair of complicated inguinal hernia: Advantages in comparison with conventional repair
Authors: Allaeys Mathias , Poortmans Natalie , Berrevoet Frederik
Published: August 2023

The adoption rate of robot-assisted surgery has skyrocketed in recent years, despite limited evidence, an unclear clinical benefit, and an increase in cost. The laparoscopic approach to inguinal hernia repair by either transabdominal or extraperitoneal approach has gradually gained traction owing to distinct advantages over traditional open repairs. Although robotic inguinal hernia repair has been established as a safe alternative to conventional laparoscopy, as of yet no superiority has been proven. We aim to give an overview of certain clinical situations, in which the robot might be advantageous. Specifically, we discuss inguinoscrotal hernia repair, inguinal hernia repair after prostatectomy, and mesh explantation. In our opinion, robotic systems are an invaluable tool in the case of mesh resection or recurrence after previous anterior and posterior repairs. With the increased expansion of the surgical tools and techniques to repair abdominal wall problems, a definitive and clear rule as to which cases should be handled robotically and which should not will be difficult and probably unattainable. We are very much proponents of a tailored approach, where every individual case deserves its surgical plan, bearing in mind all aspects of a patient, with the aim of the best surgical outcome.
What is new in parastomal hernia repair
Authors: Hoffmann Henry , Nowakowski Debora , Kirchhoff Philipp
Published: August 2023

Parastomal hernias (PSH) are a frequent problem mostly developing 2–3 years after index surgery impairing the life quality of affected patients. Therefore, effective prevention and treatment seems of utmost importance. However, many different surgical techniques for the treatment of PSH have been described with partially contradicting results and a low level of evidence. Therefore, this article focuses on a systematic overview of prevention and treatment for PSH. Regarding the prevention of PSH mesh-based techniques are suggested to reduce the rate of subsequent PSH, although the “keyhole” mesh, which is often used, has been shown to be ineffective for many reasons. For the treatment of PSH, the use of “funnel-shaped” meshes or Sugarbaker repair provides the most promising results. The keyhole mesh repair of PSH should be abandoned.
Epidemiology and treatment of groin and ventral hernias in the Zinder region, Niger Republic
Authors: Adamou Harissou , Amadou Magagi Ibrahim , Habou Oumarou , Magagi Amadou , Sani Rachid
Published: August 2023

OBJECTIVE:

To describe epidemiological, therapeutic, and prognostic aspects of groin and ventral hernia in adults at Zinder National Hospital.

MATERIALS AND METHODS:

This was a retrospective data collected over a period of 10 years (January 2012–December 2021). All patients aged at least 18 years operated for abdominal wall hernia were included. A value of P < 0.05 was considered significant.

RESULTS:

A total of 921 patients were included. In these patients, groin hernia was present in 78.8% (n = 726), umbilical hernia in 13.25% (n = 122), linea alba hernia in 7.3% (n = 67), and Spiegel’s hernia in 6 cases (0.65%). The mean age was 48 ± 17.2 years. Men accounted for 80.9% (n = 745). Rural origin was 67% (n = 623) and poor 63.8% (n = 588). The stage of hernia strangulation represents 32% (n = 295). The median time to surgical consultation was 8 years. This delay was associated with rural origin (odds ratio [OR] = 1.42; P = 0.0142), poverty status (OR = 1.67; P = 0.0001), and inguinal location (OR = 1.75; 0.0371). General anesthesia was used in 58.7% (n = 541). Bowel necrosis was seen in 9.33% (n = 86). For all groin hernias (n = 783), 96.2% (n = 753) underwent herniorrhaphy and 3.8% (n = 30) underwent a Lichtenstein procedure. For all ventral hernias herniorrhaphy was performed in 95% (n = 245) and mesh repair in 5% (n = 13). Morbidity was 15.4% (n = 142) and mortality 1.74% (n = 16). This was associated with age over 60 years (OR = 3.06; P = 0.0341), ASAIII and ASAIV classes (OR = 5.21; P = 0.015), complicated clinical forms (OR = 4.87; P = 0.023), emergency surgery (OR = 4.51; P = 0.003), and the occurrence of bowel necrosis (OR = 4.11; P = 0.001). The median follow-up was 6 months (range: 3–36 months). Overall, hernia recurrence was recorded in 69 cases or 7.6%. This was associated with emergency surgery (OR = 6.26; P = 0.000) and age over 60 years (OR = 3.02; P = 0.000).

CONCLUSION:

In our context, the management of groin and ventral hernias is an important activity for the surgeon. Inguinal hernias predominate and hernia strangulation is an element of poor prognosis.
Robotic transabdominal preperitoneal morgagni hernia repair technique
Authors: Janowski Courtney , Sioda Natasha , Liu Siwen , Sabatino Alissa , Ballecer Conrad
Published: August 2023

Robotic transabdominal preperitoneal Morgagni hernia repair: A step-wise approach.

Morgagni hernia (MH) is an atypical and rare type of diaphragmatic hernia that presents surgical challenges given its location and proximity to vital structures. Classically, these hernias have been repaired either open or laparoscopically with the use of an intraperitoneal onlay mesh without defect closure. Borrowing from the groups’ excellent experience in robotic transabdominal preperitoneal hernia repair (rTAPP) ventral and atypically located hernias, this approach has shown promise in repairing MHs in albeit a small cohort of patients. The rTAPP technique in our opinion overcomes many of the challenges and pitfalls associated with atypical hernias, including those of the diaphragm, providing excellent visualization and facilitating wide preperitoneal dissection with a complete reduction of the hernia sac located in the anterior mediastinum. The wide preperitoneal exposure allows for directed diaphragmatic closure, minimizing the risk of injury to mediastinal structures, placement of a large uncoated mesh sandwiched in between layers of the abdominal wall, and safely targeted fixation at cardinal points. Preperitoneal mesh allows for the use of a more cost-effective uncoated mesh that is not exposed to the viscera. It also allows for minimal and targeted fixation without the use of tacks, leading to decreased postoperative pain and complications. In this article, we are detailing the rTAPP approach in managing MHs.
Low back pain and motor control dysfunction after pregnancy
Authors: Tuominen Reetta , Jahkola Tiina , Mikkonen Jani , Luomajoki Hannu , Arokoski Jari , Vironen Jaana
Published: August 2023

Purpose:

Pregnancy-related low back pain is a common condition. Persistent postpartum diastasis recti may cause back pain and motor control dysfunction. The role of diastasis in pregnancy-related back pain remains debatable. This study aimed to compare participants with increased symptoms after index pregnancy with those reporting no change in back pain or subjective movement control and to analyze inter-rectus distance.

Materials and Methods:

This case-control study included a cohort of women who delivered 1 year earlier. We recruited participants with increased symptoms (n = 14) after index pregnancy and controls (n = 41) and recorded their inter-rectus distance using ultrasound. A questionnaire was completed, and an ultrasound performed twice for each study group.

Results:

At the baseline, there was no significant difference in inter-rectus distance between cases and controls (mean 2.45 ± 1.01 cm and 2.09 ± 1.03 cm, respectively). A year after index pregnancy symptomatic cases had significantly wider inter-rectus distance than controls (mean 3.45 ± 0.90 cm and 2.40 ± 0.79 cm, respectively). Motor control dysfunction test results were not associated with core stability problems or back pain in this cohort. There was a difference in the sit-up test between cases and controls (mean 4.7 ± 4.2 and 8.2 ± 3.9, respectively).

Conclusion:

Women who reported increased back pain and core instability after index pregnancy had wider inter-rectus diameter than controls. In the case group with more symptoms after pregnancy, the classification of rectus diastasis (RD) changed from mild abdominal RD (2–3 cm) to moderate (>3–5 cm). RD may contribute to persistent pregnancy-related lumbopelvic pain.
Surgical repair of abdominal wall hernias in rural southeast Nigeria
Authors: Ogbuanya Aloysius Ugwu-Olisa , Ugwu Nonyelum Benedette
Published: August 2023

Background:

Abdominal wall hernias constitute a significant cause of morbidity and mortality globally, but more importantly, they present a more pathetic situation in rural areas of sub-Saharan Africa and other developing nations. In our setting, the rate of elective repair is still too low and many cases present late, often with complications. This study aimed at documenting the spectrum, barriers to early repair, and factors that influence the outcomes of repair.

Materials and Methods:

A prospective study of adult patients surgically treated for abdominal wall hernia in rural southeast Nigeria between January 2014 and December 2019.

Results:

Overall, 975 patients were recruited: 706 (72.4%) had simple uncomplicated hernias, whereas the rest (269, 27.6%) presented in the emergency. Inguinal hernias comprised 74.1% of the cases followed by primary midline hernias (14.5%). Delayed presentation was common, with only 2.3% presenting within three months and the main reason being financial constraint (31.0%) followed by ignorance (12.2%). A third (324, 33.2%) of the patients harbored complete inguinoscrotal/inguinolabial hernias. Nearly a quarter (240, 24.6%) had comorbid illnesses, 14.9% harbored recurrent hernias, and more than a third (43.4%) had hernias with defect sizes >5 cm. Wound infection rates were 34.6% in the emergency group, 26.2% in the elderly, 20.7% for those with recurrent hernias, and 17.1% in those with comorbidities. Morbidity rates were greater in patients with hernia defects >10 cm (37.8%), inguinoscrotal/inguinolabial hernias (18.5%), and those who received bowel resection (56.7%). Generally, elevated wound infection and high overall morbidity rates were associated with emergency presentation (P = 0.000), advancing age (P = 0.030), procedures performed by a nonspecialist surgeon (P = 0.014), and large hernia variants (P = 0.000). Overall, mortality rate was 2.9%, but it was 9.7% in those with emergency repair. The main independent predictors of mortality were intestinal resection (P = 0.000), delayed presentation (0.003), advanced age (0.020), and comorbidities (P = 0.002).

Conclusion:

Delayed presentation, often in an emergency setup, is common among patients with abdominal wall hernias in our rural practice. Financial impediments and ignorance were the main barriers to early presentation and elective repair. Consequently, morbidity and mortality rates were high, especially in the setting of advancing age, delayed presentation, coexisting medical conditions, and bowel resection.
To compare the outcome of inguinal hernia repair under local and spinal anesthesia
Authors: Maurya Naveen K. , Asif Shadab , Tahir Saleem , Aishwarya Kumar , Shiromani Swarnlata
Published: August 2023

INTRODUCTION:

The most frequent form of hernia is inguinal hernia, affecting around 15% of adult males. The optimal surgical anesthetic method for ambulatory inguinal hernia repair is unknown at the moment, and there is no consensus on the procedure. The goal of this study was to examine the outcome of inguinal hernia repair under local anesthesia compared with spinal anesthesia.

MATERIALS AND METHODS:

In this prospective observational study, 80 patients were randomly assigned into two groups by the SNOSE method with a different mode of anesthesia: group SA (n = 40) and group LA (n = 40). Lichtenstein tension-free hernioplasty was done in all patients. Pre- and post-OP clinical examinations (3rd day) were looked for complications.

RESULTS:

There were no significant demographic differences between the two groups. When compared with the SA group, the LA group experienced much less post-operative pain. With local anesthesia, post-operative ambulation was substantially faster. The use of a local anesthetic allowed for a shorter stay in the hospital and a speedy return to regular activity. In general, local anesthesia was linked to less post-operative complications in the early aftermath.

CONCLUSION:

Local anesthesia is a preferable choice to spinal anesthesia for short stay or daycare surgery, particularly for patients who are unable to tolerate spinal anesthesia. As a result, Lichtenstein’s hernioplasty performed under local anesthesia is attracting considerable interests in the field of groin hernia repair.
A single surgeon's experience of 1000 consecutive transabdominal preperitoneal repair cases and measures to prevent recurrence
Authors: Tazaki Tatsuya , Sasaki Masaru , Kohyama Mohei , Sugiyama Yoichi , Yamaguchi Takuro , Takahashi Shinya , Nakamitsu Atsushi
Published: August 2023

PURPOSE:

In laparoscopic transabdominal preperitoneal repair (TAPP), the use of a larger mesh has been shown to reduce the rate of recurrence of hernia. However, recurrence may still be observed occasionally, especially in procedures performed by inexperienced surgeons. The purpose of this study was to clarify the learning curve of TAPP and to establish a procedure that precluded the possibility of recurrence.

MATERIALS AND METHODS:

We analyzed the learning curve based on operative time, recurrence, and complication in a single surgeon's experience of 1,000 consecutive TAPP. In addition, by examining cases showing recurrence, techniques necessary to prevent recurrence were clarified.

RESULTS:

The operative time stabilized after 60 cases and continued to reduce thereafter. Recurrence of nine hernias in eight patients within 1 year of surgery was observed up to the 482nd case. Recurrence or intraoperative complication was not confirmed since then. Recurrence after primary inguinal hernia repair presented as indirect hernia-type recurrence. The causes of recurrence were incomplete parietalization in indirect sliding hernia, insufficient dissection of the lateral dorsal side, and up-rolling mesh placement with the lateral dorsal side.

CONCLUSION:

Recurrence can be prevented by sufficiently dissecting the preperitoneal space on the lateral dorsal side and taking care to avoid up-rolling of the mesh while it is being placed.
A simple technique for definite closure of full thickness abdominal wall defect in open abdomen after temporary applied split thickness graft
Authors: Lorentziadis Michael , Nafady Hego Moustafa Mahmoud , Al-Jurini Hanan
Published: August 2023

Open abdomen (OA) has gained a wide acceptance in the management of abdominal surgical catastrophes. Definite reconstruction of OA is an operative challenge as various methods are used. Dynamic techniques are preferred for the closure of OA. If other methods fail to close the OA, then temporary split thickness skin graft can be applied and refer the definite closure for later. We used a modification of an existing technique, in a 47-year-old female patient with a big midline incisional hernia due to temporary closure of OA with partial-thickness skin graft, who was operated for permanent closure of the defect. In order to avoid complications from extensive dissection, we invaginated the grafted area and realigned the recti muscles with on lay mesh reinforcement with excellent outcome. This technique of inverting the previous grafted area when it can be applied is an easy and safe method with rewarding results.
Feasibility of robotic repair of parastomal hernias
Authors: Schmitt Kyle M. , Albaugh Vance L. , LeBlanc Karl
Published: August 2023

BACKGROUND:

Parastomal hernias present a common complex surgical problem that has a severe clinical impact on quality of life. Several techniques for repair have been described with open or minimally invasive techniques, although recurrence and reoperation continue to be common problems. In the following, a case series utilizing a technique for a minimally invasive repair using the Di Vinci robotic platform for a mesh-reinforced, modified Sugarbaker repair is described.

STUDY DESIGN:

This study is a retrospective review of 24 cases of robotic-assisted parastomal hernia repairs performed by a single surgeon from 2014 to 2020. Primary endpoints of interest were operative times and length of stay, as well as postoperative complications.

RESULTS:

Twenty-four patients were included in the study. The average operative time was 194.8 min (range: 95–378 min) and the average console time was 149.5 min (range: 72–319 min). The average length of stay was 3.9 days. No patients required conversion to either a laparoscopic or an open procedure, although two complications required reoperation. Twelve patients developed minor complications, including four who developed a postoperative seroma, but none of them required surgical intervention.

CONCLUSIONS:

This is the first and largest series describing a technique for a robotic-assisted parastomal hernia repair. This shows that this procedure can be reliably undertaken with the robotic platform with consistent and reproducible results and few complications. Further long-term research will be needed as new robotic techniques evolve and patients will need follow-up regarding recurrence rates and any late complications evaluated.
When hernia mesh erodes into the bowel
Authors: Nair Ishwarya , Slater Kellee
Published: August 2023

Incisional hernia repair surgery is commonly performed by using a synthetic mesh; due to its low complication rate. This article describes the management of a patient with mesh erosion into the small bowel, a rare complication of mesh-based ventral hernia repair. Fatigue secondary to iron-deficiency anemia and disfigurement from his hernia were his only symptoms. The patient was conservatively managed for several years due to the risks associated with restorative surgery. Eventually, due to deterioration of his health as well as advances in the techniques of abdominal wall reconstruction, the patient underwent surgery. The patient made excellent recovery. The complications associated with the synthetic mesh are likely to be very underreported. This article discusses the factors leading to mesh erosion, including mesh type, fixation methods, mesh migration, and mesh position, and it emphasizes the importance of reporting and following up hernia patients to advance the science behind mesh technology and surgical techniques surrounding ventral hernia repair.
Upfront debulking surgery or delayed surgery after neoadjuvant chemotherapy for advanced-stage epithelial ovarian cancer: Comparison of survival from a noncancer center in India
Authors: Shekhar Shashank , Singh Pratibha , Vishnoi Jeewan R , Goel Shuchita , Pareek Puneet , Sharma Charu , Goyal Manu , Yadav Garima , Jhirwal Manisha , Soni Sweta , Misra Sanjeev
Published: August 2023

Background:

In advanced-stage epithelial ovarian cancer (EOC) standard of care is upfront debulking surgery (UDS) followed by adjuvant chemotherapy. Interval debulking surgery after neoadjuvant chemotherapy (NACT-IDS) is a reasonable alternative.

Methods:

This study was a retrospective review of patients of Stage III/IV EOC treated either by UDS or NACT-IDS between January 2016 and December 2018 to report the comparison of progression-free survival (PFS) and overall survival (OS) of patients with advanced-stage EOC treated with either UDS or NACT-IDS.

Results:

Out of 50 patients, 19 (38%) underwent UDS, and 31 (62%) received NACT. The mean follow-up duration was 27.7 months. No gross residual disease was achieved in 52.6% of the UDS group and in 70.4% of the NACT-IDS group. The median PFS of 20 and 30 months was observed in the UDS and NACT-IDS groups, respectively (log-rank P = 0.054). The median OS was 36 months in the NACT-IDS group and could not be reached in the UDS group (log-rank P = 0.329). Only residual disease was significantly associated with survival (hazards ratio 3.03, 95% confidence interval: 1.19–7.74) on multivariate Cox regression analysis.

Conclusions:

In advanced-stage EOC, the survival outcomes of NACT-IDS are comparable with those of UDS. Apart from the patient-specific parameters, the decision for UDS or NACT-IDS should take in account the expertise of the surgeon and the institutional capacity as a whole.
Clinical presentation and outcomes of pediatric anaplastic large cell lymphoma: A tertiary center experience from India
Authors: Sahoo Debasish , Gupta Aditya Kumar , Wajid M Abdul , Meena Jagdish Prasad , Seth Rachna
Published: August 2023

Background:

Anaplastic large cell lymphoma (ALCL) is an uncommon T-cell lymphoma, accounting for 10–15% of pediatric non-Hodgkin lymphoma (NHL). Outcomes of ALCL have not improved in recent years despite better chemotherapy and supportive care. This study aimed to analyze the clinical profile and outcomes of pediatric ALCL patients at our center.

Materials and Methods:

Medical records of children with ALCL from July 2017 to December 2019 were reviewed. Their clinical and laboratory details were noted. The outcomes of all patients were recorded.

Results:

Ten patients were diagnosed with ALCL during this period. The median age at diagnosis was 8 years, with 7 patients being boys. Lymph nodes were the primary site of involvement in four children. Extranodal involvement was seen in 60%. One patient had the underlying chronic granulomatous disease (CGD). Systemic (B) symptoms were seen in 70%. Three children had hemophagocytic lymphohistiocytosis (HLH) at presentation. All of them had stage-III disease. Seven patients were treated on the Berlin-Frankfurt-Münster-non-Hodgkin lymphomas (BFM-NHL) 90 protocol and three children are currently in remission. Four patients had disease relapse/progressive disease while on therapy. Three children had HLH at presentation and all had poor outcomes.

Conclusions:

Pediatric ALCL has diverse and atypical clinical presentation and a high index of suspicion is needed for diagnosis. ALCL is an aggressive malignancy and is responsive to multiagent chemotherapy, though survival has not improved over the past decade. The integration of novel agents may improve the outcome.
Assessment of the outcomes of eating additional fruits or nuts on periodontal condition – A clinical study
Authors: Dar Ajaz Ahmed , Nissar Insha , Shaktawat Neha , Sharma Supriya , Bhati Rajendra Singh , Tomar Monika
Published: August 2023

Background:

Periodontal condition is a multifaceted chronic inflammatory condition that necessitates the formation of a pathogenic biofilm, the countenance of which is influenced by a variety of host-dependent factor grounds. The goal of the analyses presented in this article was to establish the outcomes of a huge upsurge in fruit or nut consumption on probing pocket depth.

Materials and Methods:

After the baseline investigations, the participants were randomly assigned to eat an extra 7kcal/kg body weight/day of additional fruit or nuts by drawing ballots. The ratio of randomization was 1:1. When the entire sums of probing pocket depths of the participants that were a minimum of 4-mm deep were compared amid groups, the difference was statistically significant (P = 0.012).

Conclusion:

This randomized trial found no evidence that eating a lot of fruits had a deleterious impact on periodontal condition or infection.
Anticaries vaccine
Authors: Vijaywargiya Neelam , Verma Manish , Saxena Divya , Ganguly Suparna , Pagare Nilima , Khatri Margie
Published: August 2023

The mutans streptococci bacteria have long been acknowledged as the prime disease-instigating agents in dental caries, the disease that causes tooth decay. Caries vaccines have shown promising outcomes in animal trials, but they are still far from being effective in humans owing to political, monetary, as well as ethical concerns. Candidate vaccines must be evaluated in clinical trials to progress toward practical vaccine development. Passive immunization strategies that appear to be promising will need to be tested further in the clinic.
Evaluation and comparison of the antimicrobial activity of herbal extracts with the standard irrigant against Enterococcus faecalis
Authors: Atom Jenny , Devi Ningthoukhongjam Rati , Kangabam Nikita , Thoudam Bebika Devi , Lairenlakpam Ronel , Singh N. Sukumar
Published: August 2023

Background:

Numerous actions to diminish the number of microorganisms in the root canal system comprise the usage of a variety of functional techniques, irrigation methods, and intracanal medications. Irrigation goes hand in hand with resources to help remove pulp tissue and/or microorganisms.

Purpose:

The intent of this trial was to assess as well as compare the antimicrobial activity of herbal irrigant with normal irrigant (2.5% sodium hypochlorite [NaOCl]) against Enterococcus faecalis to test its effectiveness as root irrigation water.

Materials and Methods:

The culture was elevated overnight at 37°C in brain heart infusion (BHI) broth followed by testing microbial growth for changes in turbidity for 24 h. BHI broth comprising E. faecalis is vaccinated on a BHI agar plate using a grass planting method utilizing a sterile glass dispenser. Five test herbal discs (Curcuma longa [CT]-turmeric, Azadirachta indica [AI], MI, Propolis [P], and Triphala [T]); in addition to two control discs (ethanol as well as NaOCl) positioned on a custom plate.

Results:

The average blocking area with a drop-down program for each drug was observed to be: NaOCl (24.0 ± 1.74) >P (14.6 ± 1.84) > AI (09.5 ± 1.72) > T (06.4 ± 0.83) > CT (04.3 ± 04.1± ±0.83).) > Morinda citrifolia (03.2 ± 0.30) > ethanol (00.1 ± 0.01).

Conclusions:

P and AI have shown assuring outcomes in the completion of E. faecalis. Nevertheless, their work has been observed to be under NaOCl.
Peripheral cemento-ossifying fibroma
Authors: Roopesh U. , Ambika S. , Usha Arjun Madhu , Kumar Arun
Published: August 2023

The gingiva is frequently the spot of localized growths that are problematic to diagnose clinically besides can only be distinguished as a distinct entity by consistent histomorphology. The peripheral ossifying fibroma is a type of fibro-osseous benign tumor that can recur even after it has been removed. Clinical as well as histologic features are discussed, in addition to differential diagnosis, treatment, and follow-up recommendations. Clinically, it is tough to distinguish amid most reactive gingival lesions, especially in the early phases, so it is critical to rule out causative aspects as well as histological examination of the tissue for confirmation.
High-flow Nasal Cannula in Pediatric Patients
Authors: Puspaningtyas Niken W. , Dewi Rismala , Pudjiadi Antonius H.
Published: August 2023

High-flow nasal cannula (HFNC) provides conditioned high-flow oxygen through an open system with high pressure and high velocity. HFNC has been widely used in neonatal patients with comparable benefit to CPAP; however, the use in pediatric patients has not been well evaluated. In pediatric patients, a regular nasal cannula is widely used as oxygen therapy, but the flow provided is limited because the humidity is not optimal. While HFNC as noninvasive oxygen therapy can deliver heated, humidified gas, via nasal cannula. High-velocity HFNC makes oxygen-rich gases occupy the dead space of the nasopharynx, increasing FiO2, and improving alveolar ventilation. The use of HFNC in children begins with bronchiolitis patients, also considered effective in various respiratory disorders including cases of hypoxemic respiratory failure. HFNC has been shown to have a better patient tolerance, less nose damage, and less work for the staff than CPAP and noninvasive ventilators (NIV). HFNC can be used in the emergency department and even the patient ward, while CPAP and NIV require intensive care unit facility as it needs close monitoring. HFNC is considered safe with mild side effects such as epistaxis and skin irritation that have been reported. While serious side effects such as pneumothorax are rarely reported because open system HFNC can prevent a sudden increase in airway pressure.