bluuebunny/crossref_metadata_2025 huggingface dataset:
ROBOTIC TRIPLE NEURECTOMY FOR POSTOPERATIVE INGUINAL PAIN
Authors: Villalobos R , Maestre Y , Barranquero A G , Gas C , Semeraro C , Escartin A
Published: May 2024

Background

Postoperative chronic inguinal pain is a very catastrophic situation in a patient that underwent an inguinal hernia repair. The first step is to dismiss is a recurrent hernia exits. Then the patient is diverting to the pain unit in order to assess the use of drugs, infiltrations, rhizolysis or another treatment. If these procedures don´t work, a triple neurectomy is consider improving the pain. Literature defends the proximal neurectomy to have better results. We present a patient that was subjected to a robotic triple neurectomy approach because he continued with pain despite 3 hernioplasties and different treatments with the pain unit.

Method

A Veress needle was used to create the pneumoperitoneum. After that, an 8 mm robotic trocar was introduced just above the belly bottom, then 1 upward equidistant 8 mm trocar and another downward were placed. The trocars were numbered in 1, 2, 3 from the up to the down. The fourth arm was put away. Number 1 was used for the bipolar fenestrated, number 2 for the camera and number 3 for the scissors and needle driver.

Results

After peritoneal dissection of the myopectineal orifice (MPO), a plug mesh and direct defect were found. The MPO was dissected then we continued upward, and the parietal compartment was dissected to achieve the nerves. After a rigorous dissection a segment of the iliohypogastric, ilioinguinal and genitofemoral nerves were divided. A15 × 15 cm Dynamesh IPOM was placed in the MPO and fixed in the Cooper´s ligament. Finally, the peritoneum was closed using a 2–0 barbed suture. The patient revealed progressive decreasing of the pain after one month.

Conclusion

The excellent vision and manipulation of the robotic platform could improve our results in these complex cases.
COMPARISON OF TOTAL EXTRAPERITONEAL (TEP) AND EXPANDED VIEW TOTAL EXTRAPERITONEAL (eTEP) METHODS AT INGUINAL HERNIA REPAIR
Authors: Agar M , Agca B , Tasdelen I , Fersahoglu A T , Bilgili A , Segmen O , Fersahoglu M , Gunes Y , Topaloglu B , Ergin A , Aydin M T , Iscan Y , Memisoglu K
Published: May 2024

Background

Laparoscopic hernia repair has been accepted as first-line treatment for inguinal hernia by major surgical institutions today, with low complication and recurrence rates. The aim of this prospective clinical study, we compared two different laparoscopic approaches in terms of technical ease, patients' early postoperative quality of life, pain management, complication and early recurrence rates.

Method

Patients with inguinal hernia who were planned to undergo laparoscopic hernia repair were randomized and operated with total extraperitoneal repair (TEP) and extended view total extraperitoneal repair (eTEP) methods in July and August 2023. During the postoperative follow-up, 24th-hour pain scores and 24th-hour quality of life scores were noted with a visual analogue scale (VAS) and quality of recovery test (QoR T15). At the 1st week outpatient clinic follow-up, their pain scores were questioned with VAS. They were checked by physical examination for complications or early recurrence. Patients were called for follow-up at the 1st and 3rd months after the surgery.

Results

The number of fixative staples was significantly higher in TEP group (p < 0.001). The operation time was significantly shorter in eTEP group (p: 0.031). Time to return to work was significantly longer in TEP group (p: 0.024). VAS scores on the 1st postoperative day were found to be significantly lower in eTEP group (p < 0.001), no significant difference was detected in the 1st week scores. The QoR test scores on the first postoperative day were significantly higher in eTEP group (p:0.006). The difference between number of patients with seroma, ecchymosis or hematoma was not significant in two groups.

Conclusions

Both methods we used did not make a significant difference in the incidence of complications. On the other hand, we revealed that eTEP method may be more advantageous in terms of ease of surgery, patients' quality of life in the early period.
CONGENITAL DIAPHRAGMATIC HERNIA IN PATIENT WITH 1P36 DELETION
Authors: Alhatemi A Q M
Published: May 2024

Introduction

Congenital Diaphragmatic Hernia (CDH) is a condition characterized by the protrusion of abdominal contents into the thoracic cavity due to a defect in the diaphragm. While typically observed in the neonatal period, CDH can present in later life.

Case Presentation and Management

This case report describes the presentation, diagnosis, and management of a nine-year-old boy with 1p36 deletion syndrome who presented with respiratory distress, abdominal pain, vomiting, and anorexia. The initial diagnosis was tension pneumothorax (Figure 1), and thus the patient underwent chest tube placement. However, a high-resolution CT scan revealed a left hemi diaphragmatic hernia, and the patient eventually underwent an emergency laparotomy due to acute-onset respiratory distress. Intraoperatively, a diagnosis of Bochdalek hernia with gastric perforation was made, and the CDH and gastric perforations were resolved successfully.

Results and Conclusion

This case highlights the importance of considering late-presenting CDH as a possible diagnosis in paediatric patients with similar symptoms and the radiological findings suggestive of tension pneumothorax. Early recognition and prompt surgical intervention can lead to the successful management of such cases.Figure 1.Preoperative Chest radiograph showing large hyperlucency, and the dimension were approximately 18 × 10 cm in the left hemithorax. A significant mediastinal shift to the right can be observed.
A SINGLE-CENTRE, RETROSPECTIVE STUDY OF INCISIONAL HERNIA REPAIR OUTCOMES POST KIDNEY TRANSPLANTATION
Authors: Anastasopoulos N A , Hussain S , Herbert P , Muthusamy A , Dor F , Papalois V
Published: May 2024

Background

Incisional hernias (IH) post renal transplantation (RT) can cause significant morbidity in renal transplant recipients (RTR). This was a retrospective cohort study of outcomes post IH-repair in RTR.

Method

We analysed all the IH repairs in RTR from May 2018 to May 2023. We documented post-transplant andx post IH-repair complications, length of stay, survival, and recurrence. Data analysis was performed using Jamovi 2.3.28.

Results

We performed 35 IH repairs in RTR from 05/2018 to 05/2023 in patients with a mean age of 56.7 ± 10.1 years and a mean BMI 29.7 ± 6.49 kg/m2. A history of previous hernia operation and open abdominal operations was present in 11.4% and 22.9%, respectively. The types of repairs performed were primary: 5.7%, onlay: 62.9%, inlay: 2.9% and sublay: 28.6%. In terms of mesh, in 18.1% a polyglactin 910 mesh was used, 57.6%, polypropelene and in 24.4% a composite mesh. Mean hernia neck size was 8.9 ± 5.6 cm. Post repair, there was no perioperative mortality, no significant episodes of perioperative bleeding and no collections drained, with an average 5.5 ± 3.9 days of length of stay. 20% of this cohort experienced a recurrence post-hernia repair. There was a 6% of superficial wound dehiscence rate and a 3% of surgical site infection. Pearson’s correlation test revealed that hernia recurrence was not related with neck size, post-transplant complications or pre- and post-transplant characteristics, as well as post-transplant outcomes.

Conclusion

One in five RTR that underwent an IH repair experienced a recurrence. Patient BMI, previous abdominal operations and wound complications post-transplant are not risk factors for hernia recurrence or other IH repair complications.
LAPAROSCOPIC ETEP (EXTENDED TOTALLY EXTRAPERITONAL REPAIR) VENTRAL HERNIA SURGERY – RESULTS FROM 2021 TO 2023
Authors: Andersen G , Elden E , Vorontsov D , Græslie H
Published: May 2024

Background

In our surgical department, we've recently shifted to ETEP surgery with retromuscular mesh placement as our preferred technique for both primary ventral hernias and recurrent hernias with prior implants. This abstract outlines the outcomes of 30 cases treated with ETEP surgery between 2021 and 2023.

Methods

The cohort of 30 patients presents a diverse range of hernia complexities, from umbilical hernias with diastasis recti to large ventral hernias with prior implants.

Results

Our surgical times varied widely, spanning from 122 to 420 minutes, with a median of 197 minutes. Hospital stays with a median of 3 days (range 1–12). Six cases required bilateral Transversus Abdominis Release (TAR), while five patients needed unilateral TAR. Two patients underwent hybrid surgery with both open and laparoscopic surgery. Postoperative complications included four cases of bleeding, with two necessitating laparoscopic reoperation within 24 hours. Follow-up comprised clinical assessments and CT scans 1–3 months post-surgery, with additional CT scans for some patients one year post-surgery. Except for one early breakdown of the posterior layer and one small linea alba injury, CT scans showed adequate abdominal wall reconstruction in all patients. To date, we have not encountered any hernia recurrences or wound or mesh infections, with only one patient developing a symptomatic seroma after surgery.

Conclusion

Laparoscopic retromuscular mesh placement via ETEP surgery appears promising for achieving superior anatomical abdominal wall reconstruction compared to IPOM. Our results thus far indicate favorable outcomes based on post-surgery CT evaluations and clinical follow-up.
IMPLEMENTATION OF A MULTIDISCIPLINARY COMPREHENSIVE HERNIA CENTRE: OUTCOMES AND LESSONS LEARNT
Authors: Birch A , Cocciolo F , Alabbasi I
Published: May 2024

Background

AWR is an elective procedure aimed at enhancing the quality of life for individuals dealing with complex hernias. Patients with obesity, a history of smoking, or diabetes tend to experience poorer outcomes in elective hernia repair. Pre-optimization before surgery becomes crucial to enhance patients’ surgical outcomes.

Aim

A multidisciplinary clinic and pre-optimization process have been implemented. This paper seeks to underscore the progress achieved through the adoption of a multidisciplinary approach, emphasizing the importance of a comprehensive strategy in managing these challenging cases.

Methods

Once patients get referred to the Comprehensive hernia centre, they are seen in clinic and discussed at the weekly Multidisciplinary Team (MDT) meeting and if appropriate they will be sign-posted into the pre-optimising process. A weekly Advanced Clinical Practitioner (ACP) telephone clinic has been established for the ongoing monitoring of patients requiring pre-optimization. Upon achieving their pre-optimization goals, patients are placed on the surgery list, and if required, their surgery is expedited appropriately. The paper includes a review of all patients seen in the MDT clinic at the Comprehensive Hernia Centre in 2023.

Results

49 patients were listed for pre-optimization, with 8 needing smoking cessation, 45 requiring weight loss, and 13 needing diabetes control. Within the same period, 42 patients underwent surgery, with 22 requiring pre-optimization. Currently, 68 patients are undergoing post-surgery follow-up.

Conclusion

Our data shows that the majority of patients undergoing AWR require pre-optimisation, particularly regarding weight loss. By having a dedicated telephone clinic patient can be supported to achieve their targets prior to AWR surgery.
HOW TO IMPLEMENT THE NEW METHOD? INITIAL EXPERIENCE WITH INTRAOPERATIVE FASCIAL TRACTION IN CZECHIA
Authors: Bystricky P , Suhajek S , Benda P , Oupicky J , Peteja M , Polednik J , Prudius V
Published: May 2024

Aim

Midline closure can be difficult or impossible when restoring large abdominal wall defects. There are several possibilities how to close the midline, but most of these techniques are not easy to learn and perform properly. Intraoperative fascial traction (IFT) is a relatively new method that delivers promising results in recent studies. It can avoid inapproprate use of other complex techniques, especially component separation. The aim of this retrospective analysis was to demonstrate the effectiveness and potential pitfalls of implementing this new method, and evaluate complication rate of ITF under the specific conditions of Czechia.

Materials and Methods

This multicentric retrspective review evaluates first 16 cases of complex hernias treated by intraoperative fascial traction in 7 Czech centres.

Results

The average fascial distance measured intraoperatively was 13,3 cm. The mean operation time was 155 min, including 30 min of fascial traction. A mesh in a sublay position was applied in all cases. In all cases, it was possible to achieve midline closure, but in 2 cases, an additional component separation was performed. Postoperative complications occured in 2 patients (12,5%); both of them needed a NPWT due to an infected subcutaneous serohematoma and subcutaneous dehiscence.

Conclusions

IFT is a new and effective procedure for treatment of complex abdominal wall defects. In a relatively small setting, our own protocol was applied, including patient selection, hands-on workshops and supervision, intensive exchange of experiences. Easy implementation, effectiveness and safety of this method were proved.
PREHABILITATION FOR EVERY AWR? COMPARISON OF LONG-TERM RESULTS OF SUBLAY/TAR TECHNIQUE
Authors: Bystricky P , Suhajek S , Keprta D
Published: May 2024

Aim

Patients with complex abdominal wall defects are recommended to be treated in specialised centres. Prehabilitation of these patients, including physiotherapy, weight loss, diabetes management, smoking cessation, is strongly recommended. However, most of „non-complex“ hernias are often treated by general surgeons without any knowledge of the importance of patient´s prehabilitation. The aim of our study was to compare 2 groups of patients with complex/non-complex hernias, and to determine if patients with non-complex hernias without comorbidities can profit from preoperative optimization, too.

Materials and Methods

50 patients treated in 1 centre by the same team were included in this retrospective review. 2 subgroups of patients were determined: A; W1–2 hernia, no prehabilitation, sublay-mesh only, and B; W3 hernia, prehabilitation, component separation technique-TAR. Complications were evaluated by Clavien-Dindo classification. A clinical control, standardized ultrasound, and a standardized questionnaire, were made 7–24 months after surgery.

Results

Operation time and length of hospital stay was shorter in subgroup A. There was no difference in recurrence in 2 subgroups, determined by clinical examination and ultrasound. Post-op complication rate (mainly wound complications) was surprisingly higher in the subgroup A. The Quality-of-Life Questionnaire showed greater limitations before treatment but better outcomes and improvement in the subgroup B.

Conclusions

Preoperative optimization has demonstrated patient´s benefits and better results in complex incisional hernias. It can reduce complication rate, improve patient´s outcome and increase of patient´s satisfaction also for W1–2 hernias without comorbidities.
OPEN INGUINAL HERNIA REPAIR WITH SELF-GRIPPING PARIETEX PROGRIP MESH: A GOLD STANDARD TECHNIQUE WITH 0% CHRONIC PAIN AND RECURRENCE
Authors: Ceci F , Mascagni P , Scorsi A , Saraceno F , Muzi M G
Published: May 2024

Background

Chronic pain and recurrence rates are the main challenge in modern inguinal hernia surgery. The purpose of our study was to retrospectively evaluate the early and long-term results after a standard, safe and effective technique using a self-gripping mesh (Parietex Progrip®, Covidien).

Method

The study was conducted from 2018 to today in a Hernia Center. 106 patients underwent open inguinal hernioplasty with Progrip mesh. Reassessments performed at 1 week, 1, 6 months, 3 and 5 years recording complications above all chronic pain and recurrence.

Results

The average age was 57 years, SD +/- 11.7. Two patients were affected by recurrent inguinal hernia and 5 by bilateral inguinal hernia. The sample consists of 98 males and 8 females. The mean operating time was 52 minutes SD +/- 15.56. No recurrences, cases of chronic pain or mesh infections were recorded postoperatively; we found 2 seromas at the first outpatient check-up, 1 in a patient treated for a recurrent hernia.

Conclusion

This case series is the continuation of our previous experience begun in 2006 including data on 970 procedures (0 chronic pain and 3 relapses), for a total of 1076 patients performed by a single operating surgeon. Our results show 0% chronic pain and recurrence in 106 patients and encourage the use of self-gripping mesh (Progrip) in inguinal hernioplasty.
HERNIA RECURRENCE AFTER LAPAROSCOPIC MESH REMOVAL FOR CHRONIC POSTOPERATIVE INGUINAL PAIN FOLLOWING PREPERITONEAL REPAIR: LONG-TERM OUTCOMES
Authors: Chaoui A M , Zwaans W A R , Loos M J A , Slooter G D , Rops J P
Published: May 2024

Introduction

Minimally invasive inguinal hernia repair results in 6–12% of patients experiencing chronic pain. The mesh can constitute the root of the problem. Literature concerning laparoscopic mesh removal is scarce. A recently published study has demonstrated feasibility and safety of this technique. However, little is known about hernia recurrences after laparoscopic mesh removal. This observational study aims to describe the rate of hernia recurrence following laparoscopic mesh removal in patients with chronic postoperative inguinal pain (CPIP) after preperitoneal inguinal hernia repair and reports the effect of the intervention on pain.

Methods

A retrospective study of prospectively collected questionnaires and operative findings was conducted. The patient population constitutes of eighty-nine consecutive patients undergoing a laparoscopic mesh removal for CPIP between November 2011 and July 2022. Hernia recurrence was based on anamnestic and clinical findings. Pain scores were quantified using the Numeric Pain Rating Scale (NRS).

Results

Eighty-three patients were included in the present study (median age 57 years). We noted a hernia recurrence in eighteen patients (21.7%). Intraoperative findings concerning mesh conformation were also reported. Median pain scores dropped significantly from 7 to 3 (p < 0.05).

Conclusion

This retrospective study shows that laparoscopic mesh removal for CPIP following preperitoneal inguinal hernia repair results in an inguinal hernia recurrence in 1 out of 5 patients. Patients should be well-informed preoperatively about this finding. To the best of our knowledge, this is the first study describing hernia recurrence risk after laparoscopic mesh removal.
ONCOLOGICAL PATHOLOGY OF THE ABDOMINAL WALL: A CHALLENGE FOR ABDOMINAL WALL SURGEONS
Authors: Charef El Jari L , del Campo Martín M , Fra Corral D , García Galocha J L , López Antoñanzas L , Torres García A J , Soria M J
Published: May 2024

Introduction

Mesenchymal tumors are the tumor line that most frequently affects the abdominal wall. This pathological category includes all neoformations of mesenchymal tissues, muscle, vessels, adipose tissue, among others. They are rare tumors that require extensive extirpations and complex reconstructions.

Aim

To point out the importance of multidisciplinary units to provide patients the best oncological, functional and aesthetic results.

Material and Methods

We present a case series of patients affected by abdominal wall tumors of mesenchymal type, who have received treatment in the sarcoma unit of San Carlos Clinical Hospital in Madrid between 2015 and 2023. The sarcoma unit includes, among other specialists, abdominal wall and plastic surgeons.

Results

A total of 17 patients have received surgery, there were 9 males and 8 females. The average age was 58 years.

The inguinal region and the root of the thigh were the most affected sites (9). The most common tumor type was liposarcoma (5). The remaining cases were femoral sheath leiomyosarcoma, schwannoma, chondrosarcomas and osteosarcomas. The surgical treatment of these patients required vascular and osteoarticular reconstruction by expert surgeons in these areas.

The tumor line that most frequently involved the anterior wall of the abdomen were tumors of fibroblast origin. These cases required extensive excisions of the entire abdominal wall which was reconstructed using different types of flaps performed by plastic surgeons.

Conclusions

The treatment of abdominal wall tumor pathology should be carried out in reference units and by multidisciplinary surgical teams as different organs and systems are usually affected.
SAFETY AND EFFECTIVENESS OF A BIOSYNTHETIC, FULLY-SLOWLY RESORBABLE MESH, MADE FROM P4HB* IN VENTRAL AND INCISIONAL HERNIA REPAIR: A GREEK MULTICENTER CLINICAL STUDY
Authors: Chatzimavroudis G , Kourlaba G , Christodoulidis G , Zatagias A , Maroulis I , Chrysoheris P , Kotoreni G , Apostolidis S , Bouhagier K , Pavlidis T , Zacharoulis D , Papaziogas B , Kolovos P , Stefanou G
Published: May 2024

Aim

During the last decade a new type of meshes has launched, the biosynthetic slowly/fully resorbable meshes. Among them, mesh made from P4HB looks very promising due to its specific characteristics. The purpose of this study was to evaluate the safety and effectiveness of P4HB mesh in ventral/incisional hernia repair.

Material and Methods

This was a Greek multicenter retrospective clinical study including all patients who underwent ventral/incisional hernia repair with the use of P4HB mesh between May 2017 and October 2022. Patients’ demographic data and data regarding comorbidities, CDC wound classification, hernia characteristics and type of operation, were recorded. Postoperative complications and recurrence were evaluated.

Results

During study period, 85 patients (54.1% men) suffering from ventral/incisional hernias (mean age: 62.3 years and mean BMI: 30.8) underwent hernia repair with P4HB mesh. Of them, 69.5% suffered from hypertension, 42.4% from diabetes, 23.5% from COPD, 29.4% from cardiopathies, 49.6% were active smokers and 45.9% had a history of SSI. According to CDC wound classification, 47.1% of cases were non-clean. Open repair was performed in 91.8%, the defect was closed in 96.5%, while component separation was applied in 68.3% of patients. Regarding postoperative surgical site occurrences (SSOs), seroma occurred in 20%, hematoma in 4.7%, cellulitis in 7.1% and SSI in 3.5% of patients. With the exception of one case, all SSOs were successfully treated conservatively. With a mean follow-up of 40 months, only 2 (2.3%) recurrences were observed.

Conclusions

The use of P4HB mesh is safe and effective in ventral/incisional hernia repair, even in non-clean cases.

P4HB: PHASIX mesh
MESH VERSUS SUTURE FOR ELECTIVE PRIMARY UMBILICAL HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Dias Rasador A C , Balthazar da Silveira C A , Lima D L , Nogueira R , Malcher F , Sreeramoju P , Cavazzola L T
Published: May 2024

Aim

Recent guidelines recommend the use of mesh in umbilical hernia repair (UHR) for defects >1 cm. However, primary closure is still performed in UHR, especially for small defects (<2 cm), for which there is no published data to determine the optimal approach. Thus, we performed a systematic review and meta-analysis comparing the use of mesh with primary closure in elective primary UHR.

Material and Methods

We searched for studies comparing mesh with suture in UHR in PubMed, Scopus, Cochrane, Scielo, and Lilacs. Studies with recurrent or emergency conditions were excluded. Outcomes were recurrence, seroma, hematoma, and wound infection. Subgroup analysis was performed for hernia defects <2 cm. We used R statistics for statistical analysis.

Results

2895 studies were screened and 56 were reviewed. 12 studies were included, comprising 2926 patients (47.6% in mesh and 52.4% in the suture group). Mesh repair showed lower rates of recurrence in the overall analysis (RR 0.50; 95% CI 0.31 to 0.79; P = 0.003; I2 = 24%) and for hernia defects <2 cm (RR 0.56; 95% CI 0.34 to 0.93; P = 0.03; I2 = 0%). Suture repair showed lower rates of seroma (RR 1.88; 95% CI 1.07 to 3.32; P = 0.03; I2 = 0%) and wound infection (RR 1.65; 95%CI 1.12 to 2.43; P = 0.01; I2 = 15%).

Conclusion

The use of mesh during UHR generates a higher risk for seroma and wound infection compared to primary closure. Nevertheless, mesh repair is associated with lower recurrence rates in a long-term follow-up for both small and large defects. Therefore, mesh repair should be the surgical approach for umbilical hernias.
UNILATERAL TRANSVERSUS ABDOMINIS MUSCLE RELEASE WITH RETROMUSCULAR MESH REPAIR AS A SOLUTION FOR A SECOND RECURRENCE OF LARGE MULTILOCULAR INCISIONAL HERNIA AFTER LIVER TRANSPLANTATION
Authors: Drs A , Frank J , Fronek J
Published: May 2024

Background

Transversus abdominis muscle release was published by Novitsky et al. in 2012. It is a posterior component separation technique allowing the closure of large abdominal wall defects and the insertion of very large retromuscular meshes without damaging the vessels and intercostal nerves.

Method

We would like to present a case of a second recurrence of a large multilocular incisional hernia after liver transplantation and its solution.

Results

We present a patient after liver transplantation in January 2021. In April 2022 retromuscular sublay mesh repair was performed for subcostal incisional hernia. In December 2022 onlay mesh repair was performed for medial recurrence of the previous incisional hernia. Four months later, unfortunately, the second recurrence appeared. At the beginning, we proceeded conservatively, but because of an increasing size of the hernia, we decided to perform a retromuscular mesh plastic. Because of the size of the defect (fascial gap 10 × 20 cm), with the transversus abdominis muscle release. Due to the violated tissue planes after previous plastics, we performed only unilateral (left) release. It was sufficient to close the posterior rectus sheath without any tension. Large retromuscular mesh was placed and covered by closure of the anterior rectus sheaths. The patient was discharged on the third postoperative day without any complications.

Conclusion

Transversus abdominis muscle release with retromuscular mesh placement provides a great solution for difficult recurrent ventral hernias.
IT’S TIME TO CHANGE THE GUIDELINES FOR RECURRENT INGUINAL HERNIA AFTER POSTERIOR REPAIR, RE POSTERIOR TEP APPROACH
Authors: Dudai M , Ganiem M
Published: May 2024

The guidelines are that a Recurrent Open hernia should be repaired by a Posterior approach. While recurrent Posterior is recommended to be repaired with an Open anterior approach. We'd like to discuss the recommendation and present our data for TEP repair of recurrent LAP hernia.

Since 2016, we have operated on 934 patients with Groin Hernias, 130 had a Recurrent Hernia, of which 33 was after LAP, 14 after TAPP and 19 after TEP. We started with TAPP, but quickly switched to TEP that allows the separation of all the mesh that was left attached to the peritoneum. We learned to begin separating the mesh from the lateral to medial.

The surgery lasted longer, but there was no conversion to Open. The recovery after surgeries were regular and there was no recurrence. We switched to absorbable takers and glue for avoiding pain.

There're significant advantages of TEP approach to repair a recurrent Posterior: 1. The edges of the mesh are not left exposed in the hernia defect in front of the bowel; 2. The mesh's removal completely from the posterior wall reducing pain; 3. Detecting defects that aren't visible in an Open.

Repairing recurrent hernias requires skill and experience. In our opinion, there are advantages in repairing a recurrent Posterior hernia with the TEP approach, and we've shown that the repair can be performed safely and successfully. We suggest considering changing the guidelines and allowing surgeons to choose the approach they want to repair a recurrent Posterior hernia. More data should be collected.
EFFECTIVENESS OF EMILOS SURGERY IN PATIENTS WITH DIASTASIS RECTI COMBINED WITH UMBILICAL HERNIA
Authors: Feleshtynskyi Y , Koval O , Svyrydovskyi S
Published: May 2024

Background

The aim of the study is to assess the effectiveness of surgical treatment of diastasis recti of the abdominal muscles combined with umbilical hernia using EMILOS and SCOLA procedure. Randomized clinical study.

Method

An analysis of the surgical treatment of 126 patients with diastasis of rectus abdominis combined with the umbilical was carried out. The age of patients is from 20 to 75 years. The average age is (42±1.3) years. There were 95 women, 31 men. In 1 group (n = 64), surgical treatment was performed according to the EMILOS method. In the 2nd group (n = 62), surgical treatment was performed according to the SCOLA method.

Results

After surgery, seroma was observed in 4 (6.3%) patients of the 1st group, in 10 (17%) of the 2nd group, there was no wound infection in the 1st group, among the patients in the 2nd group, wound infection was observed in 2 (3, 1%), chronic pain in group I in 2 (3.1%), in group II – in 6 (10%) patients. Long-term results from 1 to 36 months showed that among 35 patients of the 2nd group after SCOLA surgery, diastasis recurrences were found in 7 (13%), and among 34 patients of the 1st group after the EMILOS surgery in 1 (1.5%).

Conclusion

EMILOS alloplasty for umbilical hernias combined with diastasis of rectus abdominis muscles is more effective compared to SCOLA surgery due to retromuscular mesh placement, which reduces the frequency of postoperative complications and recurrences.
EVALUATION OF TAR AND RAMIREZ IN GIANT INCISIONAL HERNIAS
Authors: Feleshtynskyi Y , Lerchuk O , Chomiak V , Vatamaniuk V
Published: May 2024

Background

The aim of the study the evaluation of the effectiveness of TAR in comparison with the Ramirez operation for giant incisional hernia. Randomized clinical trial.

Method

An analysis of surgical treatment of 112 patients with giant postoperative ventral hernias was performed. The age of patients is from 30 to 80 years. The average age is 52 ± 1.3. There were 72 women, 40 men. In the first group, TAR technique was performed on 67 patients with retromuscular mesh placement. In the second group, 65 patients underwent the Ramirez procedure in combination with the "Onlay" technique.

Results

The postoperative results showed that among the patients of the 1st group. intra-abdominal hypertension was observed in 1 (1.4%) patient, in the 2nd group in 5 (7.6%). Complications of the postoperative wound, in particular, seroma among patients of the 1st group was diagnosed in 5 (7.4%), in the 2nd group in 9 (13.8%), infection observed in 1 (1.4%) patient of the 1st group and in 3 (4.6%) patients of the 2nd group. Chronic postoperative pain, respectively, in 4 (5.9%) and 6 (9.2%). Long-term results were studied in terms of 1 to 36 months in 42 patients of the 1st group and 40 patients of the 2nd group. Recurrences were found in 1 (2.3%) patient of the 1st group and in 3 (7.5%) patients of the 2nd group.

Conclusion

The obtained results showed a higher efficiency of the TAR technique compared to the Ramirez operation for giant postoperative ventral hernias.
USE OF FASCIAL TRACTION DEVICE IN OPEN ABDOMEN CLOSURE – A CASE REPORT
Authors: Fernandez Baeza M , Santidrian Zurbano M , Dominguez Bastante M , Mansilla Rosello A
Published: May 2024

Aim

Open abdomen management is a therapeutic option for patients in whom abdominal wall closure should not or cannot be performed. Deferred closure of the abdominal wall often presents difficulties and comorbidity. The use of a fascial traction device may yield benefits in these patients.

Material and Methods

Description of a clinical case.

Results

A 68-year-old male with diabetes mellitus, hypertension, history of smoking, and former alcohol use underwent orthotopic liver transplantation for alcoholic cirrhosis, hepatitis C virus, and hepatocellular carcinoma. Complications included hemorrhagic shock requiring re-intervention. Damage control surgery was performed leaving the abdomen open, and a fascial traction device was applied. The device was maintained for 5 hours, followed by a 1-hour rest period, repeated for 4 days. Following this period, with patient stabilization, abdominal wall closure was performed, demonstrating significant fascial approximation and achieving primary closure using the small bites technique in two layers. The only complication encountered was a seroma. The patient was discharged 27 days post-intervention.

Conclusions

In patients with an open abdomen, deferred closure of the abdominal wall is often complex due to fascial retraction. Therefore, the use of fascial traction devices in these cases may offer a significant advantage for abdominal wall closure, potentially avoiding or reducing fascial retraction and, in many cases, obviating the need for complex wall repair techniques in these fragile patients.
EARLY EXPERIENCE OF ROBOTIC INGUINAL HERNIA REPAIR WITH THE NEW HUGO RAS SYSTEM IN EUROPE
Authors: Ferri V , Vicente E , Quijano Y , Hernandez S. F , Duran H , Diaz E , Fabra I , Malave L , Ruiz P , Balelli L , Broglio A , Caruso R
Published: May 2024

Introduction

Less than 1 year ago, the new robotic system Hugo RAS (Medtronic, Minneapolis, MN, USA) was approved for general surgery. It introduced the novelty of utilizing independent robotic arms in a multimodular system, providing versatility for performing increasingly complex surgeries that require different angles.

Results

A total of 42 inguinal hernia repairs were performed using the HUGO system in 25 patients, including 17 bilateral inguinal hernias and 8 unilateral hernias. The average docking time was 5.4 minutes (range: 4.3–7.8 minutes). The average console time was 67.9 minutes for bilateral repairs and 31.3 minutes for unilateral repairs. The average total procedure time was 113.1 minutes for bilateral repairs and 52.2 minutes for unilateral repairs.

Conclusions

The HUGO RAS system is safe, reproducible, and suitable for complex hernias. We have introduced an alternative guide setup for this surgery. Our series represents the first patient series in Europe and the second worldwide.
TREATMENT OF ABDOMINAL WALL SARCOMAS: OUR EXPERIENCE
Authors: Galán Raposo L , Gotor Santos T , Sánchez-Brunete Medina V , Sutil Reguera N , Gómez Shevyakova O , Gisbert Aparicio M , de Diego Domínguez A , Fernández Fernández-Rebollos A , Medrano Montero I , Herrera Kok J H , Diago Santamaría M V
Published: May 2024

Aim

To describe the reconstruction of the abdominal wall after excision of a NFS.

Material and Methods

We present a case of a 27-year-old patient with NF1 and a diagnosis of NFS located between the greater and lesser oblique muscles of the left flank. After performing a complete extension study, the tumour was excised en bloc including the last costal arches, lateral abdominal wall and left iliac blade. The left deep epigastric artery was preserved to ensure perfusion of the muscle flap. The peritoneum was sutured using polyglycolic acid mesh. Subsequently, biosynthetic trimethylene carbonate mesh and irreabsorbable polyvinylidene fluoride mesh were interposed. Then, a left latissimus dorsi muscle free flap and a free skin graft were performed.

Results

Postoperative course without complications, discharge after 20 days. Histological result confirmed complete excision with a minimum margin of 1 cm. Treatment was completed with adjuvant chemotherapy. At 2 years follow-up there were no recurrences or incisional hernia.

Conclusions

NFS is a rare and invasive neoplasm that requires an aggressive and complex procedure. Its approach requires a multidisciplinary team with experience in the treatment of soft tissue sarcomas.
PARASTOMAL HERNIA REPAIR IN BRICKER TYPE URINARY DIVERSION USING THE MODIFIED PAULI TECHNIQUE: A CASE REPORT
Authors: Gallardo A , Garcia J L , Talavera P , López L , Peña M J , del Campo M , Gámez M , Charef L , Fra D , Torres A
Published: May 2024

Introduction

The incidence of parastomal hernia (PH) associated with Bricker ileal urinary diversion is approximately 20%. Surgery becomes necessary in the presence of symptoms or development of complications.

Clinical case

A 77-year-old woman with a Bricker urinary diversion following radical cystectomy presented to the emergency department with 72 hours of evolving obstructive symptoms, coupled with a large PH featuring incarcerated bowel. A CT scan confirmed complete intestinal obstruction.

Urgent surgery was conducted, revealing ileum incarceration without perforations. Reduction of the intestinal content was performed, restoring viability. Transversus abdominis release (TAR) around the stoma was executed, followed by the placement of a retromuscular progrip mesh using the Pauli technique. The patient was discharged after 8 days without complications.

Discussion

The surgical treatment of PH remains controversial, lacking a consensus as the most effective technique. We opted for modified Pauli technique, involving retromuscular dissection, subsequent components separation via TAR and mesh repair according to the Keyhole technique. This combination leverages the advantages of each of procedures to reduce the recurrence risk: retromuscular mesh placement physiologically pushing the wall, utilization of wider prostheses reinforcing a larger surface area, complete mesh contact with the wall facilitating integration around the defect, and direct stoma exit without the need for repositioning.

Conclusions

The modified Pauli technique with Keyhole mesh placement, while demanding, can provide advantages in emergency surgery without causing significant postoperative complications.
INCARCERATED URETER IN INGUINAL HERNIA: A CASE REPORT
Authors: González Valverde F M , Rodríguez-Lucas J M , Medina-Manuel E , Sandoval Marin J , Moreno García C , Alarcon P , Jimenez-Moreno I M , Hurtado Vázquez A M , Del Valle-Ruiz S R
Published: May 2024

Aims

To describe a clinical case of a right inguinal hernia with an incarcerated ureter.

Methods

A 75-year-old male patient with a history of radical prostatectomy and rectal neoplasia was followed up. On control CT scan, a right indirect inguinal hernia containing a small segment of right ureter was identified as a finding at abdominal level.

Results

Incidental finding of a right indirect inguinal hernia with a small segment of ureter, paraperitoneal. Due to the patient's age, comorbidities and absence of symptoms, follow-up and expectant management was decided.

Conclusions

Inguinal hernias with retained ureter are very rare, with a predominance of indirect hernias. There are 2 types: paraperitoneal and extraperitoneal. The most common is paraperitoneal, in up to 80% of cases, where the ureter is accompanied by a hernial sac and other intra-abdominal organs may appear. Extraperitoneal hernias are usually associated with retroperitoneal fat. Treatment is usually herniorrhaphy.
ROBOTIC UNILATERAL TRANSVERSUS ABDOMINIS RELEASE FOR LATERAL INCISIONAL HERNIAS – ANALYSIS OF 14 CASES
Authors: Gröger C , Kundel L , Adam U , Köckerling F , Riediger H
Published: May 2024

Background

Originally described for complex midline hernias, the transversus abdominis release (TAR) might be useful for the repair of lateral incisional hernias by facilitating the tension free defect closure and allowing a sufficient overlap of extraperitoneal placed meshes. Robotic surgery is the latest innovation in abdominal wall surgery.

Method

We present our data of 14 cases of robotic hernia repairs using TAR for lateral incisional hernias regarding perioperative data und early outcome.

Results

Between January 2023 and January 2024 14 robotic hernia repairs for lateral incisional hernias were performed. Mean defect diameter was 5 cm (range: 2–15 cm). Two patients presented with additional ventral hernias. All meshes were placed in the extraperitoneal space. Ipsilateral transversus abdominis release was performed in all 14 patients for tension free defect closure and for sufficient overlap of the implanted meshes (polypropylene, mean mesh dimension: 17 × 16 cm, 302 cm²). Mean operation time was 169 min (range: 76–343 min). In the postoperative course one patient underwent diagnostic laparoscopy to rule out bowel injury. Another patient underwent laparotomy on the first postoperative day for repair of a small bowel injury after extensive adhesiolysis (Mesh exchanged for bioresorbable scaffold with hydrogen barrier, discharge at day 7). The median hospital stay was 3 days (range: 2–7).

Conclusion

Robotic surgery for lateral incisional hernia repair with extraperitoneal mesh placement and defect closure using TAR shows promising perioperative results. Long-term results need to be further investigated.
EVALUATING THE IMPACT OF AGE ON TAPP INGUINAL HERNIA REPAIR OUTCOMES: A RETROSPECTIVE ANALYSIS
Authors: Janik M , Sroczyński P , Jędras K
Published: May 2024

Aim

This study aims to assess the influence of advanced age on the safety and efficacy of Transabdominal Preperitoneal (TAPP) inguinal hernia repair.

Material and Methods

Conducted at the General Surgery Clinic of the Military Institute of Aviation Medicine in Warsaw, this retrospective analysis included 128 patients who underwent elective unilateral TAPP hernia repair from January 2022 to March 2023. Patients aged 65 and above (n = 54) were compared to a control group below 65 (n = 74). Data on demographics, operative details, and postoperative outcomes were analyzed using descriptive and inferential statistics.

Results

The elderly group (mean age 72.02) showed no significant difference in operative time (mean 71.83 minutes) or hospitalization length (mean 3.089 days) compared to the control group. Surgical site infections were non-existent in the elderly group versus 2.78% in the control. Hernia recurrence was slightly higher in the elderly (1.79%) than in the control group (1.39%), but not significantly.

Conclusions

The study reveals that advanced age does not adversely affect the safety or efficacy of TAPP hernia repair, with comparable outcomes in elderly and younger patients. These findings suggest that age alone should not be a contraindication for TAPP procedure, highlighting the importance of evaluating individual patient risk factors. Further research with larger cohorts is recommended to consolidate these findings.
IN SITU EVALUATION OF THE HERNIA MESH BIOMECHANICAL STABILITY
Authors: Jourdan A , Vegleur A , Bodner J , Rousset P , Le Ruyet A , Passot G
Published: May 2024

Aim

Biomechanical stability between the mesh and the surrounding tissues is crucial to achieve successful tissue integration and avoid migration. In this study, we propose a novel approach that combines experimental and numerical methods to measure mesh stability in situ in cadavers, during insufflation of the abdominal cavity.

Methods

Micro stainless-steel beads (Ø 0.8 mm) were attached to a hernia mesh, creating a 2 cm spaced grid (Figure 1). The mesh was implanted in the retro-rectus plane and beads were placed in the rectus muscle tissue. A catheter inserted into the abdominal cavity allowed pressure insufflation. CT scans captured abdominal acquisitions at 0, 5, 15 and 30 mmHg. Using 3D segmentation software, beads were marked, and coordinates exported. A finite element model, based on initial bead positions, determined deformed configurations. Principal strain in mesh and muscle was computed and compared.

Results

Beads motion was mainly oriented toward the anterior direction. It reached 49.3 ± 10.5 mm at 30 mmHg and was limited above 15 mmHg (Figure 2). At 30 mmHg, the relative displacement between muscle and mesh beads was 1.3 ± 0.3 mm and the principal strain was 4.7 ± 1.1% in the mesh and 12.9 ± 4.7% in the muscle. The mesh was stretched in the longitudinal direction.

Conclusions

This methodology is a promising tool for the assessment of hernia mesh stability. It can capture relative displacement and strain difference between mesh and muscle. It could be used to compare the impact of different fixation modalities on the response of the hernia repair.

Figure 1: Synthetic hernia mesh with micro beads Figure 2: Experimental and numerical workflow
SPIGELIAN HERNIA. PRESENTATION OF 2 CASES
Authors: Kochylas N , Papaeleftheriou S , Taibiris G , Magganas D
Published: May 2024

Aim

Spigelian hernias are rare hernias that account for <2% of ventral hernias. They manifest in the “Spiegel zone” and are usually small. The treatment is surgical since they pose a serious risk of strangulation. Here are presented 2 cases of strangulated Spigelian hernias.

Case 1

87-year-old female presented to the emergency room (ER) due to small bowel obstruction secondary to a large incarcerated spigelian hernia. In surgery the small bowel loops were reduced and the hernia repaired with composite mesh intraperitoneally. Her postoperative course was uneventful.

Case 2

54-year-old male presented to the ER with a strangulated Spigelian hernia. Intraoperatively, ischemic small bowel loops were reduced and enterectomy was performed through a midline incision. The hernia itself was repaired with primary closure with Nylon loop. 1 year later the patient presented with incisional hernia from the midline incision and underwent a Rives-Stoppa repair. No spigelian hernia recurrence was discovered at the time.

Conclusion

Spigelian hernias are rare, with a high rate of incarceration. The optimal surgical approach varies, especially in strangulated cases, and depends on the particulars of each case and the resources of the center.
LAPAROSCOPIC INGUINAL HERNIA REPAIR AND EVALUATION OF POSTOPERATIVE QUALITY OF LIFE IN ELDERLY PATIENTS: SINGLE CENTER RESULTS
Authors: Korucuk E , Gumus T , Temel R , Basci F , Sezer T O , Ersin S
Published: May 2024

Background

Inguinal hernias (IH) constitute approximately 75% of all abdominal wall hernias and occur in 25–30% of the population. Although surgery is the only treatment for IHs, there is no definite consensus on the technique. In our study, we aimed to compare IH repair techniques in elderly patients.

Method

Between December 2018 and December 2023, 280 patients who underwent laparoscopic TAPP (L-TAPP) repair and Lichtenstein hernioplasty (LH) for IH in our center were included and retrospectively reviewed. Patients were divided into 2 groups according to the operation technique and age limit of 65 years.EuroQol-5D-3L scale was used as a quality of life (QOL) test.

Results

The mean age of the patients was 56.23 years. 264 (94.3%) were male, 16 (5.7%) were female. There were 93 (33.2%) patients over 65 years of age.LH was administered to 62 (66.7%) and L-TAPP to 31 (33.3%) of these patients.When the patients who underwent L-TAPP were evaluated, there was no statistically significant difference in terms of early and late complications and recurrence. When the QOL of both patient groups was evaluated, no significant difference was observed, while life satisfaction was high. When patients over 65 years of age were divided into LH and L-TAPP, there was no statistically significant difference in terms of hernia types, hospitalization time, early and late complications and recurrence. When the QOL was evaluated, in terms of usual activities and self-care parameters, it was found to be significantly different with more favorable results in the L-TAPP group.

Conclusion

Accordingly, we think that laparoscopic repair of IH in elderly patients can be safely performed in experienced centers and patients who underwent L-TAPP had a better quality of life.