bluuebunny/crossref_metadata_2025 huggingface dataset:
LONG TERM RECURRENCE RATES AFTER ELECTIVE VENTRAL, INCISIONAL AND PARASTOMAL HERNIA REPAIRS
Authors: Henriksen N A , Helgstrand F
Published: May 2024

Background

Most studies report a one- or two-year recurrence rate, but studies evaluating long-term follow-up are lacking. The aim of this nationwide cohort study was to evaluate the cumulative long-term recurrence rates of umbilical, epigastric, incisional, parastomal, port-site and other ventral hernia repairs over a 15-year period.

Methods

All types of primary elective ventral hernia repairs (umbilical, epigastric, incisional, parastomal, port-site and other ventral hernias) registered in the Danish Hernia Database from 1st of January 2007 until 31st of December 2022 were included. A multivariable Cox regression analysis was performed for evaluation of factors associated with recurrence, and cumulative rate of operation for recurrence was presented in a Kaplan-Meier plot.

Results

After 15 years, operation for recurrence was 10.5% after umbilical, 14.3% after epigastric, 18–20% after incisional and port-site and 40% after parastomal hernia repairs. The rate of recurrence repair continued to rise through the period. Increasing defect size, repair without mesh and reoperation within 90 days were found to be significantly associated with risk of recurrence repair after umbilical, epigastric and incisional hernia repair after adjustment for gender, age and Charlson comorbidity score. For parastomal hernias, the only significant risk factor for recurrence repair was readmission within 90 days.

Conclusion

The recurrence rate keeps on rising, suggesting that following patients for more than a few years is important. Risk of recurrence after parastomal hernia repair Notably, only patients operated for recurrence were included in the current study and the true recurrence rate is likely to be much higher.
RISK OF VENTRAL HERNIAS IN RELATION TO PARITY IN WOMEN, A POPULATION-BASED STUDY
Authors: Katawazai A , Järnbert-Pettersson H , Wallin G , Sandblom G
Published: May 2024

Introduction

The influence of pregnancy on the risk of ventral hernia recurrence is not known. This study aims to assess whether the frequency of pregnancies is associated with an elevated risk of developing ventral hernias.

Method

This nationwide study cohort constitutes women borne 1950 – who were registered in the Swedish Birth Register (MBR). Data on pregnancies, distinguishing between vaginal and caesarian sections, were retrieved from the Birth Register. The cohort was cross-matched with the National Patient Register (NPR) to identify subsequent primary hernia repairs.

Results

A total of 1,630,754 women born between 1950 and 1980 were included in the study. Among them, 1,588,609 (92.3%) were registered for at least one birth. The incidence rate for Umbilical Hernia Repair (UHR) and Epigastric Hernia Repair (EHR) was 13.21 per 100,000 person-years and 5.4 per 100,000 person-years, respectively. When compared with women registered for one delivery, the incidence rate ratio for UHR was 1.3 (95% CI: 1.26–1.33, P < 0.001) among those registered for two deliveries and 1.6 (95% CI: 1.58–1.68, P < 0.001) among those registered for ≥3 deliveries.

The incidence rate ratios were 1.29 (95% CI: 1.20–1.39, P < 0.001) and 1.34 (95% CI: 1.24–1.45, P < 0.001) for EHR among women with two and ≥3 registered deliveries, respectively.

Conclusion

A history of more than one pregnancy is associated with an increased incidence of umbilical and epigastric hernias.
CONCOMITANT VERSUS STAGED REPAIR OF VENTRAL HERNIAS DURING BARIATRIC SURGERY: A SYSTEMATIC REVIEW
Authors: Lyons N , Jones A , Collie B , Delamater J , Shagabayeva L , Cobler-Lichter M , Akintonwa O , Nguyen J , Liang M , Bernardi K
Published: May 2024

Background

Obesity is a risk factor for the development of ventral hernias, which are found in about 8% of bariatric surgery candidates. It is controversial as to whether patients should undergo bariatric surgery and ventral hernia repair concomitantly, or in a staged approach. We aimed to determine the ideal approach for bariatric patients with ventral hernias.

Method

A systematic review of the literature was performed using PubMed, Scopus, and Cochrane Library from inception to October 2023. Randomized controlled trials and observational studies comparing concomitant repair (CR) with staged repair (SR) were included. Cumulative analysis was performed with Fischer’s exact test.

Results

A total of 1001 titles were screened. Seven observational studies evaluating 11,906 patients (3,528 CR, 8,378 SR) met inclusion criteria. Mean age was 46 and 76% were female. Mean body mass index at time of bariatric surgery was 47.6, and the average length of follow-up was 28 months. CR had a higher reoperation rate (5.5% vs. 2.5%, p < 0.001) and mortality (0.32% vs. 0.06%, p = 0.001) than SR. However, SR had a higher rate of bowel obstruction (13.5% vs. 1.4%, p < 0.001), and surgical site infection (20.5% vs. 10.0%, p < 0.001). There was no statistical difference in surgical site occurrence (4.9% vs. 4.5%, p = 1) or recurrence rate (12.9% vs. 4.1%, p = 0.052) for SR vs. CR.

Conclusion

The decision of whether to repair ventral hernias concomitantly during bariatric surgery or in a staged approach should be individualized. Randomized controlled trials and more prospective studies are needed before guidelines can be developed.
OPEN VERSUS LAPAROSCOPIC INCISIONAL HERNIA REPAIR FOLLOWING LIVER TRANSPLANTATION: AN UPDATE OF SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Sanha V , Kasakewitch J P G , Lima D L , Nogueira R , Cavazzola L T , Malcher F , Sreeramoju P
Published: May 2024

Aim

This study aims to compare the outcomes of open versus laparoscopic repair techniques in patients who have undergone liver transplantation (LT) and subsequently developed incisional hernias (IH). Given the frequent occurrence of IH post-LT and the evolving surgical approaches, this analysis seeks to elucidate the most effective method in terms of complication rates, operation time, and recurrence.

Material and Methods

A comprehensive literature review across databases including PubMed, Cochrane, LILACS, SciELO, and EMBASE was conducted. The review adhered to the Cochrane Collaboration and PRISMA statement guidelines, considering studies that compared open and laparoscopic repair methods for IH post-LT.

Results

After screening 334 studies, six were included. The study encompassed a total of 338 patients, with 32% undergoing laparoscopic repair and 68% receiving open repair. The meta-analysis showed that laparoscopic repair typically required more time, averaging 20.30 minutes longer (CI: 2.14–38.46; P = 0.03). However, when comparing laparoscopic and open repair methods, there were no statistically significant differences in infection rates (OR: 1.12; CI 0.34–3.63; P = 0.85), recurrence rates (OR 0.61; CI 0.28–1.33; P = 0.22), overall surgical complications (OR 0.59; CI 0.31–1.13; P = 0.11), or the length of hospital stay (Mean Difference [MD] -0.67; CI -2.30–0.97; P = 0.42). The quality assessment of the studies indicated a moderate risk of bias.

Conclusion

Open and laparoscopic repair methods for IH post-LT yield comparable postoperative outcomes. The main distinction lies in the longer operation time associated with laparoscopic repair.
INDEPENDENT PATIENT DATA META-ANALYSIS OF PROPHYLACTIC MESH PLACEMENT FOR INCISIONAL HERNIA PREVENTION (AFTER ABDOMINAL AORTIC ANEURYSM SURGERY): A COLLABORATIVE EUROPEAN HERNIA SOCIETY PROJECT (I-PREVENT-AAA)
Authors: van den Berg R , Den Hartog F P J , Bali C , Matsagkas M , Bevis P M , Earnshaw J J , Debus E S , Honig S , Berrevoet F , Detry O , Stabilini C , Muysoms F E , Tanis P J ,   European Hernia Society Prophylactic mesh study group collaborators European Hernia Society Prophylactic mesh study group collaborators:, Diener H , Kölbel T , Reinpold W , Zapf A , Bibiza-Freiwald E , Georvasili V K
Published: May 2024

Introduction

Incisional hernia (IH) is a prevalent and potentially dangerous complication after abdominal surgery, especially in high-risk groups. Prophylactic mesh augmentation (PMA) of the abdominal wall has been studied as a preventive measure for IH-formation, but strong recommendations are lacking. Our primary aim was to evaluate the effectiveness of the use of PMA after open abdominal aortic aneurysm (AAA)-surgery for the prevention of IH by performing an individual patient-data meta-analysis (IPDMA). Secondary aims include evaluation of postoperative complications, and identification of subgroups that benefit most from PMA.

Methods

A systematic literature search to identify Randomized-Controlled Trials (RCTs) that compare PMA after open AAA surgery to primary suturing (PS), was conducted. Lead authors of eligible studies were asked to share individual participant-data. A one-stage analysis was performed and Cox-regression analyses were used to assess time-to-event outcomes.

Results

Five RCTs were included in our IPDMA, which resulted in 488 analysed patients. PMA resulted in a Hazard Ratio (HR) of 0.25 (95%CI 0.12–0.50) for the reduction of IH occurrence. No significant differences were present when comparing onlay with sublay mesh (HR 0.56, 95%CI 0.24–1.28). Patients treated with an onlay mesh had significantly more seroma formation in comparison to PS (OR 22.1,95%CI 1.88–259.58) and patients with a sublay mesh had fewer re-operations than those treated with PS (OR 0.47,95%CI 0.43–0.51). Subgroup analyses showed the effectiveness of PMA in various subgroups (e.g., high BMI patients).

Conclusion

PMA after open AAA surgery is an effective measure to reduce IH formation in a wide variety of patients.
LEFT PETIT´S HERNIA IN ANCIENT PATIENT
Authors: Alonso Gómez S , Granados Hernández P , Morante Perea A P , Martinez Cortijo S
Published: May 2024

Aim

To describe a step by step open surgical technique of a primary left Petit´s hernia in an elderly patient.

Introduction

Petit's lumbar hernia is a rare defect of the posterior abdominal wall. It appears at the level of the lower lumbar triangle, limited by the iliac crest at the inferior border, the external oblique muscle as the lateral border, and the latissimus dorsi muscle as the medial border.

Methods

We present the case of an 84-year-old woman who consulted for a mass in the left lumbar region. On physical examination, an increase in volume was appreciated in the left lumbar area (theoretical Petit's triangle) that was manually reduced and that protruded with the Valsalva manoeuvre. CT scan showed a defect in the lumbar fascia with protrusion of the left colon through the defect. The hernia sac measured 6 cm, and the maximum hernia defect was 2 cm.

Results

The patient was placed in the prone position. The hernia sac was dissected and reduced. Dissection of the retromuscular and retroperitoneal space was performed in all directions. A heavy-weight mesh was placed in the retroperitoneal space without fixation. After the transversalis closure a second light weight mesh was placed in the retromuscular place fixated with glue, closing the muscle gap on top. The patient was discharged uneventfully on the 2nd postoperative day.

Conclusion

The interest of this video is to present a rare case of Petit´s hernia. The open double mesh approach is effective and good option in case of Petit´s hernia.
BOTULINUM TOXIN AND e-TEP IN EPIGASTRIC M1M2W3 INCISIONAL HERNIA AFTER HEPATIC TRANSPLANT
Authors: Bellido-Luque J , Scammon Duran A , Alpizar-Rivas O , Sanchez Matamoros Marin I , Nogales Muñoz A , Morales-Conde S
Published: May 2024

A 73-year-old female with history of diabetes mellitus and hepatic transplant presents with discomfort in a reducible 10 cm M1M2W3 incisional hernia. Botulinum Toxin was injected 4 weeks prior to the surgery in order to achieve the medialization of both rectus muscles without tension avoiding the need to do a posterior component separation.

The patient is operated using a full endoscopic minimally invasive extraperitoneal approach (e-TEP). A 2 cm incision on the left subcostal region is made, exposing and opening the anterior rectal sheath (ARS), medializing the left rectus muscle. A dissection balloon is introduced to release the retromuscular space. Two more trocars are inserted in the left hypochondrium and left iliac fossa (10 mm, 5 mm respectively). We then proceed to incise the medial aspect of the left posterior rectus sheath (PRS) and start the preperitoneal dissection doing the crossover above the umbilicus. Cranially, we carefully section the adhesions of the old laparotomy to connect the preperitoneal space with the retrodiaphragm space bilaterally to not only correct the defect but to also enforce the laparotomy scar. The hernia is then reduced and the defect is closed with a barbed suture. A wide pore PPL mesh is inserted, covering both retrodiaphragm and preperitoneal spaces. The mesh is fixated. A drainage is placed and removed 24 h after surgery. The patient is discharged 24 h after without complications. In the CT scan 6 months after surgery the correction of the defect was confirmed and pain and aesthetic results where satisfactory.
INTERCOSTAL POST-TRAUMATIC HERNIA
Authors: Gené C , Clavell A , Castellví A , Martínez C , Rodriguez R , Horneros J , Torres A
Published: May 2024

Background

Intercostal posttraumatic hernias are very rare but clinically significant conditions that occur as a result of blunt or penetrating chest trauma.

Methods

A 66-year-old female with a history of high energetic trauma and consequent 8th and 9th right rib fractures presented several months later with a progressive onset of right side swelling. The CT scan revealed an intercostal hernia between the 8th and 9th right ribs, containing small bowel loops and right colon.

A month prior to surgery 300 IU of Botox® was injected bilaterally in between the lateral muscles of the abdominal wall. A combined thoracic and abdominal open repair approach was performed. An anterior disruption of the diaphragm was appreciated, which led to the presence of abdominal contents in the pleural cavity. The repair combined the placement of a P4HB mesh with a PP mesh in the retromuscular space. Then, the diaphragm was sutured using reinforced teflon pledgets, polypropylene single stitches and a second P4HB mesh was placed on top of it. Finally, the 8th and 9th ribs were reapproximated using non-absorbable sutures.

Results

The postoperative period was uneventful, and no recurrence occurred during the first 6-months of follow-up.

Conclusions

Managing intercostal hernias resulting from traumatic accidents, can be challenging, especially when anatomical distortions are involved. This case highlights the importance of tailored surgical approaches for addressing intercostal hernias with a meticulous dissection to allow proper identification of the structures involved in the hernia repair.
TAPE REPAIR. TRANSABDOMINAL PARTIAL EXTRAPERITONEAL REPAIR FOR LAPAROSCOPIC REPAIR OF SUPRAPUBICS HERNIAS
Authors: Sánchez-Ramírez M , Valera Z , Naranjo J R , Morales-Conde S
Published: May 2024

Background

TAPE is suitable for laparoscopic repair of Suprapubic hernias where lower margin is within 5 cm from pubic arch. These hernias are known to occur after transverse or low vertical incisions in gynecological, urological or bowel related surgery. The repair of suprapubic hernias is as such difficult due to absent posterior rectus sheath, proximity to urinary bladder and essential neurovascular structures.

Method

After creation of pneumoperitoneum, the position of the ports is decided on the basis of the location of the suprapubic defect. 12 mm and Two additional ports of 5 mm are made on the lateral abdominal wall, mainly on the left flank to assess the hernial defect, previous scar and perform adhesiolysis. This allows space for adequate prosthetic overlap. The hernial content is completely reduced to expose the fascial borders of the defect. A peritoneal flap is dissected starting close to one anterior superior iliac spine (ASIS) and extended to the contralateral ASIS. The flap is inferiorly dissected till space of Retzius so that pubic arch and Cooper’s ligaments on either side are completely exposed. Medially, dissection is meticulous and carefully done avoiding any sort of iatrogenic injury to the urinary bladder. Close the defect with continuous suture with barbed suture of 1. A composite mesh (GORE® SYNECOR) of the appropriate size is chosen so that an overlap of at least 5 cm is achieved around the defect. The lower margin of the mesh must extend below the pubic arch by 1–2 cm to a low firm fixation to Cooper’s ligaments bilaterally with tackers CapSure™Permanent fixation. The rolled mesh is passed through a 12 mm port is spread inside the abdomen in a manner so that the surface with adhesion barrier faces the abdominal viscera. Spiral tacks are used to fix the mesh at two points on the Cooper’s ligaments on both sides. Circumferential fixation is also done at the mesh margins and around the margins of the hernial defect in the manner of double crowning. The peritoneal flap raised initially is made to reperitonealize the maximum possible part of the mesh.

Results

The main advantage of TAPE technique is suitable mesh overlap of more than 5 cm from the distal margin of the hernial defect. The fixation of the lower mesh margin to the Cooper’s ligaments on either side increases the strength of repair. The procedure does allow part of the mesh to remain in the extraperitoneal space. Since polypropylene meshes can be safely used, it allows to minimize the cost of procedure.

Conclusion

Laparoscopic repair of suprapubic incisional hernias is a safe and effective treatment option that offers several advantages over traditional open surgery. With careful patient selection and appropriate surgical technique, most patients can expect a successful outcome with low rates of recurrence and minimal complications.
A MULTIDISCIPLINARY TEAM APPROACH TO ABDOMINAL WALL RECONSTRUCTION: ASSESSING THE RESULT OF COMBINED HERNIA AND PLASTIC SURGERY TECHNIQUES
Authors: Alsannaa F , Almadani J , Alajaji T , Alobaysi S , Alnefaie F
Published: May 2024

Aim

To evaluate short-term outcomes of patients undergoing abdominal wall reconstruction (AWR) via a combined surgical management approach involving complex abdominal hernia repair and concurrent body contouring procedures performed by general and plastic surgery teams.

Material and Method

A retrospective review was conducted of patients who received AWR between 2021–2024 that utilized a combined surgical technique. Procedure included abdominal wall reconstruction along with tissue expander insertion, abdominoplasty, or panniculectomy based on individual patient needs.

Eight cases were included in our study, one case with skin loss due to flap necrosis from previous abdominoplasty (Figure 1), one case post deep inferior epigastric perforator (DIEP) flap procedure and previous abdominoplasty, and the rest were with excess skin (Figure 2).

Primary outcomes were surgical complications, hernia recurrence, and patient satisfaction.

Result

Among our cases who underwent AWR, eight cases underwent a combined surgical management approach with follow up from up to 16 months.

Our short-term results are favourable and revealed high patient satisfaction with no evidence of hernia recurrence and excellent cosmetic outcome.

Conclusion

A combined surgical management and multidisciplinary team approach found to be a promising and encouraging that allows the involved teams to share their different experiences and techniques in order to provide a high quality of care and remarkable patient satisfaction.
ROBOTIC ENHANCED VIEW TOTAL EXTRAPERITONEAL REPAIR (eTEP) WITH ENDOSCOPIC POSTERIOR LINEA ALBA RECONSTRUCTION (EPLAR) FOR INCISIONAL HERNIA: EARLY RESULTS FROM 34 CASES
Authors: Bauer R C , Pradella C , Schupp L , Rosenblum I , Schenkluhn B , Eucker D , Rosenberg R , Lamm S H
Published: May 2024

Background

Laparoscopic incisional hernia repair offers advantages compared to open surgery. However, laparoscopic reconstruction of the linea alba is technically demanding and may be facilitated by the robotic approach. In this study, we present our experience with robotic eTEP with EPLAR for incisional hernia repair.

Method

A standardized robotic system was utilized. After preparing the retrorectus space, EPLAR was conducted with long-term absorbable barbed suture in a running fashion and a macroporous, nonresorbable mesh was introduced. Perioperative data were prospectively recorded in a register. One year follow-up was conducted using a standardized questionnaire.

Results

From January 2022 to September 2023, robotic eTEP with EPLAR was performed in 34 patients (41% female) with incisional hernias. Hernia width was W1 (<4 cm) in 38% of cases, W2 (4–10 cm) in 56% and W3 (>10 cm) in 6%. The mean operation time was 161 minutes. There were no intraoperative complications. The median length of stay was three days (range, 2–7 days). Postoperative complications occurred in four patients (one pulmonary embolism, one seroma, two cases of urinary retention). No reoperations were necessary. One year follow-up has been completed in 11 patients, with 90% reporting being free of pain.

Conclusion

In our setting, robotic eTEP with EPLAR demonstrated favorable outcomes with no surgical site infections and excellent cosmesis. EPLAR may result in better abdominal core stability than other techniques using mesh placement with or without defect closure, as well as providing better ergonomics for the surgeon.
FASCIAL TRACTION AS AN ALTERNATIVE TO POSTERIOR COMPONENT SEPARATION IN PATIENTS WITH HISTORY OF PERITONEAL SURGERY – A CASE REPORT
Authors: Gajda Escudero J , Sánchez López J D , Ferrero Celemín E , Rodriguez Haro C , Hernández O’Reilly M , Mellado Sánchez I , Peck García C , Picardo Nieto A L
Published: May 2024

Aim

The aim of this communication is to present an alternative to posterior component separation for midline incisional hernia repair in patients with a history of peritoneal surgery.

Material and Methods

We present the case of a 62-year-old female patient with a history of stage IV rectal cancer who underwent ultra-low anterior resection, hysterectomy and resection of peritoneal implants. Subsequently the patient presented peritoneal progression, so she underwent peritonectomy with HIPEC. She came to our office presenting a M3-M5W2 eventration with a 10 cm defect, very symptomatic.

Given the history of peritonectomy, the performance of a Transversus Abdominis Release (TAR) was discarded, opting for repair using a fascial traction device and the performance of a Rives-Stoppa technique. To facilitate traction, botulinum toxin was injected into the abdominal muscles.

Results

A Rives-Stoppa technique was performed with placement of a retromuscular polypropylene mesh. The defect was closed by means of a fascial traction device, applying 14–16 kg of force for 25 min. The anterior fascia was closed without bridging nor tension.

The patient presented no complications in the immediate postoperative period and was discharged on the 2nd postoperative day. At 11 months the patient presents good general condition, with a continent abdomen and no signs of recurrence.

Conclusions

Peritoneal surgery is an increasingly used therapy in patients with late-stage cancers. These procedures may preclude the performance of techniques involving posterior component separation. The use of fascial traction devices is a viable alternative for abdominal wall repair in patients with a history of peritonectomy.
PREOPERATIVE USE OF BOTULINUM TOXIN AND PROGRESSIVE PNEUMOPERITONEUM IN L3 INGUINAL HERNIA WITH LOSS OF DOMAIN – A CASE REPORT
Authors: Gajda Escudero J , Martínez Alegre J , Sánchez López J D , Rodriguez Haro C , Hernández O’Reilly M , Mellado Sánchez I , Peck García C , Ferrero Celemín E , Vaquero Pérez M A , Picardo Nieto A L
Published: May 2024

Aim

The aim of this communication is to present a case of preoperative progressive pneumoperitoneum (PPP) and injection of botulinum toxin type A (BT) in a patient with a L3 inguinal hernia and loss of domain.

Material and Methods

We present the case of a 74-year-old patient with a L3, non-reducible, right inguinal hernia with loss of domain. An abdominal CT scan was performed, showing a hernial orifice of approximately 6.6 × 5.4 cm containing mesenteric fat, ileum and part of the bladder inside.

Given the size of the hernia, PPP and BT and was proposed to increase intra-abdominal pressure prior to surgery.

Results

Botulinum toxin is injected into the rectus abdominis, transverse and oblique muscles. An intraperitoneal catheter is placed, through which 1000 cubic centimeters of pneumoperitoneum are introduced daily until reaching 9000 cc.

Open hernioplasty is performed according to the Litchenstein technique, reducing the hernial content in its entirety. A polypropylene mesh is placed. Intra-abdominal pressure was monitored and measured at 9 mmHg before surgery, 12 mmHg during the procedure, and 15 mmHg after the procedure.

Conclusions

In patients with large L3 hernias and loss of domain, reduction of the herniated content have the risk of producing an abdominal compartment syndrome. There are several techniques to maintain an appropriate intra-abdominal pressure prior to surgery, such as BT or PPP, although their use is mainly described for midline hernias. The use of BT and PPP may be a useful therapy in the treatment of large inguinal hernias with loss of domain.
TAILORED APPROACH TO ABDOMINAL WALL RECONSTRUCTION: LESSONS FROM A COMPLEX HERNIA CASE
Authors: Gaspar Reis S , Sobrino Brenes L , Llosa Pérez J , Pérez Huertas R , Ramon Naranjo Fernández J , Morales-Conde S
Published: May 2024

Background

Complex abdominal hernias present challenges in surgical practice, necessitating innovative strategies for successful reconstruction of the abdominal wall.

We aim to elucidate the intricacies of reconstructing the abdominal wall in a complex hernia case, addressing preoperative considerations, intraoperative techniques, and postoperative outcomes.

Method

Presentation of a case of complex abdominal hernia through the case description, presentation of complementary diagnostic exams, and photographic documentation of the surgical steps.

Results

We present the case of a 49-year-old male patient with a history of obesity and multiple surgical interventions due to anorectal agenesis, including a previously closed colostomy. He was referred to our center due to a complex incisional hernia. Clinical examination and CT imaging revealed an umbilical hernia (M3W1, European Hernia Society Classification (EHSc)), and a left paramedian hernia (M3M4W3, EHSc), along with multiple retracted scars.

The patient underwent a preoperative preparation program for obesity and abdominal wall prehabilitation with Botulinum Toxin. Four weeks after, he underwent abdominal wall reconstruction via laparotomy. The reconstruction involved posterior wall repair using the "small bites" technique, placement of a self-gripping mesh in a sublay position, and closure of the anterior aponeurosis using the same technique. The recovery proceeded without complications, and the patient was discharged on the 3th postoperative day.

Conclusion

This case highlights the importance of a thorough diagnostic and surgical approach in managing complex abdominal hernias. It also emphasizes the need for individualized preoperative strategies and advanced surgical approaches to ensure favourable outcomes for patients with complex abdominal hernias.
INCISIONAL HERNIA AFTER LIVER TRANSPLANTATION: LONG TERM OUTCOMES AND EVALUATION OF QUALITY OF LIFE AFTER HERNIA REPAIR
Authors: Gumus T , Korucuk E
Published: May 2024

Background

Incisional hernia development after liver transplantation is observed in approximately 40% of patients. Patient-related factors such as smoking, obesity, comorbidities, immunosuppressive therapy and patient-independent factors such as mesh and suture material used are effective in the development of hernia. In our study, we aimed to investigate the risk factors, long-term outcomes and quality of life after hernia repair in patients operated for incisional hernia after liver transplantation.

Method

Among 220 patients who underwent liver transplantation in our center between October 2018 and October 2023, 15 patients who underwent surgery for post-transplant incisional hernia were included in the study and retrospectively reviewed. Mercedes incision was present in all patients, and the same mesh and suture were used in hernia repair. EuroQol-5D scale was used as a quality of life test.

Results

Of the patients included in the study, 10 (66.7%) were male and 5 (33.3%) were female. The mean age at hernia repair was 60.26 years. The mean BMI was 56.73. 10 patients (66.7%) were smokers. 9 patients (32.1%) were on tacrolimus, 7 patients (43.8%) on everolimus, 14 patients (93.3%) on mycophelonate mofetil, 7 patients (43.8%) on prednol. When the time between transplantation and hernia operation was evaluated, a statistically significant difference was found between everolimus users and non-users (p = 0.001). The mean hernia development time was 29.0 months in the everolimus group and 42.0 months in the non everolimus group.

Conclusion

In our study, similar to the literature, we found that mTOR inhibitor drugs shortened the duration of hernia development and recurrence could be prevented with drug regimen modification. In addition, it was observed that patients defined their health status better and their quality of life improved after hernia repair in transplant patients.
USE OF PROGRESSIVE PREOPERATIVE PNEUMOPERITONEUM ON A PATIENT WITH A COMPLEX INCISIONAL HERNIA
Authors: Marolt U , Šturm M , Einfalt M , Gorjanc J , Genc M , Potrč S
Published: May 2024

The incidence of complex incisional hernias is increasing due to increasing number of major abdominal surgeries being performed, damage control surgery with open abdomen, and delayed abdominal wall closure. Also advances in intensive care, an ageing population, and the obesity epidemic are influencing the number of complex incisional hernias. Incisional hernia repair has evolved steadily over time, from open onlay mesh techniques or open IPOM to gold-standard Rives-Stoppa hernioplasty, and minimally invasive laparoscopic procedures to component separation techniques recently for very big hernias. At the same time, due to the inadequate results of modified surgical techniques and mesh placement methods in complex incisional hernias, new methods of extending the length of the abdominal wall emerged. These extension methods are progressive preoperative pneumoperitoneum (PPP), tissue expanders, and botulinum toxin A (BTA). In this article, we report our experience with the use of BTA, PPP, and the transversus abdominis release separation technique (TAR) on a patient with a complex incisional hernia with loss of domain. In our opinion, PPP should be considered in conjunction with BTA for incisional hernias with loss of domain, as it may facilitate primary closure, reintroduction of hernia sac contents into the abdomen, and reduction of complications after surgery.
PATIENT MANAGEMENT AND TREATMENT WITH PERINEAL HERNIAS. OUR EXPERIENCE
Authors: Martínez Alegre J , Sánchez López J D , Ferrero Celemin E , Vaquero Pérez M A , García-Sancho Téllez L , Picardo Nieto A L
Published: May 2024

Aim

Secondary perineal hernias is a defect of the pelvic floor originating after pelvic surgery. We present our experience in management and treatment of this kind of hernias.

Material and Methods

We have a short group of patients operated on for perineal hernia secondary to abdominoperineal rectum amputation by same surgeon, same method and same kind of mesh.

Results

We have operated five patients, (three men and two women) with symptomatic perineal hernias since 2021. All of them were diagnosed by physical examination and CT. We prefer perineal approach (Martijnse technique) because it is a less invasive technique and we can fix mesh exactly where we want. We use a mesh double-sided fixed in four cardinal points and perineal drain. We haven´t had any postoperative complications. Actually, four of them are asymptomatic, one patient suffered a stroke five months later and died.

Conclusions

Perineal approach is a safe method to repair perineal hernias avoiding abdominal injuries and fixing mesh in correct position.
AN HORROR MOVIE: A COMPLEX VENTRAL HERNIA AFTER A SEVERE CASE OF NECROTISING FASCEITIS
Authors: Melo Pinto D
Published: May 2024

Introduction

We present a case of a 58-year-old woman with history of severe sepsis after a perinatal abscess. This necrotising fasciitis lead to a partial destruction of the abdominal wall and required multiple surgical debridement (with partial removal of recuts muscle), colostomy and hyperbaric treatment. After controlling the infectious process, we performed a progressive surgical closure with a planned ventral hernia with phasic prosthesis and dermoepidermic graft.

Methods

This patient had her follow up appointment to prepare for reconstructive surgery with weight loss and biofeedback. She did a CT that demonstrated a ventral hernia (89 × 90 mm) between recuts muscle and transversus. This hernia classified as M2-M5+W3 on the right and L4+W3 on the left. We used adjuvant therapy with botulinum toxin and subcutaneous expansor.

Results

The reconstruction was performed in two steps. First, we performed a colostomy closure with no complications. After one week we performed an abdominal wall reconstruction with transversus abdominal release. Due to some skin necrosis and risk of infection identified during surgery we decided to differ the closure with a prosthesis with double layer (one reabsorbable and one synthetic) and a dermoepidermic flap.

Conclusion

Complex abdominal wall hernia are difficult cases to treat due to anatomical changes and infectious complications associated. New materials are being developed that can help to overcome some difficulties that we face.
RE-LAPAROSCOPIC REPAIR OF RECURRENT INGUINAL HERNIA FOLLOWING PREVIOUS LAPAROSCOPIC APPROACH: OPTIMISED DISSECTION IS THE KEY
Authors: Moollan Y , Badiani S S , Tsakanov S , Rajkomar K , Berney C R
Published: May 2024

Aim

Re-laparoscopic repair of recurrent inguinal hernia following previous laparoscopic approach can provide similar clinical outcome when completed with the appropriate level of surgical experience. Our objective was to evaluate the feasibility and safety of redo laparoscopy, and document any unexpected new perioperative findings potentially overlooked during initial surgery.

Material and Methods

The clinical data of all patients who underwent re-laparoscopic repair (TEP or TAPP) for post-laparoscopic inguinal hernia recurrences between October 2011 and November 2023 was retrieved from a prospectively maintained institutional database.

Results

Twenty-nine patients (4 females), mean age of 50.9 years old, were retrospectively reviewed. Thirty-three pre-operative diagnosis of inguinal hernia recurrence were made. TAPP technique for redo was the preferred approach in 23 patients (79.3%). Inadequate mesh placement during the first repair was the main factor contributing to recurrences. No intraoperative complications were encountered and there were no conversions to open.

Fifty-one groin hernias were repaired, including 33 recurrent inguinal hernias, nine primary inguinal hernias on the contralateral side, and nine new incidental defects found in six patients (three femoral, one Laugier’s, one pre-vascular, four obturator hernias). Five of them were identified on the same side of previous laparoscopic repair. Four of those hernias were found in three female (75%) and five in three male patients (12%). We did not record any postoperative complication.

Conclusions

Re-laparoscopic repair of recurrent inguinal hernia post laparoscopy is safe and allows simultaneous treatment of incidental new defects, including those probably overlooked during the initial procedure from suboptimal groin dissection.
ENVIRONMENTAL SUSTAINABILITY OF ABDOMINAL WALL SURGERY – INGUINAL HERNIA: A STUDY PROPOSAL
Authors: Paiva de Oliveira G , Maillo C
Published: May 2024

Background

Inguinal hernia surgery is a common surgical procedure worldwide, with over twenty million surgeries being performed annually. However, healthcare delivery contributes significantly to pollution, accounting for 5 to 8% of greenhouse gas emissions in developed countries. This project aims to evaluate the environmental effects of inguinal hernia surgery throughout the patient's journey and identify opportunities for optimization.

Method

This study involves a process-based, multicenter evaluation of ten consecutive patients undergoing inguinal hernia surgery. It examines three key phases: preoperative, intraoperative, and postoperative. Critical variables for each phase were identified and measured according to established guidelines. Boundaries were set to include all relevant and achievable information.

Results

A structured form was developed with specific fields and detailed instructions for each phase. Preoperative data includes the number of consultations, commutes, and exams. Intraoperative data encompasses the number of personnel involved, the volume of anaesthetic gas used, and the quantification of surgical waste. Postoperative data includes the number of wound care treatments, consultations, and commutes. Direct emissions and primary and secondary process activity data will be measured, such as waste management, energy consumption, and commute estimation.

Conclusion

Environmental sustainability is increasingly recognized as crucial across all human activities, including healthcare. With the global population exceeding 8 billion, prioritizing health without considering environmental impact is no longer acceptable, especially if it does not provide significant value. Abdominal wall surgery, given its prevalence, offers an opportunity to optimize resources and reduce the environmental impact of healthcare.
TREPP VERSUS MIS APPROACH FOR INGUINAL HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Rasador A C , Balthazar da Silveira C A , Kasakewitch J P G , Lima D L , Nogueira R , Sreeramoju P , Malcher F
Published: May 2024

Aim

Guidelines recommend minimally invasive surgery (MIS) for unilateral groin hernia repair (GHR) due to reduced chronic pain. The most performed approaches consist of posterior mesh placement by the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques. However, it remains unclear whether the main advantage of those techniques stems from the MIS approach or posterior mesh placement. As the transrectus preperitoneal (TREPP) technique is an open option for posterior mesh placement, we conducted a systematic review and meta-analysis comparing TREPP and MIS techniques for GHR.

Material and Methods

Cochrane, Embase, Scopus, Scielo, and PubMed were systematically searched for studies comparing TREPP and MIS techniques for GHR. Outcomes assessed were recurrence, cumulative surgical site occurrences (SSO), surgical site infection (SSI), and postoperative pain.

Results

29 studies were screened and 8 were thoroughly reviewed. Three studies were included, of which two compared TREPP with TEP technique, and one compared TREPP with both MIS techniques. We found lower SSI rates for the MIS approaches (0.61% vs. 0.33%; RR 3.96; 95% CI 1.04 to 15.16; P = 0.04). There was no statistical differences regarding recurrence (2.42% vs. 2.51%; RR 1.01; P = 0.98), postoperative pain (4.2% vs. 6.4%%; RR 0.61; P = 0.4), and SSO (4.2% vs. 4.0%%; RR 0.6; P = 0.43) between TREPP and the MIS techniques.

Conclusion

Our systematic review and meta-analysis found a lower SSI for the MIS repair but did not find differences regarding recurrence, SSO, and postoperative pain.
LAPAROSCOPIC VERSUS ROBOTIC TRANS ABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR: A RANDOMIZED CONTROLLED TRIAL
Authors: Rodha M S , Guha S , Chaudhary R , Badkur M , Sharma N
Published: May 2024

Introduction

Minimal invasive inguinal hernia repair (LIHR or RIHR) is a pivotal advancement, focusing on minimizing postoperative pain and recurrence rates. This randomized controlled trial aims to compare outcomes of laparoscopic and robotic TAPP inguinal hernia repair, hypothesizing superior outcomes with the robotic approach.

Materials and Methods

This study was a single-center based, open-labeled, parallel-arm randomized controlled trial including all consenting adult patients with uncomplicated inguinal hernia, presenting to, AIIMS Jodhpur between January 2022 and June 2023. Patients were randomized and allocated in a 2:1 ratio into two arms, laparoscopic and robotic groups respectively. The primary outcome, postoperative pain was assessed by using VAS at 3,6 and 12 hours, and secondary outcomes were operative duration, hospital length of stay, urinary retention, and other complications.

Results

The baseline characteristics are as below:

The median (IQR) VAS at 3, 6 and 12 hours are as below:

No statistically significant difference was found in VAS between the groups.

The median (IQR) operative duration was as below:

No statistically significant difference was noted in the overall operative duration between the groups. However, the peritoneal dissection time was significant in the robotic arm with a p-value of 0.008.

No difference was noted in the length of hospital stay, postoperative urinary retention rates, and complication rates at 1-week and 4-week follow-up.

Conclusions

There is no statistically significant difference between robotic and laparoscopic TAPP inguinal hernia repair. While robotic TAPP shows reduced peritoneal dissection time, overall operative duration remains similar due to docking/undocking.
INITIAL EXPERIENCE IN THE USE OF CHIMNEY MESH FOR THE REPAIR OF PARASTOMAL EVENTRATIONS IN OUR HOSPITAL
Authors: Rodríguez Lucas J M , Medina Manuel E , Del Valle Ruiz S R , Valero Soriano M , Jiménez Moreno I M , Hurtado Vázquez A M , Sandoval Marín J , Moreno García C , González Valverde F M
Published: May 2024

Aim

Parastomal hernias are one of the most common stoma complications. Although they are frequent, few are operated due to the low percentage of complications.

Material and Methods

This is a descriptive and retrospective study of the parastomal eventroplasties performed during 2023 using the chimney mesh by the Abdominal Wall Unit. The patients were evaluated after follow-up of their stomas by the General Surgery and Urology Service.

Results

5 patients were operated, 4 men and 1 woman, mean age of 72 years (range: 65–78). The Body Mass Index was 28.016 (range: 23.46–32.37). Two patients had urostomies for bladder tumors, two patients had terminal colostomies for one rectal neoplasm and another for complicated diverticulitis, and one patient had both for bladder neoplasm with rectal infiltration that required Miles surgery. The surgery time for eventroplasty was recorded in 3/5 patients with a mean time of 160 min (range 165–180). In 2 patients laparoscopic cholecystectomy was performed for symptomatic cholelithiasis in the same surgical time. No intraoperative incidences were recorded during the procedures. In the postoperative period one patient required parenteral nutrition due to prolonged ileus that improved with conservative treatment (Clavien Dindo II). There were no major complications. The mean hospitalization time was 8.4 days (range 4–19) and during the outpatient follow-up we have not registered hernia recurrences.

Conclusion

The initial use of chimney meshes is giving good results in the selected patients, although the initial sample is small and the follow-up time is quite short to reach definitive conclusions.
Predictive value of pretreatment circulating inflammatory response markers in the neoadjuvant treatment of breast cancer: meta-analysis
Authors: Dowling Gavin P , Daly Gordon R , Hegarty Aisling , Hembrecht Sandra , Bracken Aisling , Toomey Sinead , Hennessy Bryan T , Hill Arnold D K
Published: May 2024

Background

Systemic inflammatory response markers have been found to have a prognostic role in several cancers, but their value in predicting the response to neoadjuvant chemotherapy in breast cancer is uncertain. A systematic review and meta-analysis of the literature was carried out to investigate this.

Methods

A systematic search of electronic databases was conducted to identify studies that explored the predictive value of circulating systemic inflammatory response markers in patients with breast cancer before commencing neoadjuvant therapy. A meta-analysis was undertaken for each inflammatory marker where three or more studies reported pCR rates in relation to the inflammatory marker. Outcome data are reported as ORs and 95% confidence intervals.

Results

A total of 49 studies were included, of which 42 were suitable for meta-analysis. A lower pretreatment neutrophil-to-lymphocyte ratio was associated with an increased pCR rate (pooled OR 1.66 (95% c.i. 1.32 to 2.09); P < 0.001). A lower white cell count (OR 1.96 (95% c.i. 1.29 to 2.97); P = 0.002) and a lower monocyte count (OR 3.20 (95% c.i. 1.71 to 5.97); P < 0.001) were also associated with a pCR. A higher lymphocyte count was associated with an increased pCR rate (OR 0.44 (95% c.i. 0.30 to 0.64); P < 0.001).

Conclusion

The present study found the pretreatment neutrophil-to-lymphocyte ratio, white cell count, lymphocyte count, and monocyte count of value in the prediction of a pCR in the neoadjuvant treatment of breast cancer. Further research is required to determine their value in specific breast cancer subtypes and to establish optimal cut-off values, before their adoption in clinical practice.
Position of the Infectious Diseases Society of America and the HIV Medicine Association on Team-based Infectious Diseases Care and the Roles of Advanced Practice Providers and Clinical Pharmacists
Authors:   Infectious Diseases Society of America (IDSA), Balter Laurence , Beieler Alison M , Burdette Steven D , Chakraborty Rana , Ashley Elizabeth Dodds , File Tom , Haddad Marwan , Keruly Jeanne , Marcelin Jasmine R , Nelson Sandra B , Powderly William , Rogers Sara , Wheeler David , Weddle Andrea
Published: May 2024

Strengthening and expanding interprofessional team-based care is an important component of the Infectious Diseases Society of America's Workforce Development Strategy to expand and promote equitable access to expert infectious diseases (ID) care. This statement defines the roles of care team members and highlights the need for ID curricula and training programs for advanced practice providers to support implementation of ID team-based care.