bluuebunny/crossref_metadata_2025 huggingface dataset:
P-096 EVALUATION OF EPIDEMIOLOGICAL PARAMETERS OF INGUINAL HERNIA IN A SPANISH RURAL AREA
Authors: Vaqué Alcázar C , Martinez E , Soria J , Álvarez E , Carvajal F , Negre D , Díaz F
Published: May 2023

Aim

To describe the epidemiological, clinical and surgical parameters of the population undergoing inguinal hernioplasty in a small rural hospital

Material and method

All patients who underwent an inguinal hernia repair at our Hospital in 2021 were included. A search was made in the medical records to identify epidemiological, clinical and surgical risk factors.

Results

208 patients were gathered, of which 31 (14,9%) had a bilateral hernia, 50 (24%) had previously been operated on the other side and 11 (5,2%) were recurrences. This translates into an annual incidence of 227,27/100.000, with a recurrence rate of 5%. 136 (65%) were outpatient with only 1 hospitalization.

Conclusion

In our rural hospital the incidence and recurrence rate is the same as described in the literature.
V-002 Robotic suprapubic eTEP retrorectus repair for incisional hernia
Authors: Vierstraete M , Muysoms F
Published: May 2023

Aim

A retrorectus mesh position is often considered the most suitable for the repair of a midline incisional hernia. The minimal invasive extraperitoneal approach is gaining popularity.

Material & Methods

A 56-year-old female patient, who had a laparoscopic deroofing of a bile cyst in her history, presented with an incisional midline hernia (EHS M2-M3, width 6.6 cm). Preoperative optimization via dietary instructions reduced her BMI from 40 kg/m2 to a BMI of 35 kg/m2.

Results

A robotic extraperitoneal approach via suprapubic docking was performed. The patient is positioned supine and flexed for 15° at the level of the spina iliaca. An intraperitoneal trocar is placed to explore the abdomen for adhesions. Three trocars are placed in the suprapubic position in the extraperitoneal plane whereafter the robot is docked. A dissection in the cranial direction is performed in the retrorectus plane by incising both posterior rectus fascia in a symmetric way. A preperitoneal plane behind the linea alba is created. At the level of the hernia defect the hernia sac is opened, and adhesions are freed. Once the retrorectus space is dissected up to the xyphoid, the linea alba is reconstructed with a barbed suture size 0. A self-fixating mesh is placed in the retrorectus position. The posterior layer of the peritoneum is closed. The postoperative course was uneventful.

Conclusions

We present an extraperitoneal minimal invasive approach to the retrorectus plane allowing for an adequate retrorectus dissection and mesh placement like in a classical Rives-Stoppa repair.
V-004 ROBOTIC PARASTOMAL HERNIA REPAIR WITH RETROMUSCULAR MESH (PAULI TECHNIQUE)
Authors: Rodríguez González D , Guil-Ortiz B , Tuñón-Féquant C , Casanova-Ramos R , Montes-Montero A , Arteaga-González I J
Published: May 2023

Aim

Parastomal hernia is a common complication of ostomy formation. We present a case of robotic parastomal hernia repair with retromuscular mesh (Pauli technique).

Material and Methods

Patient was 58 years-old man and had history of anterior resection of the rectum, terminal colostomy and onlay mesh parastomal hernia repair. After 2 months of parastomal hernia repair, the patient developed a recurrence (type III, European Hernia Society Classification).

Results

Robotic parastomal hernia repair was performed with transabdominal approach. Firstly, a small adhesiolysis of the colon to the stoma orifice was made. Then, the peritoneum and posterior sheath of the left rectus muscle was incised. The retrorectal space was dissected. The hernia sac was incised circumferentially. TAR dissection was launched lateral to the stoma. After the development of the landing zone for the mesh, the posterior retromuscular fascia was incised lateral to the stoma. The inner orifice of stoma was repositioned. A large-pore polypropylene mesh (20×28 cm) was placed in the retromuscular space and fixed it, lateral to the ostomy orifice. Finally, the retromuscular pocket was closed by suturing the posterior fascia to the linea alba. The patient was discharged on postoperative day 4 and had no complications. After 4 months of follow-up, no hernia recurrence had been recorded.

Conclusions

Robotic Pauli is a technique to repair parastomal hernias that provides wide coverage of the defect and avoids leaving mesh intraperitoneally. They could provide a secure repair and prevent postoperative complications (pain or intestinal ileus). It is technically challenging but feasible.
V-005 Robot assisted parastomal hernia repair of an ileal conduit stoma
Authors: Vierstraete M , Muysoms F
Published: May 2023

Aim

The optimal surgical treatment of a parastomal hernia after ileal conduit urinary division has yet to be determined. Data is scarce and reported recurrence rates after different approaches in parastomal hernia repair remain high.

Material & Methods

A 65-year-old male patient, who had a history of a radical cystectomy with an ileal conduit urinary diversion, presented with a recurrent symptomatic parastomal hernia. He had a previous repair of his parastomal hernia via an open retromuscular approach with a unilateral posterior component separation (transversus abdominis release).

Results

A robot assisted repair of the recurrent parastomal hernia was performed using a partial intraperitoneal onlay mesh technique (PIPOM). Intraoperatively, intraluminal Indocyanine green (ICG) was used to identify the ileal conduit loop. A closure of the defect was performed with a barbed suture whereafter the repair was reinforced with a PVDF IPST ‘Chimney’ parastomal mesh. The latter being partially covered by peritoneum. The postoperative course was uneventful, and the patient went home on postoperative day one. The patient had no complications and a well-functioning ileal conduit stoma 6 weeks after surgery.

Conclusions

The repair of a recurrent parastomal hernia after ileal conduit urinary division represents a surgical challenge. After a previous retromuscular approach, a robotic assisted approach using a partial intraperitoneal onlay mesh technique (PIPOM) represents a feasible technique with promising results.
V-009 Robot-Assisted Repair of a Traumatic Hernia After a Pelvic Fracture: Case Report and Literature Review
Authors: De Troyer A , Allaeys M , Eker H , Berrevoet F
Published: May 2023

Aim

Traumatic abdominal wall hernias (TAWH) are an uncommon clinical entity, accounting for less than 0.2% of all blunt trauma injuries. Management and operative technique are still a matter of debate and the role of the robotic surgical platform in traumatic hernias has not been reported on. We present a robot-assisted repair of a TAWH through a fracture of the left iliac wing. We aim to describe our operative approach and perform a review of the literature.

Material and methods

A 46-year-old male with a history of a high energetic trauma presented with a symptomatic swelling in the left lumbar region. Further imaging showed an important defect of the abdominal wall caused by a disruption of the iliac and gluteus muscles and non-union of a left iliac wing fracture. This caused a herniation of the descending colon. A robot-assisted transabdominal preperitoneal hernia repair (TAPP) with synthetic mesh was performed in elective setting.

Results

The postoperative course was uneventful. Discharge was possible at postoperative day one. There was no surgical site infection, seroma, or recurrence after a follow-up period of 6 months.

Conclusions

To our knowledge, we describe the first robot-assisted repair of a TAWH through a pelvic fracture. Our technique was safe and feasible. In difficult to reach areas of the abdomen, a robot-assisted repair might be a valid approach. Larger studies are needed to confirm our initial experience in traumatic abominal wall hernia surgery.
V-011 STEPWISE ABDOMINAL WALL RECONSTRUCTION OF THORACOLUMBAR HERNIA AFTER RESECTION OF CHODROSARCOMA OF X AND XI RIB
Authors: Garcia Ureña M A , Medina M , Avilés A , Morejon S , Vaello V , Martinez J , Robin Valle De Lersundi A , Cruz A , Lopez Monclus J , Blazquez Hernando L A
Published: May 2023

Aim

Thoracolumbar hernias may be the result of previous surgery involving costal resection or operative access. They can also develop after trauma or cough. The abdominal wall reconstruction in these defects can be a real challenge. Our aim is to present a stepwise approach for a preperitoneal mesh repair. The advantage of this video is that the previous resection of ribs allowed a complete exposition of the posterior abdominal wall.

Methods

This is a 61 years-old man, that underwent costal 2 consecutive resections for chondrocostal tumor of X and XI ribs and mesh reconstruction. The patient developed soon an incisional hernia. The patient was set in a modified decubitus position. A stepwise retromuscular preperitoneal dissection was planned: 1 subdiphragmatic, 2 iliac, 3 posterior and 4 medial. The overextended dissection reached the central tendon, linea alba, psoas, quadratum lumborum and ipsilateral Cooper ligament. After closing the peritoneum, a 50×50 mid-density polypropylene mesh was implanted in the preperitoneal retromuscular position over an absorbable mesh that helped to create the 3D dimensional configuration of the lateral and posterior abdominal wall (“taco” configuration). The ribs were approximated and fixed to the mesh with mesh-sutures. Finally, the muscle layers and skin were closed.

Results

The patient was discharged uneventfully on 5th postoperative day. Up to 6 months of follow-up the patient remains without pain and with a continent abdominal wall.

Conclusions

Applying the concept of giant reinforcement of visceral sac (Stoppa) to the posterolateral abdominal wall may help to manage these challenging situations.
V-016 TAPP APPROACH FOR A GIANT INGUINOSCROTAL HERNIA
Authors: Serrano González J , Díaz Pérez D , Román García De León L , Colao García L , Hernández Bartolomé M , Almeida Romera N , Esteban Agustí E , Galindo Jara P
Published: May 2023

Aim

We present the case of a patient with giant inguinoscrotal hernia and the laparoscopic approach performed.

Material & Methods

54yo Male, no medical history except for BMI41. He is evaluated in outpatient clinic for asymptomatic left inguinoscrotal hernia of ten years of evolution. He denies digestive symptoms. Difficulty in urination without symptoms of obstruction.

On examination, 20×15cm left not reducible inguinoscrotal hernia extending to the mid-thigh.

Minimally invasive approach, TransAbdominal PrePeritoneal, was performed. The content of the hernia is a long portion of sigma and a large amount of fat from the greater omentum. After returning them to the abdominal cavity with the help of pressure from the outside, the TAPP technique was performed without incident, with localization of elements of the spermatic cord. Polypropylene mesh 12×15cm fixed with tackers and cyanoacrylate is placed.

Results

the patient was discharged on the 4thPO day with no incidents. Subsequently he developed a large seroma that required percutaneous drainage and heart failure that caused large scrotal edema, resolved with diuretic treatment. Ten months later there is no recurrence.

Conclusions

Giant inguinoscrotal hernia is a surgical challenge. Anterior or posterior approach, open or minimally invasive, can be performed. Sometimes intestinal resection and/or orchiectomy is required. The need for preoperative conditioning with botulinum toxin and even pneumoperitoneum can be considered.

We presume that, when possible, the minimally invasive posterior approach is the best technique for these large defects since it provides the best surgical field in the most resistant plane for inguinal hernia repair.
V-021 MIDLINE RESTORATION VIA EMILOS TECHNIQUE
Authors: Giacone Aguiar J A , Valinoti A C , Olivero A A , Sadava E E
Published: May 2023

Aim

In recent years, numerous minimally invasive techniques have been developed for the repair of midline hernias associated with diastasis recti. The eMILOS technique (Endoscopic mini/less open sublay technique) allows midline repair with mesh placement in the retromuscular space through a small trans-hernial incision without entering the abdominal cavity.

Material & Methods

We present a case of a 45 year-old male who complained of umbilical bulge and pain. On physical exam, an umbilical hernia measuring 2cm was observed, associated with 5cm diastasis recti. Midline restoration via eMILOS approach was decided. In this technique, a transhernial endoscopic approach is performed with two 5mm ports on both flanks, allowing a complete dissection of the retromuscular space. First, a sublay approach of the umbilical hernia is performed. The hernial content is reduced and the posterior sheath is closed. Then, we place a homemade device (consisting of a wound protector, a surgical glove and a port) to perform the endoscopic approach. When the retromuscular space is completely dissected, both anterior and posterior sheaths are closed with barbed sutures. A large heavy polypropylene mesh is placed and fixed with absorvable tackers and glue. Afterwards, the endoscopic step is over and the ports are taked out, the umbilical fascia is closed with a running suture and the umbilicus scar is fixed.

Results

The patient presented a favorable evolution, with no recurrence a year postoperatively.

Conclusions

The eMILOS technique is a safe and effective alternative for the treatment of diastasis recti associated with midline defects.
V-023 ETEP REPAIR OF AN M2-3 W2 INCISIONAL HERNIA WITH AN ASSOCIATED SPIEGEL HERNIA. A CASE REPORT
Authors: Medina Pedrique M , Aviles Oliveros A , Morejon Ruiz S , De Robin Valle De Lersundi A , Martinez Caballero J , Vaello Jodra V , Muñoz Rodriguez J , García-Ureña M Á
Published: May 2023

Aim

To describe a case of an extended-view totally extraperitoneal approach for both an M2-3 W2 incisional hernia with an associated right Spiegel hernia.

Material & Methods

A 68a female with a previous medical history of a midline laparotomy after diffuse peritonitis presented with a midline bulge in the upper third of the previous surgical wound. Preoperative CT scan showed a midline hernia of 4cm and found a right-sided Spiegel hernia of 3cm. Endoscopic treatment of both defects was offered and accepted.

Results

Patient was placed in supine position. Retromuscular space was created using blunt dissection with a balloon, which helped with direct visualization. Two 5mm trocars were placed in the left pararectal region. Dissection was performed and crossover from left to right was achieved following standard eTEP procedure. Reduction of preperitoneal fat was performed, and midline defects identified. Dissection was continued to the Retzius space and Cooper's ligaments. Identification and reduction of the Spiegel hernia followed. After completing the dissection of the retro rectus and preperitoneal space, primary closure was performed. A lightweight polypropylene mesh was deployed. No complications ocurred and discharge was on the 2nd day.

Conclusions

Treatment of incisional hernias is in evolution, as minimally invasive techniques have developed greatly since their description and now have a more widespread use among surgeons. eTEP is a novel approach that can be used for the treatment of midline incisional and some primary hernias, as shown in the case, with satisfactory short-term results and similar long-term outcomes to other techniques.
V-028 HYBRID (LAPAROSCOPIC AND OPEN) REPAIR WITH REVERSE TAR TO TREAT A LATERAL INCISIONAL HERNIA WITH DENERVATION OF THE RIGHT ABDOMINAL MUSCLES
Authors: Maillo C , López-Monclús J , Sacadura Fonseca J , Oliveira G , Tavares K , Figueiredo N
Published: May 2023

Aim

Lateral incisional hernias with denervation of the muscles of the abdominal wall are a problem difficult to solve. The repair of the defect does not guarantee a functionality of the abdominal muscles if the lack of force of the abdominal wall is not solved.

With the technique we present there is a minimally invasive reinforcement of the mid lateral wall affected.

Material and Method

54 yo female. Previous surgeries: biliary cystadenoma 2014 by Makuuchi laparotomy (2 surgeries), Ooforectomy 2011, Hysterectomy 2013, Mamoplasty 2001, 3 vertebral surgeries. Six months after the surgery she felt a growing lump in the right side of the incision. Physical exam: right lateral incisional hernia and small umbilical hernia. Asymmetry of the abdominal wall because of flaccidity of the right abdominal muscles.

Ultrasound

Voluminous incisional hernia in the right flank dependent of the right transverse sub-costal incision with a hernia ring of 20mm and hernia sac 60mm of diameter increasing with Vasalva maneuvers.

Surgical technique

Hybrid approach laparoscopic and lateral by e-TEP to dissect the retrorectal bilateral space and lateral preperitoneal approach with reverse TAR. A macroporous polipropilene preperitoneal mesh is placed from the right psoas to left semilunar line and from top to bottom of the abdominal wall.

Result

Discharged 2nd po. day without complications. 5 months after surgery she has a symmetric abdominal wall without recurrence.

Conclusion

Hybrid technique to repair lateral hernias with denervation allows a wide repair with low morbidity and good tolerance with excellent result in abdominal functionality.
V-029 TRANSABDOMINAL LAPAROSCOPIC MANAGEMENT OF RECURRENT LUMBAR HERNIA (GRYNFELT)
Authors: Trujillo Díaz J , Martinez Moreno C , Gómez López J R , Concejo Cutoli P , Atienza Herrero J , Martin Del Olmo J C
Published: May 2023

Aims

Lumbar hernias are very rare defects of the posterior abdominal wall.They can be classified as Grynfelt in the upper lumbar space(it is the most frequent) and Petit in the lower lumbar triangle. Its treatment can be performed by open approach, or by laparoscopic approach(TAPP or TEP), observing a lower incidence of recurrences and postoperative pain by laparoscopy.

Methods

Video-case.

Results

78-year-old female who attended the clinic presenting a lump that had been increasing in size and was causing pain in the left upper lumbar region. Surgical histories: open lumbar hernioplasty(2018). Physical examination: recurrent left-lumbar hernia(Grynfelt).CT-scan: left-lumbar hernia(defect:45mm) with colon into the hernial sac and a large paraesophageal hiatal hernia. Since the hiatal hernia also needs to be treated, we decided to perform a laparoscopic TAPP-approach to treat the lumbar hernia.The patient was placed in the right lateral decubitus. We use 3 ports(1×12mm,2×5mm) to perform the surgery and place a 10×15cm PVDF mesh fixed with Tisseel and closed the peritoneum with V-Lock 3-0.The patient presented a satisfactory evolution without complications and was discharged in 1°POD. No recurrence.

Conclusion

Lumbar hernias are a disease with a very low incidence, so there is no clear consensus on the best surgical treatment.Our group think the laparoscopic approach in this type of hernia, whether through the transabdominal(TAPP) or extraperitoneal(TEP) approach, is the most appropriate, since it offers the advantages of minimally invasive surgery(less postoperative pain, shorter LOS) and <postoperative complications related to the surgical site and a lower incidence of hernia recurrence have been reported.
V-030 LAPAROSCOPIC TAPP MCBURNEY'S INCISIONAL HERNIA REPAIR: A CASE REPORT
Authors: Vera Vasquez C A , Lupu I , Alonso V , Ye Zhou Y , Gonzalo Prats B , Solans Solerdelcoll M , Gonzalez Lopez J A , Moral Duarte A
Published: May 2023

Background

Lateral incisional hernia surgery represents an underappreciated challenge for general surgeons. McBurney's incisional hernia (L3) after appendectomy is rare, with an incidence between 0.1 and 0.9%. Several studies have found fewer postoperative complications with the laparoscopic approach compared with open approach.

Objective

To show a video of a transabdominal preperitoneal (TAPP) approach for McBurney's incisional hernia associated with a small right lateral inguinal hernia.

Method

We report a case of a 52 years old man, with previous open appendectomy in 2013, diagnosed with McBurney's incisional hernia (L3W2R0) and small right inguinal hernia (L1M0F0P). The patient was scheduled for laparoscopic TAPP incisional hernia repair.

Results

The patient was operated as ambulatory surgery with no intraoperative complications. No recurrence nor other complications detected during short, 4th month, follow up after surgery.

Conclusions

Minimal invasive hernia repair with preperitoneal mesh of lateral abdominal hernias cause less postoperative pain, have a short hospital stay, lower incidence of surgical site and mesh infection, and possibly can reduce recurrence as a wider mesh overlap of the defect is possible. This technique has shown to be feasible and reproducible in selected cases.
V-035 TRANSVAGINAL EVISCERATION, LAPAROSCOPIC APPROACH
Authors: Serrano González J , Román García De León L , Hernández Bartolomé M , Martínez Campos D , Zabala Salinas J , Colao García L , Gallardo Herrera A B , Galindo Jara P
Published: May 2023

Aim

We present the laparoscopic approach of a case of transvaginal evisceration after hysterectomy.

Material & Methods

50 yo Female, with a history of bilateral ovaric and endometrial endometroid carcinoma, for which bilateral laparoscopic anexectomy and subsequent hysterectomy and cytoreduction surgery were performed two months earlier. She consulted to emergency department for metrorrhagia and abdominal discomfort of one week's evolution. Physical examination revealed a dehisced vaginal vault with evisceration of small bowel loops. Abdominal CT scan was performed in which other intra-abdominal complications were ruled out. Urgent surgical intervention was decided and a minimally invasive approach was proposed.

During the operation, dehiscence of the vaginal vault was observed without other findings. The separated edges are refreshed and a running suture is performed with a barbed suture. As reinforcement, a titanized polypropylene mesh was placed and fixed with cyanoacrylate.

Results

The patient was discharged on the 2nd postoperative day without incident.

Conclusions

Transvaginal evisceration is a rare complication that usually occurs after hysterectomies. If it is not possible to reduce the contents, it can cause suffering of the herniated structures. The treatment consists of closing the defect and acting on the complications it may cause. The minimally invasive approach provides the already known benefits for the patient and a better vision and surgical field for the surgeon.
V-037 LAPAROSCOPIC REPAIR OF FORAMEN OF WINSLOW HERNIA CONTAINING THE RIGHT COLON
Authors: Kapsampelis P , Saunders J , Prce D , Shah I A , Gerogiannis I
Published: May 2023

Aim

A 74-year-old woman with hypothyroidism, dyslipidaemia and past abdominal surgeries presented with severe abdominal pain, nausea, bloating and anorexia. On clinical examination, the abdomen was soft with tenderness on palpation in the epigastrium. The laboratory workup revealed leukocytosis. Abdominal CT showed the caecum, the ascending colon, and the hepatic flexure herniated in the lesser sac through the Foramen of Winslow. Even though the initial plan was conservative management, the hernia was persistent and not resolving in the repeat CT scan. A decision was made to proceed with laparoscopic exploration. We aim to present a video of a laparoscopic repair of a Foramen of Winslow hernia.

Material and methods

Laparoscopy revealed free intrabdominal fluid and part of the right colon in the lesser sac. The hernia was reduced manually, and the colon was inspected, revealing no signs of ischemia. As the caecum was very mobile, a caecopexy was performed by suturing the cecum and the ascending colon to the lateral abdominal wall using non-absorbable interrupted sutures. The operation was performed with three ports, a 10 mm infraumbilcal port for the scope and two 5 mm ports in the right lower quadrant of the abdomen.

Results

Recovery was uneventful, and the patient was discharged the following day. In follow-up, pain and bloating had completely resolved, and her quality of life was significantly improved.

Conclusions

This was a challenging case from the technical and the decision-making point of view, with a good outcome and no complications.
V-040 PRIMARY ABANDON-OF-THE-SAC: A CASE REPORT
Authors: Vera Vasquez C A , Ye Zhou J , Lupu I , Gonzalo Prats B , Homs Samso R , Solans Solerdelcoll M , Gonzalez Lopez J A , Moral Duarte A
Published: May 2023

Background

Inguinal hernia repair is one of the most frequent surgical procedures worldwide. Several minimally invasive approaches have been developed. Laparoscopic hernioplasty offers less pain, faster recovery and a lower incidence of wound infection. However, the best approach in repairing large inguinoscrotal hernias and the optimal management of the distal sac and its risks are still debated. There may be a higher risk of visceral or cord structures damage, ischemic orchitis, seroma or haematoma when opting for a complete dissection of the hernia sac which may extend deep into the scrotum.

Objective

To show a video of a transabdominal preperitoneal (TAPP) approach using the primary abandon of the sac technique. The aim of this is to reduce the complications above-stated.

Method

We report a case of a 33 year old man, without previous abdominal surgery, diagnosed with a large right inguinoscrotal hernia, which appeared 1 year ago and became painful. The patient was scheduled electively for a TAPP surgery.

Results

Surgery was performed by means of day surgery. No intraoperative complications. No seroma nor haematoma detected in the postoperative period.

Conclusion

Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. The primary abandon of the sac is a feasible and reproducible technique and is a safe manner to overcome the difficulties of the distal sac management.
V-041 ROBOTIC MONOLATERAL TAR FOR LATERAL INCISIONAL HERNIA IN PREVIOUS COLOSTOMY SITE
Authors: Capoccia Giovannini S , Camerini G , Rossi L , Rubartelli A , Carlini F , Longo G , Drago B , Epis L , Stabilini C
Published: May 2023

Background

Novitsky described the Transversus Abdominis Muscle release (TAR) extending the retromuscolar plane (RMP) improving the midline restoration (MR) with high morbidity.

The robotic approach seems to have the same effectiveness reducing wound complications.

Video's comment

A 58-year-old male submitted to Hartmann procedure for acute diverticulitis, developed an incisional hernia (IH) (3cm width) on colostomy site, L2-W1 according to IH-EHS classification and an umbilical IH of 2cm width (EHS classification: M3-W1), after Hartmann reversal.

We planned the abdominal wall repair with R-TAR by drawing on the skin the dimension of the mesh with an overlap of 7cm from the defect, helping us to orient the dissection using transfascial needles.

After the pneumoperitoneum created and the lateral-right sided-docking of Da Vinci Xi, we incised the lateral edge of right posterior rectus sheet (PRS) and dissected the RMP. The incision of the medial edge of the PRS and the identification of the linea alba allows the crossing-over to the contralateral RMP.

We reduced the umbilical IH and dissected completely the left RMP to the flank defect and the Neurovascular Boundles.

We started the division of TA fibers and we dissected the preperitoneal plane beyond the IH sac and to the arcuate line.

We closed the defects with a 0-vloc and the peritoneum with a 3/0-vloc both barbed.

We implanted a 15×30 Progrip selfigripping mesh and we closed the peritoneal-flap with a 2/0-vloc barbed suture.

The patient was discharged in 2 days and any complication were recorded after 30 days.
V-042 ONSTEP - VIDEO REVISION OF THE TECHNIQUE
Authors: Botelho P , Barreira A L , Souto R , Paiva Oliveira G , Onofre S , Luz C
Published: May 2023

ONSTEP is an open preperitoneal approach for inguinal hernia repair. The technique is simple, fast and consists of twelve standardized steps.

The video provides a full step-by-step description of the technique, with some tips and tricks included.

The case refers to a 35-year-old man with a right-sided primary inguinal hernia.

The procedure took around 15 minutes, was uneventful, and no clinically significant postoperative pain was noted. The patient was able to return to work within 2 weeks. After two years of follow-up, the patient remains pain–free and without recurrence.

The ONSTEP technique is an excellent option for inguinal hernia repair, especially for primary unilateral hernias in male patients. The authors believe that this approach should be part of the hernia surgeon´s therapeutic armamentarium.
V-043 Laparoscopic TAPP repair for strangulated femoral hernia
Authors: Correia De Sá T , Basto T , Soares F , Gonçalves Á , Marques I , Barros Da Silva J
Published: May 2023

Aim

To present a case of a strangulated femoral hernia successfully submitted to laparoscopic transabdominal preperitoneal (TAPP) repair and segmental enterectomy.

Material and Methods

Video recording of the surgical procedure and patient clinical files.

Results

A 75-year-old woman with previous medical history of diabetes and dyslipidaemia, went to the Emergency Department with complaints of generalized abdominal pain and absence of bowel moves since the previous day. On physical exam, an incarcerated left femoral hernia was evident. She also presented a renal dysfunction and computed tomography scan revealed a femoral hernia containing a bowel segment with upstream intestinal occlusion. Laparoscopic correction was proposed.

Laparoscopy revealed an ischemic loop of bowel incarcerated in the femoral hernia defect, which was manually reduced. Signs of irreversible ischemia were present, but no perforation was evident. TAPP correction was performed with a polypropylene flat mesh of 37.8g/m2 with wide pores. After, the umbilical incision was extended and an extracorporeal segmental enterectomy with totally mechanical anastomosis was made. The patient had a favourable postoperative course with no complications.

Conclusions

Urgent groin hernia surgery with mesh requiring segmental enterectomy, but without gross peritoneal contamination, is associated with decreased recurrence rates and similar postoperative complications. In experienced centres, laparoscopic surgery may be associated with better results, although randomized multicentre studies are needed.
V-045 PREPERITONEAL APPROACH FOR BILATERAL SPIGELIAN AND RECURRENT LEFT INGUINAL HERNIAS
Authors: Álvarez De Sierra P , Zárate Gómez J , Supelano G , Peinado B , Gil J M , Conde S , López Baena J Á , Fernández Luengas D , Merello J
Published: May 2023

This is a case presentation of a preperitoneal repair of a bilateral Spigelian hernia and a recurrent left inguinal hernia. A 71 year old male patient was admitted in the Emergency department after a 3 hour right quadrant acute pain. On his medical record he had an anterior left inguinal repair (Lichtenstein) 6 months before. The physical examination revealed a bulge on the right lower quadrant. The Spigelian hernia was incarcerated but easily reduced. The CT scan findings include a bilateral Spigelian hernia (bowel content), a small umbilical and a left inguinal omental hernia. The patient did not suffer any other incarceration episodes before the surgery, programmed 10 days later. We present the video of the surgical TEP repair, a preperitoneal access, triple hernia reduction, double 15×20cm polypropilene tailored mesh placement. The patient was discharged on the second postoperative day, and had an uneventful recovery with no recurrence after 3 months followup.
V-048 COMBINED ETEP AND OPEN APPROACH FOR M4 AND L3 VENTRAL HERNIA AFTER COMPLICATED INGUINAL HERNIA REPAIR
Authors: Guevara-Martínez J , Gutierrez E , Chavarrias N , Zapata C , Arteaga P , Prieto F , Fondevila C , Salido S
Published: May 2023

We present the case of a 49 y-o woman with a previous open inguinal hernia repair with a superficial surgical site infection during the immediate postoperative period. She required surgical debridement and negative pressure therapy. Ten months after surgery she persisted with discharge and inflammatory changes. The preoperative CT-scan revealed a misplaced mesh with chronic inflammatory changes in the right inguinal and hypogastric region. An M4 3,5cm diameter defect with a right lateralized 13×5×10cm hernia sac was also observed. A combined open and eTEP approach for mesh removal and retrorectus hernia repair was proposed. Retrorectus dissection began at the left rectus muscle, using two 5 mm trocars for dissection and after crossover a contralateral Hasson trocar was placed. A M4-5W2 and L3 hernia with omental fat and partial bladder sliding into the hernia sac was observed. The right posterior fascia was fibrotic and laterally retracted. After sac contents were fully mobilized, a right partial TAR was necessary in order to close the peritoneum and obtain an adequate dissection for mesh placement. A 25×20cm polypropylene mesh was placed in the retrorectal space. Using a right inguinal incision, previously infected mesh was removed and a silver coated polypropylene mesh was placed below the anterior fascia. The patient was discharged on the third postoperative day and her one month follow up visit was uneventful. We conclude that in this case a hybrid approach can provide an adequate mesh placement via eTEP, with mesh removal by a less invasive approach.
V-050 Abdominal wall reconstruction after resection of dermatofibrosarcoma protuberans
Authors: Morejón Ruiz S , Vaello V
Published: May 2023

Aim

Surgical repair of a complex defect after resection of Dermatofibrosarcoma protuberans.

Materials-methods: Dermatofibrosarcoma protuberans, is an uncommon soft tissue tumor that involves the dermis, subcutaneous fat, and in rare cases, muscle and fascia. We present a 49-year-old patient diagnosed with Dermatofibrosarcoma of the anterior abdominal wall who underwent Mohs surgery to achieve complete resection, resulting in a 12cmx10cm defect in the epigastrium affecting skin, subcutaneous tissue, linea alba and both anterior rectus sheaths.

This tumor is considered an intermediate-grade malignancy with a low likelihood of metastasis but a high local recurrence rate. The optimal treatment is Mohs-micrographic surgery, that allows complete margin assessment and tissue preservation.

Results

Dissection of the retrorectus space is extended caudal to the defect, while dissection proceeded cranially by sectioning the posterior rectus sheath to enter the subxiphoid preperitoneal space. A polypropylene mesh is extended in sublay position. Given the asymmetry of anterior fascia defect, the Chevrel (Welti-Eudel) technique is performed on the left side in order to reconstruct the linea alba. The fascial defect was later covered with an onlay biosynthetic mesh. Finally, closure of the skin was achieved with an O-Zetaplasty ensuring adequate viability of the skin flaps. The patient did not present any postoperative complications.

Conclusions

Resection of locally aggressive tumours such as Dermatofibroma remains the only curative alternative but can pose a reconstructive challenge. Midline reconstruction and closure of large, circular defects in the epigastrium is complicated, requiring deep anatomical knowledge and a combination of different surgical approaches and materials.
V-051 SCOLA TECHNIQUE WITH PERIUMBILICAL MINI-INCISION FOR UMBILICAL HERNIA WITH BIG DIASTASIS RECTI: A CASE REPORT
Authors: Vera Vasquez C A , Gonzalo Prats B , Lupu I , Ye Zhou J , Solans Solerdelcoll M , Gonzalez Lopez J A , Moral Duarte A
Published: May 2023

Background

Diastasis of the rectus abdominis muscles (DRAM) is frequent and may be associated with abdominal wall hernias. In 2017 subcutaneous onlay laparoscopic approach (SCOLA) was described which combines diastasis recti plication and abdominal wall hernia repair without requiring a great incisions nor skin resections.

Objective

To show a video of a SCOLA technique with open periumbilical dissection through 2.5 cm periumbilical mini-incision. The aim is to reduce operative time and to improve the quality of life with good aesthetic results by a minimal invasive procedure.

Method

We report a case of a 39 years old woman with 3 previous caesarian deliveries, diagnosed with umbilical hernia and diastasis recti with a 95mm internal gap. The patient was scheduled electively for a SCOLA technique.

Results

Surgery was performed with no intraoperative complications. Persistent hematic output through drains was seen first 24h postoperatively which required blood transfusion for anemization, but no need for reoperation, correct hemoglobin controls afterward. Small hematoma detected in 1st month control, with correct resolution on 4th month control. No recurrence of umbilical hernia nor diastasis recti observed during this short follow-up.

Conclusion

SCOLA technique has been proven to be a reproductive and secure technique for those patients with DRAM associated with abdominal wall hernia that do not require nor need skin resection or great incisions. The aim of the periumbilical dissection through mini-incision is to decrease surgical time. One must consider the risk of bleeding or seroma associated with the extensive dissection in cases with great diastasis gap.
Data-driven neuropathological staging and subtyping of TDP-43 proteinopathies
Authors: Young Alexandra L , Vogel Jacob W , Robinson John L , McMillan Corey T , Ossenkoppele Rik , Wolk David A , Irwin David J , Elman Lauren , Grossman Murray , Lee Virginia M Y , Lee Edward B , Hansson Oskar
Published: May 2023

TAR DNA-binding protein-43 (TDP-43) accumulation is the primary pathology underlying several neurodegenerative diseases. Charting the progression and heterogeneity of TDP-43 accumulation is necessary to better characterize TDP-43 proteinopathies, but current TDP-43 staging systems are heuristic and assume each syndrome is homogeneous. Here, we use data-driven disease progression modelling to derive a fine-grained empirical staging system for the classification and differentiation of frontotemporal lobar degeneration due to TDP-43 (FTLD-TDP, n = 126), amyotrophic lateral sclerosis (ALS, n = 141) and limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) with and without Alzheimer’s disease (n = 304).

The data-driven staging of ALS and FTLD-TDP complement and extend previously described human-defined staging schema for ALS and behavioural variant frontotemporal dementia. In LATE-NC individuals, progression along data-driven stages was positively associated with age, but negatively associated with age in individuals with FTLD-TDP. Using only regional TDP-43 severity, our data driven model distinguished individuals diagnosed with ALS, FTLD-TDP or LATE-NC with a cross-validated accuracy of 85.9%, with misclassifications associated with mixed pathological diagnosis, age and genetic mutations. Adding age and SuStaIn stage to this model increased accuracy to 92.3%. Our model differentiates LATE-NC from FTLD-TDP, though some overlap was observed between late-stage LATE-NC and early-stage FTLD-TDP. We further tested for the presence of subtypes with distinct regional TDP-43 progression patterns within each diagnostic group, identifying two distinct cortical-predominant and brainstem-predominant subtypes within FTLD-TDP and a further two subcortical-predominant and corticolimbic-predominant subtypes within ALS. The FTLD-TDP subtypes exhibited differing proportions of TDP-43 type, while there was a trend for age differing between ALS subtypes. Interestingly, a negative relationship between age and SuStaIn stage was seen in the brainstem/subcortical-predominant subtype of each proteinopathy. No subtypes were observed for the LATE-NC group, despite aggregating individuals with and without Alzheimer’s disease and a larger sample size for this group.

Overall, we provide an empirical pathological TDP-43 staging system for ALS, FTLD-TDP and LATE-NC, which yielded accurate classification. We further demonstrate that there is substantial heterogeneity amongst ALS and FTLD-TDP progression patterns that warrants further investigation in larger cross-cohort studies.
Modelling and analysis of parameters of vacuum tube solar collector with U-shaped tube for different climates
Authors: Smaisim Ghassan Fadhil , Abed Azher M , Hadrawi Salema K , Jahanbin Farnaz
Published: May 2023

In this study, based on the energy balance for different components of a double-layered vacuum-tube solar collector with a U-tube, the thermal performance of the collector unit is investigated separately using an analytical and quasi-dynamic method. The model used in this study determines the temperature distribution in longitudinal and radial directions. In this research, the effects of physical parameters and heat transfer including the size of the collector, thermal-loss coefficient, absorption coefficient, mass flow and thermal resistance of the air layer under different climate conditions have been evaluated on the performance of the vacuum-tube collector. The results showed that by increasing the diameter of the tube with constant length, the annual thermal efficiency of the collector increased. Also, in a fixed-diameter tube, with increasing tube length, the annual efficiency increases, but this increase is meagre for lengths of >1.5 m. The optimal mass flow rate for maximum efficiency has been obtained for cities with different climates. According to the results, the optimal flow for different climates has different values that can be optimized as a relationship between the average solar radiation annually as a symbol of temperature and flow.
Advanced DC–DC converter topologies for solar energy harvesting applications: a review
Authors: Sutikno Tole , Samosir Ahmad Saudi , Aprilianto Rizky Ajie , Purnama Hendril Satrian , Arsadiando Watra , Padmanaban Sanjeevikumar
Published: May 2023

In this study, the advanced topologies of a DC–DC converter for applications involving the harvesting of solar energy are discussed. This work’s primary contribution is a guide for choosing the most effective topology for a DC–DC converter when developing solar energy collection systems. Several topologies of a DC–DC converter for solar energy harvesting applications are compared in terms of the range of power levels they can oversee, the complexity of the underlying hardware, the cost of implementation, the tracking efficiency and the overall efficiency of the converter. This article explains five innovative approaches for adapting boost converters to function as standard DC–DC converters to capture solar energy, consisting of (i) voltage-multiplier cell, (2) coupled inductor, (3) coupled inductor and switch capacitor, (4) cascaded topology and (5) voltage-lift technique. Because of the boost converter’s restrictions, it is necessary to deliver high performance. The comparison findings demonstrate that the voltage-lift-based boost-converter topology performs more effectively than the alternatives. In conclusion, the information presented in this paper can be utilized when developing solar energy collection systems to determine the sort of direct current to direct current converter that will be most effective.
Efficacy of Cognitive-Behavioral Therapy Targeting Severe Fatigue Following Coronavirus Disease 2019: Results of a Randomized Controlled Trial
Authors: Kuut Tanja A , Müller Fabiola , Csorba Irene , Braamse Annemarie , Aldenkamp Arnoud , Appelman Brent , Assmann-Schuilwerve Eleonoor , Geerlings Suzanne E , Gibney Katherine B , Kanaan Richard A A , Mooij-Kalverda Kirsten , Olde Hartman Tim C , Pauëlsen Dominique , Prins Maria , Slieker Kitty , van Vugt Michele , Keijmel Stephan P , Nieuwkerk Pythia , Rovers Chantal P , Knoop Hans
Published: May 2023

Background

Severe fatigue following coronavirus disease 2019 (COVID-19) is prevalent and debilitating. This study investigated the efficacy of cognitive-behavioral therapy (CBT) for severe fatigue following COVID-19.

Methods

A multicenter, 2-arm randomized controlled trial was conducted in the Netherlands with patients being severely fatigued 3–12 months following COVID-19. Patients (N = 114) were randomly assigned (1:1) to CBT or care as usual (CAU). CBT, targeting perpetuating factors of fatigue, was provided for 17 weeks. The primary outcome was the overall mean difference between CBT and CAU on the fatigue severity subscale of the Checklist Individual Strength, directly post-CBT or CAU (T1), and after 6 months (T2). Secondary outcomes were differences in proportions of patients meeting criteria for severe and/or chronic fatigue, differences in physical and social functioning, somatic symptoms, and problems concentrating between CBT and CAU.

Results

Patients were mainly nonhospitalized and self-referred. Patients who received CBT were significantly less severely fatigued across follow-up assessments than patients receiving CAU (−8.8 [95% confidence interval {CI}, −11.9 to −5.8]); P < .001), representing a medium Cohen's d effect size (0.69). The between-group difference in fatigue severity was present at T1 (−9.3 [95% CI, −13.3 to −5.3]) and T2 (−8.4 [95% CI, −13.1 to −3.7]). All secondary outcomes favored CBT. Eight adverse events were recorded during CBT, and 20 during CAU. No serious adverse events were recorded.

Conclusions

Among patients, who were mainly nonhospitalized and self-referred, CBT was effective in reducing fatigue. The positive effect was sustained at 6-month follow-up.

Clinical Trials Registration

Netherlands Trial Register NL8947.
Assessing the impact of piercing-sucking pests on greenhouse-grown industrial hemp (Cannabis sativa L.)
Authors: Pulkoski Melissa , Burrack Hannah
Published: May 2023

Cannabis sativa or hemp, defined as <0.3% total tetrahydrocannabinol (THC), is a specialty crop in the United States, of particular interest among growers in the southeastern United States to replace tobacco production. Tetranychus urticae (twospotted spider mite), Aculops cannabicola (hemp russet mite), Polyphagotarsonemus latus (broad mites), and Phorodon cannabis (cannabis aphids) are considered the most significant pests in greenhouse grown hemp. Mite and aphid injury can cause cupping and yellowing of leaves, resulting in leaf drop, and reduced flower and resin production. We sought to understand the effects of feeding by T. urticae and Myzus persicae (green peach aphid), as a proxy for P. cannabis, on the concentration of economically significant cannabinoids through a series of experiments on greenhouse grown plants. First, we compared the variability of chemical concentrations in samples collected from individual plants versus pooled samples from 5 plants, and found that chemical concentrations in single plants were similar to those in pooled plant samples. Next, we compared chemical concentrations prior to arthropod infestation and post infestation. When evaluating the mite feeding damage in 2020, cannabinoids in plants infested with high densities of T. urticae increased more slowly than in uninfested control plants or plants infested with low T. urticae densities. In 2021, the concentration of tetrahydrocannabinol did not differ significantly between treatments. Cannabidiol increased more slowly in plants with low T. urticae densities when compared to uninfested controls but did not differ from the high T. urticae densities 14 days after infestation.