bluuebunny/crossref_metadata_2025 huggingface dataset:
PROPHYLACTIC MESH DOES NOT PREVENT PARASTOMAL HERNIA AT LONG-TERM: META-ANALYSIS AND TRIAL SEQUENTIAL ANALYSIS
Authors: Verdaguer-Tremolosa M , García-Alamino J M , Rodrigues-Gonçalves V , Martínez-López M P , López-Cano M
Published: May 2024

Introduction

Previous randomized clinical trials (RCT) and systematic reviews evaluating parastomal hernia (PH) after a prophylactic mesh placement during end colostomy formation have reported contradictory results. This review attempted to determine the efficacy of this strategy in long-term follow-up according to the latest available data.

Methods

Medline, EMBASE, Cochrane Library, Web of Science and Google Scholar were searched. RCTs were included if they compared mesh with no mesh during initial end colostomy creation in adults to prevent PH with a follow-up longer than 2 years. To evaluate PH incidence, PH repair rate and mortality a meta-analysis was performed. Subgroup analysis included surgical approach and mesh position. A trial sequential analysis (TSA) was performed.

Results

Eight RCTs involving 537 patients were included. The incidence of PH at long term was not reduced when a prophylactic mesh was placed (RR = 0.68 [95% CI:0.46–1.02]; I2 = 81%, P = 0.06). The PH repair rate was low but no difference was found between the groups (RR = 0.90 [95% CI: 0.51–1.56]; I2=0%; P = 0.70). No difference was detected between groups when mortality was assessed (RR = 1.03 [95% CI: 0.77–1.39]; I2 = 21%; P = 0.83). Subgroup analyses did not show differences according to the surgical approach or mesh position used. With regard to TSA, an optimal information size was not achieved.

Conclusion

Prophylactic mesh placement during end colostomy formation does not prevent PH in the long term. The PH repair rate and mortality rate did not vary between groups. Heterogeneity among the included RCTs might restrict the accuracy of the results.
ROBOT-ASSISTED EXTRAPERITONEAL VENTRAL HERNIA REPAIR—EXPERIENCE FROM THE FIRST 160 CONSECUTIVE OPERATIONS WITH LATERAL eTEP AND eTAR TECHNIQUES
Authors: Vogel R , Heinzelmann F , Büchler P , Mück B
Published: May 2024

Background

As in various other surgical domains, robotically assisted procedures have become integral in the management of ventral hernias in recent years. The employment of robotic technology enables the integration of minimally invasive techniques with retromuscular mesh placement. Beyond the conventional transabdominal approach, these surgical interventions can alternatively be executed in a total extraperitoneal fashion. The objective of this study is to demonstrate that robotic total extraperitoneal management of abdominal wall hernias is safe and efficient.

Method

A retrospective analysis encompassing all patients who underwent robotic surgery for ventral hernia repair utilizing the extraperitoneal eTEP technique with a lateral approach was conducted. The study period spanned from December 2019 to December 2023.

Results

Over the study period, a total of 160 patients underwent surgical intervention utilizing the lateral robotic eTEP technique. Among these cases, 43 patients required a lateral extension of retro-rectal dissection through extraperitoneal transversus abdominis release (eTAR) due to either the hernia size or lateral hernia localization. In every instance, an uncoated synthetic mesh was positioned in the retromuscular location, accompanied by complete fascial closure. The median hernia defect area was 25 cm² (2.25–375 cm²). The median mesh size was 540 cm² (225–1350 cm²). The median mesh defect ratio (MDR) was 21 (2.3–150). Two conversions (1.72%) were necessary. One intraoperative and seven postoperative complications were encountered (5%) out of which two required reoperations (1.72%).

Conclusion

The robotic extraperitoneal eTEP technique enables a retromuscular mesh placement in a minimally invasive approach. With the possibility of combination with a transversus abdominis release, even complex findings can be treated using this technique.
REDUCED INCISIONAL HERNIA INCIDENCE AFTER COLORECTAL CANCER SURGERY- THE REIN4CETO1 RANDOMIZED CONTROLLED TRIAL
Authors: Wenzelberg C L
Published: May 2024

Aim

Incisional hernia (IH) is a common long-term complication after surgery for colorectal cancer (CRC). Using a prophylactic mesh reduces the incidence, but many surgeons hesitate mostly due to the fear of surgical site infections. The aim of this study was to investigate if the reinforced tension line (RTL) suture technique reduces the IH incidence after elective CRC surgery.

Materials and Methods

In this randomized controlled clinical trial, patients planned for CRC surgery through a midline incision at two Swedish hospitals, October 2017 until May 2021, were eligible for inclusion. Patients >18 years were randomized to two different fascia closure techniques: 4:1 small-bite technique with polydioxanone suture (the PDS-group) or RTL+ the 4:1 small-bite technique with polypropylene sutures (the RTL-group). The CT-diagnosed IH incidence was compared 1 year postoperatively.

Results

Total 248 patients were eligible, of which 160 (86M, 74F, mean BMI 25.6) were randomized at operation and 134 patients remained for analysis at 1 year; 71 in the PDS group and 63 in the RTL-group. IH was found in 19 patients: 15 (21.1%) in the PDS-group and 4 (6.4%) in the RTL-group (p ≤ 0.014, OR 3.95, 95% CI 1.24–12.6). No difference was found in base-line characteristics, surgical site occurrences or overall complications according to the Clavien-Dindo classification. Neoadjuvant radiotherapy was more frequent (p = 0.030), more patients received stomas (p = 0.020) and fascia closure time was longer in the RTL-group (p < 0.001).

Conclusions

We found fewer CT-diagnosed IH one year after fascia closure with the RTL technique in electively operated CRC patients.
THE IMPACT OF BOTULINUM TOXIN A APPLICATION ON REDUCING THE NECESSITY FOR "COMPONENT SEPARATION TECHNIQUES" IN GIANT ABDOMINAL HERNIAS: A DUAL-CENTER, POLISH-UKRAINIAN, RETROSPECTIVE COHORT STUDY
Authors: Zamkowski M , Lerchuk O , Porytsky A , Ushnevych Z , Khomyak V , Śmietański M
Published: May 2024

Introduction

Abdominal hernias are a common post-laparotomy complication, with a significant number of cases evolving into giant hernias, challenging the effectiveness of traditional surgical approaches. Component separation techniques (CST), while popular, come with several drawbacks, including irreversible anatomical alterations and increased perioperative trauma. The preoperative use of Botulinum Toxin A (BTA) has emerged as a promising alternative, potentially reducing the necessity for CST by temporarily paralyzing and elongating the lateral abdominal muscles, thus facilitating hernial defect closure.

Materials and Methods

This cohort study compared two groups of patients undergoing elective surgery for giant abdominal hernias (W3 according to the European Hernia Society classification) between 2022 and 2023 at two reference centers located in Gdansk (Poland) and Lviv (Ukraine). The NON-BOTOX group (n = 50) underwent traditional surgery, while the BOTOX group received preoperative BTA injections (n = 50). The primary outcome measured was the necessity of performing CST for anterior abdominal wall closure. Complications such as surgical site infections (SSI), seroma, and hematoma were also evaluated.

Results

Preliminary findings suggest that the preoperative application of BTA significantly reduces the need for CST in patients with giant abdominal hernias with a notable decrease in CST necessity by 38%. The groups were comparable in demographics and hernia specifics, allowing a fair comparison of surgical outcomes and complication rates.

Conclusions

Preoperative BTA application appears to be an effective strategy to decrease the reliance on CST in the treatment of giant abdominal hernias, potentially leading to simpler surgical procedures, reduced anatomical disruption, and a decrease in perioperative complications. However, during the study, two individuals reported respiratory efficiency issues following BTA administration. This observation has inspired the authors to continue their research and verify whether BTA administration benefits all patient groups equally. Further investigations are crucial to ensure the safety and efficacy of BTA use in preoperative preparation for patients with complex abdominal hernias.
WHAT WOULD YOU DO DIFFERENTLY? COMPLEX MANAGEMENT OF RECURRENT INCISIONAL AND PARA-STOMAL HERNIAS: A CASE STUDY OF A 52-YEAR-OLD PATIENT WITH COMPLICATIONS AND SURGICAL CHALLENGES
Authors: Alabbasi I E A , Sanders D
Published: May 2024

Case Presentation

A 52-year-old man with recurrent incisional hernia and para-stomal hernia presented to another hospital over the weekend due to abdominal pain, repeated vomiting, and a non-functional stoma. Enlargement of the scrotal region was noted, reflecting a pattern of similar admissions in the past. He was transferred to our unit for potential early surgery, having previously sought care for abdominal wall reconstructions at our center, including a scheduled preoperative Botox treatment.

The patient's medical history involved a 2017 emergency laparotomy for perforated diverticular disease resulting in a Hartmann procedure, and subsequent repairs for incisional and right groin hernias in 2019. The latter surgery led to wound dehiscence, prompting emergency intervention with small bowel resection and mesh removal. In 2023, the patient underwent removal of an infected right groin mesh, leaving behind a draining sinus. Hernia-related risks included ex-smoking, a reduction in BMI from 39 to 34, and diabetes.

Management and Outcomes

The patient's admission bloodwork showed slightly elevated inflammatory markers. A CT scan revealed a complex hernia scenario with distended small bowel and pockets of free fluid, suggesting at-risk bowel. The intraoperative procedure involved scar removal, adhesiolysis, and hernia repair, with complications such as dusky bowel appearance and fluid accumulation in the scrotum. The surgical approach included bilateral retro rectus with TAR, lateralization of the stoma, and mesh placement.

Discussion

In the post-operative period, the patient experienced challenges, including five days of intubation without muscle relaxation, abdominal pressure monitoring, and renal function decline requiring hemofiltration. Stoma function resumed on the third post-operative day, and the patient transitioned from total parenteral nutrition (TPN) to a mix of TPN and enteral feeding.
eTEP PAULI IN A TYPE IV PARASTOMAL HERNIA
Authors: Bellido-Luque J , Alpizar-Rivas O , Scammon Duran A , Sanchez Matamoros M I , Nogales Muñoz A , Morales-Conde S
Published: May 2024

Video abstract

A 63-year-old male with a history of abdominoperineal resection due to rectal adenocarcinoma presenting discomfort in a reducible 6 cm parastomal hernia (PSH) & M3W1 incisional hernia (Type IV PSH).

We propose a full endoscopic minimally invasive extraperitoneal modified Sugarbaker approach (e-TEP Pauli). A 2 cm incision on the right subcostal region is made, opening the anterior rectal sheath, medializing the right rectus muscle. A dissection balloon was introduced to release the retromuscular space on the right side. Two more trocars were inserted in the right hypocondrium and right iliac fossa (10 mm, 5 mm respectively).

The medial aspect of the right posterior rectus sheath (PRS) was incised, and the preperitoneal dissection was performed superficial to the Falciform ligament, doing the crossover above the umbilicus. The hernia was reduced, connecting both right and left retrorectus spaces.

A modified posterior components separation (TAR) is performed, sectioning the aponeurosis of the transverse muscle (TM), accessing the preperitoneal space laterally without sectioning the TM. The colonic stump is released and reintroduced. The anterior defect is closed maintaining adequate passage of the colonic stump, and is fixated with sutures to the lateral abdominal wall. The peritoneal orifice is sectioned to lateralize the stump. The peritoneum and PRS are closed around the colonic stump.

A PVDF-mesh covering both retrorectus and preperitoneal spaces is placed. A drainage is place and removed 24 h after. He was discharged 24 h after. In the CT 6 months after surgery, no abdominal wall defect was observed and pain and esthetic results where satisfactory.
e-TEP TAR IN A L4W3 RIGHT POST NEPHRECTOMY HERNIA
Authors: Bellido-Luque J , Alpizar-Rivas O , Scammon Duran A , Sanchez Matamoros M I , Nogales Muñoz A , Morales-Conde S
Published: May 2024

Video abstract

A 58-year-old woman with a history of right nephrectomy and open appendectomy, with a past medical history of chronic abdominal pain and bulging at the level of the nephrectomy scar. A partially reducible 9 cm lateral hernia L3W3 (EHS) was diagnosed.

The patient underwent an extended totally extraperitoneal hernia repair on the right side. A 2 cm incision on the epigastrium was made medially to the rectus muscle in order to enter the right homolateral retrorectus space. A dissection balloon was introduced to release this space. A 10 mm and 5 mm were inserted in the right hypocondrium and right iliac fossa respectively.

A posterior component separation (TAR) was performed, caudal to cranial. We sectioned the aponeurosis of the transverse muscle (TM), accessing the defect and the preperitoneal space laterally. After the hernia content was introduced to the abdominal cavity, the defect was closed. Finally, a wide pore polypropylene mesh was placed, covering the right retrorectus space with the preperitoneal Bogros/Retzius spaces. Atraumatic fixation with cyanoacrylate was used. An aspiration drainage was placed and removed 24 h after surgery. The patient was discharged the day after, and no complications were reported. In the CT scan 6 months after surgery, the correction of the defect was confirmed and pain and esthetic results were satisfactory.
LAPAROSCOPIC TREATMENT OF RIGHT INGUINAL HERNIA RE-RECURRENCE
Authors: Belkebir R , Gherardi D , Hauters P , Malvaux P
Published: May 2024

We report the case of an 81-year-old man presenting with a right inguinal hernia re-recurrence. He had undergone a laparoscopic transabdominal preperitoneal hernioplasty in 2001. The recurrence occurred in 2021, and therefore, he had to be treated with an open approach.

Past medical history included arterial hypertension, COPD, coronary artery stenting for ischemic heart disease, stage II chronic renal failure. Previous surgeries consisted of bilateral iliac arteries, percutaneous angioplasty and stenting with a right femoral arterial access, laminectomy of L3–L5, and laparoscopic cholecystectomy.

Surgical procedure

Laparoscopy confirmed a right hernia re-recurrence. Herniated ileal loop was completely reduced. Peritoneal incision was performed with a lateral-to-medial approach. The mesh was dissected away from the pre-peritoneal fat. The shrunk mesh was pulled downwards to allow the identification of the epigastric vessels, which were then dissected according to a cranial-to-caudal approach. The large hernia sac was completely reduced thus exposing the re-recurrence orifice. Dissection was carried out towards the Bogros’ space. Epigastric vessels were detached from the mesh thus allowing to expose the medial part of the myopectineal orifice. Cooper’s ligament and pubic symphysis were therefore identified. The epigastric and spermatic vessels were freed from the mesh only after the critical view of the myopectineal orifice (MPO) was achieved. The mesh was completely mobilized from the peritoneum and removed. A “landing zone” was obtained, a 15 × 10 cm self-fixating mesh positioned around the re-recurrence orifice. Peritoneum closure was performed by means of a 3–0 running barbed suture from medial to lateral.
LAPAROSCOPIC TAPP REPAIR OF SPIGELIAN AND BILATERAL INGUINAL HERNIA
Authors: Chamzin A , Theodoropoulos C , Galyfos G , Triantafyllou A , Michalopoulos N V , Toutouzas K G , Theodorou D
Published: May 2024

Introduction

A Spigelian hernia is the protrusion of preperitoneal fat, peritoneal sac, or organ(s) through a congenital or acquired defect in the Spigelian aponeurosis as defined in the last EHS guidelines for hernias in rare locations. Due to limited data no recommendation on the preferred approach could be made. We will report a case with a spigelian and bilateral inguinal hernia to show our preferred method of repair.

Case presentation

A 65-year-old male presented with a symptomatic palpable mass in the left lateral abdominal wall and bilateral inguinal hernia. We diagnosed by abdominal CT a Spigelian hernia along with bilateral direct inguinal hernias. A laparoscopic transabdominal approach was decided to manage all three hernias.

Results

Laparoscopic transabdominal approach confirmed the clinical and radiological diagnosis. The bilateral inguinal hernias were MW3-P and were repaired with invagination of the transversalis fascia into Cooper’s ligament and placement of XL 3D polypropylene mesh that was fixed in 3 points with absorbable tuckers. The Spigelian hernia was repaired by TAPP, closure of the 4 cm orifice with V-loc 1–0 and placement of a 12 × 16 cm self-gripping mesh to avoid postoperative pain due to fixation.

Conclusion

The use of laparoscopy facilitates low wound complication rate, complete intra-abdominal visualisation, repair of multiple hernia sites and probably less postoperative pain if no intrusive fixating devices are utilised. On the contrary open repair needs a wide operative field to introduce the mesh resulting in more postoperative pain, possibly increased wound complication rate and lacks the chance of simultaneous repair of concomitant inguinal hernias through the same approach.
PARASTOMAL HERNIA REPAIR
Authors: Clavell A , Herrero C , Torres A , Gené C
Published: May 2024

Background

Parastomal hernias are frequent. The optimal surgical strategy for treating symptomatic parastomal hernias (PSH) subsequent to ileal conduit urinary diversion remains an unresolved challenge, characterized by limited data and persistently high recurrence rates across diverse repair methodologies.

Methods

A 73-year-old male patient with a history of radical cystectomy and ileal conduit urinary diversion due to bladder cancer presented with a symptomatic parastomal hernia. The repair technique was performed through the stoma site involving a right retromuscular dissection. A keyhole technique with a biosynthetic PTFE mesh was used in the retromuscular and preperitoneal plane.

Results

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

Conclusions

This case highlights the importance of tailored surgical approaches for addressing parastomal hernias, a repair through the stoma site is feasible and safe.
ROBOTIC ASSISTED TOTALLY EXTRAPERITONEAL INCISIONAL HERNIA REPAIR WITH POSTERIOR COMPONENT SEPARATION AFTER ORTHOTOPIC LIVER TRANSPLANTATION
Authors: Costa T
Published: May 2024

Aim

Incisional hernia is a common complication following liver transplantation. Open repair remains the standard of care, due to the fear of adhesions and complications. Recently, some groups published a series of minimally invasive approaches. However, most of them were laparoscopic approaches with intraperitoneal mesh placement with potential complications. The robotic-assisted extended extraperitoneal approach (r-eTep) could be a feasible and safe way to treat the hernia.

Methods

We present a case of a 64-year-old male patient submitted to an orthotopic liver transplantation. One year after the procedure he developed a large incisional hernia in the midline and right upper quadrant. The hernia classification was M1-3, L 2, W 3 (15 × 20 cm). After clinical optimization, the patient was taken to the OR for a r-eTep repair of his hernia.

Results

We begin the procedure by the left quadrant of the abdomen, creating a extraperitoneal space. Three trocars of the robot are placed. The extraperitoneal space is then dissected showing the midline hernia and part of the lateral. A posterior component separation with transversus abdominis release (TAR) is done. After the complete dissection, the abdominal wall is closed and the mesh is placed.

The procedure lasted 170 minutes. There were no complications. Length of stay was 2 days. There is no recurrence in a period of 2 years.

Conclusion

R-etep with TAR is feasible and safe in patients with incisional hernia after liver transplantation. This video shows our standardization in a patient with good post-operative results.
A NEW TECHNIQUE THAT FACILITATES SURGERY IN e-TEP REPAIR
Authors: Ertem M , Babur T
Published: May 2024

With our current knowledge, the e-TEP technique is considered the best anatomical plan to place the synthetic mesh in ventral hernia repair, as it is placed in the retromuscular area (Rives-Stopa Repair). In this technique, closing the existing diastasis recti in midline hernias reduces the recurrence rate. If the midline gap in the diastasis recti is over six cm, it may be technically difficult to close it. Approximating the midline with two or three transfascial sutures during the surgery makes it easier to close this line with a continued suture. In addition, it reduces the load on the midline.

In this video presentation, we present the technique we applied. We technically use two self-locking absorbable sutures. We also close the entire distance from the symphysis pubis to the Xiphoid process in the midline. We end by joining the continued sutures, one starting from the pubis and the other from the Xiphoid, in the midline. We preferably place transfascial sutures just below and above the umbilicus. Thus, we ensure that the anatomical hollow structure of the umbilicus is preserved.

DynaMesh CICAT.

LiquiBand FIX8.

V-Loc.
LAPAROSCOPIC eTEP RIVES-STOPPA FOR THE TREATMENT OF PFANNENSTIEL INCISIONAL HERNIA ASSOCIATED WITH BILATERAL INGUINAL HERNIA AND DIASTASIS RECTI
Authors: Friedova P , Acosta Rodríguez A , Rodríguez Valenzuela N , Sánchez González J , Pérez Saborido B
Published: May 2024

Objectives

Demonstrate the benefit of the extraperitoneal endoscopic approach for the treatment of Pfannenstiel incisional hernia (IH) associated with bilateral inguinal hernia and diastasis recti.

Materials and Methods

Descriptive video of the endoscopic eTEP technique for the treatment of Pfannenstiel IH (M1W5) associated with bilateral inguinal hernia (L1, L2) using two light 3D mesh placed in inguinal space without fixation and PLP mesh with silver ions placed in supra and infraumbilical space without fixation.

Results

The postoperative period was without complications, discharge 48 hours after surgery. The patient only required continuous analgesia for the first 72 hours. Control consultation after 3 months of surgery in which the patient is painless on physical examination, absence of recurrence and excellent aesthetic results.

Conclusions

The incidence of the Pfannenstiel IH is the lowest of all IHs. However, it is quite common that patients who underwent surgery with low transverse abdominal incision can develop inguinal hernias over the years. We believe that endoscopic preperitoneal eTEP Rives-Stoppa is a feasible and reproducible technique to do a complex abdominal wall reconstruction in patients diagnosed with IH associated with diastasis recti. This minimally invasive technique offers the possibility of repairing a weak linea alba and prevent the future ventral hernias with excellent aesthetic results.
SAGA OF A DECADE! BILATERAL GROIN MESH EXPLANTATION WITH COLOCUTANEOUS FISTULA
Authors: Gandhi J , Chaudhari S
Published: May 2024

Background

Mesh-related complications following previous laparoscopic hernia repair, especially transabdominal preperitoneal (TAPP) surgery, can present significant challenges. This case report highlights the utilization of the Mesh Explantation Classification in a 60-year-old male with a colocutaneous fistula a decade after index surgery & emphasises the use of mesh explantation classification for standardisation & case reporting (Published in Hernia Surgery).

Objective

Describe the laparoscopic mesh explantation and stapled disconnection of a colocutaneous fistula in a patient with mesh-related complications post-TAPP surgery 10 years back and emphasize the mitigation strategies and technical nuances.

Methods

A 60-year-old male, previously subjected to TAPP surgery, presented with a colocutaneous fistula with faecal discharge secondary to mesh-related complications. Pre-operative colonoscopy, marking the site of the fistula and use of fluoroscopy for identification of any metal tacks were performed. The Laparoscopic mesh explantation and the disconnection of the colocutaneous fistula using an intestinal stapler and intraoperative sigmoidoscopy performed to avoid any luminal narrowing. Two pieces of polyester mesh, with metal tackers were successfully explanted without any collateral vascular injury.

Results

The patient experienced resolution of symptoms postoperatively, and there were no signs of recurrent fistula during follow-up; the explanted mesh showed features of atypical mycobacterium on the microbiology, and hence, the patient was put on one year of treatment for atypical mycobacterium, he tolerated the treatment well and recovered.

Conclusion

This case emphasises the importance of a team approach at Index surgery in every case of Mesh Explantation to get the best surgical outcomes. Mesh explantation standardisation classification helps in proper documentation by the surgeon and guides future additional treatment if required. Further research and collective documentation using standardized classifications are essential to refine and validate the approach for mesh explantation in hernia surgery.
LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA) IN A POST-PERITONECTOMY AND HIPEC PATIENT. HOW FAR CAN WE GO?
Authors: Gaspar Reis S , Navarro-Morales L , Licardie E , Moreno-Suero F , Gómez Menchero J , Morales-Conde S
Published: May 2024

Background

Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) was first described in 2018. Since then, its application has grown, particularly in challenging scenarios, such as cases following Cytoreductive Surgery with Peritonectomy and Hyperthermic Intraperitoneal Chemotherapy (CRS + HIPEC). This video aims to demonstrate the application of Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique in a complex midline ventral hernia case.

Patient and Methods

Video presentation demonstrating the step-by-step execution of LIRA technique. The video showcases the feasibility, safety, and potential advantages of this method in improving surgical outcomes.

Results

We present the case of a 66-year-old female patient with a history of multiple surgeries for ovarian cancer. In 2016, she underwent CRS + HIPEC. In 2017, she was reoperated through bilateral subcostal laparotomy due to tumor recurrence in the celiac trunk.

Because of several supra and infraumbilical hernial defects, she underwent minimally invasive abdominal wall reconstruction using LIRA technique. During the postoperative period, the patient developed a septic condition and on the tenth postoperative day a exploratory laparotomy was performed, but no signs of infection were found.

Conclusion

This case not only highlights the advancements achieved in minimally invasive techniques but also demonstrates that LIRA enables tension-free midline restoration, providing a promising alternative to conventional component separation or endoscopic procedures.
LAPAROSCOPIC TOTAL EXTRAPERITONEAL FASCIOTOMY FOR FOURNIER GANGRENE EXTENDING TO RETROPERITONEUM: A CASE REPORT
Authors: Hsieh C H , Hsu C H
Published: May 2024

Background

This case report aims to contribute to the limited literature about the feasibility and effectiveness of laparoscopic total extraperitoneal (TEP) fasciotomy in the management of extensive Fournier gangrene to the retroperitoneal space.

Material and method

We present a case of a 60-year-old man with newly diagnosed type 2diabetes and diabetic ketoacidosis. He presented with left scrotal and inguinal swelling for days. A computer tomography scan revealed extensive Fournier gangrene involving the left scrotum, left inguinal canal, left retroperitoneum, left psoas muscle and left anterior inner abdominal wall. Immediate incision and drainage at the left scrotum were performed for infection control. However, due to widespread necrotizing fasciitis in the left retroperitoneal space, fasciotomy was necessary to control infectious disease.

Result

Four-port laparoscopic TEP fasciotomy was performed to facilitate extensive drainage and debridement of necrotic tissues in the left retroperitoneal space. Klebsiella pneumonia infection was identified through aerobic culture. The patient was discharged on postoperative day 14 with one rubber drain placed in the left retroperitoneal cavity.

Conclusion

Laparoscopic TEP fasciotomy proves to be a feasible and effective option for managing extensive necrotizing fasciitis at the retroperitoneum. The procedure offers advantages such as enhanced visualization, complete drainage and debridement through small incisions, reduced postoperative pain, and a shorter hospital stay.
PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM AND ANTERIOR COMPONENT SEPERATION WITH PERITONEAL FLAP HERNIOPLASTY FOR RECURRENT INCISIONAL HERNIA AFTER TRANSVERSUS ABDOMINIS RELEASE WITH POSTERIOR COMPONENT SEPERATION
Authors: Jha A K , Kumar M , Priyadarshi R , Badani A
Published: May 2024

A 42-year-old gentleman presented with recurrent incisional hernia (M1-M4W3R1). He underwent transversus abdominis release with posterior component separation (TAR with PCS) one year ago. In the immediate postoperative period after TAR with PCS, he developed abdominal compartment syndrome (ACS). Due to ACS, the surgical team opened his midline skin sutures and anterior rectus sheath, and applied negative pressure wound therapy. Eventually, the wound healed by secondary intention. On examination, there was a wide irregular scarring at the previous wound site, along with a hernial defect of approximately 20 × 20 cm in size. He underwent a CECT abdomen, which revealed a 20 × 20 cm defect along with a loss of domain. We initially instituted the botulinum-A injection into his lateral group of abdominal wall muscles. However, we could not achieve the desired results after botulinum injection. Therefore, we switched to preoperative progressive pneumoperitoneum to increase the abdominal cavity volume. Afterwards, we scheduled him for anterior component separation (ACS). In addition to ACS, we had to preserve the peritoneal sac to facilitate midline closure. We then placed an onlay polypropylene mesh and closed the skin. During a 6-month follow-up, the patient is doing well.
rTAPP FOR THE SIMULTANEOUS TREATMENT OF RECURRENT BILATERAL SPIGELIAN AND INGUINAL HERNIAS
Authors: Olona C , Díaz A , Rodrigo M , Vadillo J , Ilari A , Jorba R
Published: May 2024

Aim

Spigelian hernias are a rare variant of primary ventral hernias. Minimally invasive surgery has allowed new treatment techniques.

The objective of this video is to demonstrate the advantages of robotic TAPP for the single-stage treatment of this type of hernia in a complex case of recurrence and bilaterality associated with inguinal hernia.

Methods

A 70-year-old patient with a history of bilateral Lichtenstein inguinal hernioplasty and right Spiegel subaponeurotic hernioplasty presented with bilateral abdominal pain and left inguinal mass.

CT: Bilateral spigelian and left inguinal hernia.

Technique

The DaVinci Xi system is docked with 3 trocars located in the epigastrium and both hypochondria. Dissection of the preperitoneal plane of the right flank is performed with reduction of the recurrent Spiegel hernia, closure of the defect with VLock suture and placement of preperitoneal polypropylene mesh. The peritoneal section is closed with VLock running suture.

On the right side, the same technique is performed, progressing distally until the dissection and reduction of the inguinal hernia, treating the two hernias together with a single mesh placed preperitoneally.

Conclusion

The robotic TAPP approach allows for single-stage resolution of various abdominal wall hernias. The correct visualization of the hernia contents, the minimum approach and repair without tension allows the rapid recovery of the patient.
MESH REPAIR AND LONG TERM COMPLICATIONS
Authors: Osorio Capitán M , Arruabarrena A , Aramendia I , Uranga A , Clemares M , Busto M J , Lopes C , Erro J M
Published: May 2024

Background

Biomedical engineering and new surgical approaches have grown together, remaining a big amount of surgical resources available today. Nevertheless, several mesh repair complications have been described, both acute and chronic. Chronic pain, fluid collections, mesh adhesions and failures have been described, characterized by enterocutaneous fistulizing disease, mesh shrinkage and migrations. Through this communication, 2 examples of those long-term complications are presented.

Material and Methods

The first patient is an 82-year-old woman with an anterior component separation made in 2016. 6 years after abdominal wall repair was carried out, the patient was hospitalized as an abdominal wall abscess was diagnosed. An enterocutaneous fistula between previous mesh and the small bowel was finally detected. A SNAP procedure was adopted, proceeding to a complete fistula escision at last. An intraabdominal long-term absorbable mesh was placed for posterior reinforcement.

The second patient is a 76-year-old man with a previous Spiegel´s hernioplasty made in 2002. The patient reported pain in the left lower quadrant, where the mentioned hernioplasty was carried out. A plug-mesh intraabdominal migration was detected through radiological imagenes. Finally, a Transabdominal Preperitoneal Repair (TAPP) procedure was made to withdraw the previous mesh and to repair the groin area.

Results

No complication was described after 6–12 months. Both patients had their symptoms solved.

Conclusion

Abdominal wall repair specialization requires knowledge about new techniques and their complications. It is crucial to know and to identify complications as soon as possible to their succesful repair.
LAPAROSCOPIC E-TEP IN GIANT TYPE I DIRECT INGUINAL HERNIA
Authors: Radhakrishnan S
Published: May 2024

Case Profile

68 yrs old, Male presented with complaints of Large right sided Inguino-Scrotal swelling since 3 yrs.

Swelling was intermittent, partially reducible and associated with a dragging type of Pain.

No other co-morbidities. CT-scan:

Tanaka Index – 20%

Plan

Laparoscopic E-TEP hernia repair.

Procedure

Supine Position under General Anesthesia.

Hernia contents reduced under anesthesia.

Ports

Enhanced Pre-Peritoneal space created by cutting Posterior Rectus Sheath from Arcuate line.

Space of Retzius & Bogros dissected.

Spermatic Cord dissected. Hernial sac dissected and separated from Pseudo sac.

Excision of Pseudo sac done.

Hernial Defect sutured with Non-absorbable barbed suture

15 × 12 cm Polypropylene mesh placed obtaining adequate coverage of Myopectineal orifice of Fruchaud.

Hemostasis confirmed. Pneumo pre-peritoneum deflated.

Port sites closed.

Dressing and strapping done.

Post operative period uneventful.

Discharged on post op day 4.
TAPP APPROACH POR BILATERAL INGUINAL HERNIA AND PLACEMENT OF CATHETER FOR CAPD: AN EXAMPLE OF HEALTHCARE EFFICIENCY
Authors: Rodríguez Mogollo J I , Tallón Aguilar L , Tinoco González J , Bustos Jiménez M , Sánchez Arteaga A , Padillo Ruíz F J
Published: May 2024

Introduction

Nowadays, the increasing complexity of patients, as well as continuous technological advances results in the existence of subjects with various pathologies susceptible to surgical management in the same procedure, with the consequent decrease in risk for the patient and greater efficiency for the healthcare system. The case described below is a clear example.

Methods

We present the case of a patient with bilateral inguinal hernia who also presents with end-stage renal disease due to polycystic kidney disease pending dialysis initiation. The patient opts for peritoneal dialysis; therefore, the repair of inguinal defects is evaluated along with the placement of the dialysis catheter in the same surgical setting.

Results

A TAPP approach was used for the repair of bilateral inguinal hernia, and subsequently, the 5 mm trocar in the left flank was utilized for the insertion of the peritoneal dialysis catheter under straight vision and its proper intraabdominal placement in the Douglas pouch.

Conclusion

Minimally invasive surgery opens up a broad field of opportunities that enables us to perform multiple procedures in a single intervention, reducing, thus, surgical and anaesthetic risks for the patient. Additionally, it allows us to reduce significantly economic costs and increase efficiency by cutting down on admission times, as it is the case presented in which all the patient's needs are addressed with a single surgical intervention.
COMPLEX ABDOMINAL WALL REPAIR IN CHRONIC MESH INFECTION WITH GASTROINTESTINAL RECONSTRUCTION
Authors: Román García de León L , Munoz-Rodriguez J M , Garcia-Urena M A , Blazquez Hernando L A , Robin Valle de Lersundi A , Polaino Moreno V , Torguet Munoz M E , Grillo Marin C , Callau Pontaque J , Lopez-Monclus J
Published: May 2024

Aim

To present the use of a biosynthetic mesh in a case of complex abdominal wall repair in chronic mesh infection and gastrointestinal tract reconstruction.

Material and Methods

This is an 89-year-old male with a history of radical cystectomy with Bricker reconstruction. As an immediate complication, he presented intestinal perforation with the need for the creation of an end ileostomy and fascial dehiscence with bridging of the abdominal wall with a bilayered mesh. Post-operatively he developed wound dehiscence with chronic mesh exposure and infection.

We performed a complete excision of the infected mesh, reconstruction of the intestinal transit and abdominal wall repair with a Rives technique with left Posterior Component Separation (PCS) according to the Madrid modification, with a prophylactic key-hole for the Bricker ileal Conduit. A biosynthetic scaffold was placed due to the infection situation (CDC-class 4 according to the CDC-Centers for Disease Control classification for Wound infection).

Results

Postoperatively the patient suffered a surgical site infection with suspected anastomotic leakage that was managed conservatively. Consequently, he developed a wound and an anterior layer dehiscence, with mesh exposition and infection. The complication was managed with antibiotherapy and negative pressure therapy, achieving complete wound closure and resolution of the infection without recurrence of the hernia in the follow-up.

Conclusions

The use of a biosynthetic scaffold is a feasible and useful resource for abdominal wall reconstruction in patients with chronic mesh infection, with good performance even in the case of early infection and environmental exposition.
TRANSFORMING TEP TO E-TEP USING ROLA TECHNIQUE WITHOUT CHANGING PORT POSITION
Authors: Sampang D C
Published: May 2024

Background

TEP technique is claimed to be the fastest procedure in posterior inguinal hernioplasty in experienced hands. It has lesser risk of visceral injuries and trocar site hernia occurrence. However, because of the absence of triangulation there is poor ergonomics and difficult to learn and teach in fellows and residents. Professor Jorge Daes modified the technique into e-TEP by placing his optical port 5 cm above the umbilicus and 4 cm lateral to linea alba opening the ipsilateral retrorectus space with the premise that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall.

Method

The ROLA technique is the release of lateral part of linea arcuata coming from the TEP port position by identifying linea semilunares. Two ways of utilizing the ROLA technique either by bottom-up or top-down approach.

Results

Without adding or changing port positions you will be able to transform the small TEP space into humungous e-TEP space and can accommodate large mesh 15 × 15 cm if indicated, can equilibrate when the peritoneum is opened and no need to add or change working port. Incarcerated hernias can be managed easily now by the TEP technique expanded to e-TEP space.

Conclusion

The ROLA technique is safe and replicable technique that can be accessed through craniocaudal and caudocranial views. This would also be the preparation of advancing hernia surgeon in bottom-up technique for e-TEP TAR.
TOTAL VISCERAL SAC SEPARATION (TVS) APPROACH FOR MIDLINE VENTRAL HERNIA. CASE REPORT
Authors: Torroella A , Cárdenas G , Gonzabay V , Mastroianni G , Boccalatte L , Ginestà C
Published: May 2024

Background

Since the introduction of minimally invasive surgery, modifications in surgical technique of abdominal wall repair are being developed to achieve equal or even better results, guaranteeing early recovery, with lower risk of recurrence and less surgical aggression. According to the EHS guidelines, preperitoneal open repair is gold standard for M3W1 hernias. The aim of this study is to illustrate a completely extraperitoneal laparoscopic approach with preperitoneal mesh location for midline hernia repair.

Method

75-year-old woman with medical history of midline laparotomy due to an appendiceal peritonitis surgery, who currently presented a midline eventration (M3W1). It was performed a laparoscopic approach with a preperitoneal space mesh placement. After the arch of Douglas identification, the preperitoneal space between the parietal peritoneum and the posterior sheath of the rectum is dissected. The hernia is identified and reduced, and dissection proceeds until it exceeds the defect. After placing a 12 × 26 cm titanium mesh fixed with cyanocrylate, the hernia defect is closed with 2/0 Vicryl simple stitches using an endoclose suture device.

Results

Postoperative pain on the VAS scale was 1, and the patient was discharged on the first postoperative day. At the moment, she remains without hernia recurrence.

Conclusions

TVS approach reproduces the indications of the EHS Guidelines, with the advantages of minimally invasive surgery. It also offers the possibility of treating in the same surgical procedure other unnoticed hernias, with a larger mesh isolated from the viscera and preserving retromuscular space. In a near future, robotic approach could provide great benefits for carrying out this technique.
HOW TO PERFORM A CAUDAL DISSECTION OF A RIVES-STOPPA: STEP BY STEP WITH ANATOMICAL RELATIONSHIPS
Authors: Tuñón-Féquant C I , López-Monclus J , Blázquez-Hernando L A , Robin-Valle de Lersundi A , Muñoz-Rodríguez J , Medina-Pedrique M , De Luca M , Avilés-Oliveros A , García-Ureña M A
Published: May 2024

Introduction

Since its introduction, the Rives-Stoppa technique has become a cornerstone in abdominal wall surgery. Widely adopted, this technique necessitates a comprehensive understanding of its procedural steps and the associated anatomical relationships. The aim of this video is to provide a careful description of the caudal dissection.

Material and Methods

We advise to follow, first, a bilateral retromuscular dissection with the nerve bundles as lateral landmarks (“ambivium”), the procedure advances caudally through a preperitoneal approach to access the Retzius space. Subsequent preperitoneal dissections on each side expose Cooper's ligaments. The intermediate fascia needs to be opened to establish a connection between the preperitoneal space of Bogros space and the preperitoneal prevesical Retzius space, facilitating the creation of the space described by Stoppa and enabling the placement of a large, preformed mesh.

Results

This detailed guide provides an overview of the Rives-Stoppa technique, highlighting key anatomical relationships that are critical for the general surgeon. The meticulous cranial dissection performed by this technique enhances surgical precision and reduces the probability of postoperative recurrence.

Conclusions

A thorough understanding of the Rives-Stoppa technique, coupled with precise anatomical knowledge, proves invaluable for general surgeons. Successful caudal dissection is imperative for mastering the technique and minimizing the risk of subsequent hernia recurrences.
ROBOTIC INGUINAL HERNIA MESH REPAIR (rTAPP) POST ROBOTIC ASSISTED RADICAL PROSTATECTOMY
Authors: Vashistha A
Published: May 2024

Materials and Method

Patient had undergone robotic assisted radical prostatectomy and later developed inguinal hernia on left side.

Patient was taken for Diagnostic Laparoscopy and 3 Robotic ports were made (8 mm each, one port was Supraumbillical and the other two ports were on the same line 8 to 10 cm lateral to supraumbillical port) and peritoneal flap raised for left inguinal hernia by meticulous dissection and reduction of the hernia sac was done and mesh placed. The procedure was uneventful.

Result

At our institution we have performed cases of Robotic Inguinal mesh Hernioplasty (rTAPP) after post Robotic Assisted Radical Prostatectomy. Out of 10 cases of Diagnostic Laparoscopy, due to dense adhesions in view of previous surgery and non-availability of flap, only four cases could be done by robotic TAPP and the rest were converted to the conventional method.

Conclusion

Robotic rTAPP, in view of a stable platform, better vision and hemostasis, resulted in precise dissection and the best results for such complex cases.
ROBOTIC NISSEN’S FUNDOPLICATION FOR HIATAL HERNIA WITH REFLUX
Authors: Vashistha A
Published: May 2024

Materials and Method

Robotic assisted Nissen Fundoplication were done in 25 cases and were evaluated for post operative pain, dysphagia and duration of hospital stay as compared to that of Laparoscopic Nissen Fundoplication.

Patients were placed in semilithotomy position with four ports technique (8 mm) and one epigastric port for Nathansen Retractor. Harmonic Energy device was used for Hemostasis and Short Gastric mobilisation. Hiatus was closed with 2–0 Ethibond suture and after complete mobilisation of fundus and esophageal dissection. Approximately 4–6 cm of esophagus was mobilised intra abdominally and fundus wrapped around the Esophagus. Two sutures were taken (one from Esophagus to Stomach, another from Stomach to Stomach). Use of Umbillical tape was done for Esophageal mobilisation.

25 cases of Robotic Assisted Nissen Fundoplication and 25 cases of Laparoscopic Nissen Fundoplication were compared for post operative pain, dysphagia and discharge from the hospital. All the parameters were better in score with Robotic surgery than in Laparoscopic surgery.

Conclusion

Robotic Nissen Fundoplication in view of precision, stable platform, better vision and hemostasis with good intra-abdominal mobilisation of esophagus leads to lesser incidence of dysphagia and early discharge from the hospital.
ROBOTIC SINGLE FLAP METHOD FOR BILATERAL INGUINAL HERNIA MESH REPAIR (rTAPP)
Authors: Vashistha A
Published: May 2024

Materials and Method

Single Flap method was used in 25 cases of Bilateral Inguinal Hernia. Patients were taken for rTAPP with three 8 mm ports, one port was supraumbillical and the other two ports were on the same line approximately 8 cm lateral to the supraumbillical port.

Incision was made on the peritoneum approximately 5–7 cm from the defect in the midline and flap developed. Dissection was done in the preperitoneal plane in the middle to raise the central flap upto the Space of Retzius and then bilateral dissection was done to reduce the Inguinal Hernia. 16 × 12 cm bilateral mesh placed and sutured in place after defining the critical view of Myopectineal Orifice. Absorbable 2–0 V-loc suture was used to close the flap from midline to the lateral side.

Result

Evaluation of 25 cases was done in view of duration of surgery, blood loss and discharge from the hospital. Mean operating time was around 45 minutes to 62 minutes in single flap method with great precision and hemostasis.

Conclusion

Robotic single flap method for bilateral inguinal hernia has the advantage of better vision and hemostasis as compared to two flaps method for bilateral inguinal hernia.