bluuebunny/crossref_metadata_2025 huggingface dataset:
APPROACH TO THE VISCERAL AND PARIETAL COMPARTMENTS IN ROBOTIC TRANSABDOMINAL PREPERITONEAL (TAPP) INGUINAL HERNIA REPAIR
Authors: Barranquero A G , Maestre González Y , Ruiz C G , Codina-Corrons L , Raich M S , García-González L , Olsina Kissler J J , Villalobos Mori R
Published: May 2024

Background

Robotic TAPP inguinal hernioplasty is increasingly popular as an introductory technique for the robotic platform, but accurate dissection is the key to achieve successful outcomes. Lourié (WebSurg, 2021) highlights the significance of the preperitoneal or intermediate fascia in delineating the visceral and parietal compartments during TAPP. The objective of the video is to demonstrate this dissection in the performance of a robotic left inguinal hernia TAPP.

Case presentation

We present the left side of a robotic bilateral TAPP hernioplasty in a male patient. After placing the robotic trocars, the peritoneum was opened from the median umbilical ligament to the iliac spine. Medial access involved dissecting the parietal compartment and safeguarding the bladder while reducing the medial hernia. Continuing to the lateral area, the dissection proceeded in the visceral compartment, preserving the intermediate fascia to protect the inguinal nerves. Both compartments were then separated by the intermediate fascia, which was sectioned to access the central area, identifying the spermatic vessels and the vas deferens. Closure involved barbed suture for the direct hernia defect and placement of a 12 × 15 cm polypropylene mesh, secured to the pectineal ligament. The left side procedure concluded with peritoneal suturing.

Conclusion

The awareness of the presence of the intermediate fascia provides us with a better anatomical approach to the myopectineal space. The dissection of the parietal and visceral compartments minimizes the risk of bladder or inguinal nerve injury in robotic TAPP hernioplasty.
LAPAROSCOPIC eTEP RS FOR RIGHT PARAMEDIAN INCISIONAL HERNIA WITH PERITONEAL FLAP
Authors: Baste N
Published: May 2024

60/male

Presented to OPD with swelling near previous laparotomy scar mark. Reducible swelling.

Increases in cough.

Past history of paramedian incision laparotomy for perforated appendicitis.

On examination – 7 × 6 cm defect near the scar mark.

CT shows a paramedian ventral hernia.

Plan – eTEP RS with unilateral TAR.

Surgery procedure

3 port eTEP RS.

Retrorectus space creation.

Cross over to the opposite side.

Dissection of peritoneum over scar mark.

Opening of incisional hernia sac.

Adhesiolysis of sac from contents.

Dissection of defect on the superior and inferior aspect.

Peritoneal flap creation. Right side TAR.

Closure of peritoneum without tension.

Closure of defect with nonabsorbable barned suture.

Placement of 20 × 15 cm mesh.

Strapping after surgery

Operative time 180 minutes. Blood loss – 100cc.

Patient was discharged on the 5th post-op day.
ROUTE FOR A SUCCESSFUL REPAIR IN A SEVERE EVENTRATION WITH LOSS OF DOMAIN: BOTOX-PNEUMOPERITONEUM AND MALMÖ REPAIR
Authors: Caraiman Gall M , Villalobos Morí R , Comas Isus J , Farré Font R , Guariglia C A , Pardo López S , Font Prat M , Valderrama Chacón S , Collera Ormazabal P , Díaz del Gobbo R
Published: May 2024

Background

Highlight the surgical challenge of rehabilitating the abdominal wall in a severe case of ventral hernia.

Method

We present a video of the safe surgical repair of a midline abdominal incisional hernia with loss of domain, employing component separation and closure according to Malmö’s technique, with previous prehabilitation with botulinum toxin infiltration and pneumoperitoneum therapy.

Results

42-year-old patient with obesity and complex abdominal incisional hernia, following a midline laparotomy for intestinal obstruction requiring resection and ileostomy due to strangulated umbilical hernia. Subsequently, an open abdomen surgery resulted when attempting ileostomy closure. Abdominal CT scan showed a large incisional hernia (M1-2-3 W3 + L1 W1) with loss of domain. We indicate prehabilitation with 20 kg weight loss, infiltration of botulinum toxin two months before surgery and progressive pneumoperitoneum therapy 12 days before final procedure involving instillation up to 13 Lt of air. Surgical repair was performed with laborious dissection of the sac and adhered bowels, without evidence of lesions. Lateral eventration of the old ileostomy’s closure is carried out with preperitoneal mesh. For midline reconstruction we choose Malmö’s technique to guarantee tension-free closure, with a retromuscular mesh. The skin was reconstructed with an inverted T incision. Thanks to the meticulous preoperative preparation combined with ERAS program, the patient was discharged on 5th postoperative day.

Conclusion

Incisional hernias with severe loss of domain require an exhaustive study and preparation, to avoid intra- and post-operative complications. Prehabilitation of the abdominal wall and patient must be taken into account prior to performing this type of reconstruction.
LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL HERNIOPLASTY (TAPP) FOR OBTURATOR HERNIA
Authors: Charef El Jari L , García Galocha J L , Fra Corral D , Gallardo Robles A , Gámez Alastuey M , López Antoñanzas L , Peña Soria M J , Torres García A J
Published: May 2024

Introduction

Obturator hernias are rare and represent <1% of incidence of all hernias. These hernias typically affect elderly, multiparous, thin women, and those patients with increased intra-abdominal pressure. Early diagnosis of an obturator hernia is very difficult and challenging as it usually presents with non-specific symptoms and signs. It is rarely visible or palpable. However, these hernias may show up as bowel obstruction as well as dysaesthesia and pain in the groin, inner thigh and knee due to obturator nerve compression (positive Howship-Romberg sign). Computed tomography (CT) is of choice for preoperative diagnosis. Surgical treatment with a laparoscopic approach is preferred in elective interventions.

Case report

A 63-year-old woman without medical history who consults because of abdominal discomfort in hipogastric and right iliac region. At clinical examination, she has no palpable hernia. Blood tests were normal. A scheduled CT scan revealed a small right obturator bladder hernia. Intervention was performed using the transabdominal-preperitoneal approach (TAPP). This video shows the steps followed in the operation (creation of peritoneal flap, reduction of the hernia, mesh placement and fixation, peritoneal closure with barbed suture). The patient has no postoperative complications.

Discussion and conclusion

Obturator hernia, although rare, is associated with high morbimortality. Laparoscopy is of choice in elective surgery. TAPP allows placement of the mesh in the preperitoneal space, the most anatomical area, to assess the vitality of the reduced organs, and is preferable in hernias whose anterior approach is difficult to access. Laparoscopy is associated with faster postoperative recovery.
A CASE OF LAPAROSCOPIC OBTURATOR HERNIA
Authors: Ferrando L , Palomo Luquero A , Otero Rondon M , Muñoz Plaza N , Jorge Tejedor D , Cruza Aguilera I , Baudino M , Casaval Cornejo L , Dominguez Arroyo I , Polanco Pérez L , Álvarez Rico M A
Published: May 2024

Case History

An 86-year-old woman arrived at our center's emergency department, complaining of abdominal pain and vomiting. She had no history of abdominal surgery or injury.

Clinical Findings

The patient displayed left iliac fossa tenderness, without peritoneal irritation or fever. Blood tests showed an increase in neutrophils and C-reactive protein. A CE-CT scan of the abdomen revealed a left obturator hernia with an 8.5 mm neck.

Therapy and Progressions

Emergency laparoscopic surgery revealed that 2 cm of small intestine had become incarcerated through the obturator hole. The hernia could be easily reduced without the need for dissection and the portion of the small intestine was not necrotic. Given the patient's age and functional status, the goal was to be as quick and decisive as possible. Due to the small size of the defect, a herniorrhaphy was performed using a barbed suture. Recovery was uneventful and the patient was discharged on day 6.

Comments

Obturator hernias are rare causes of small intestinal obstruction, and early diagnosis requires high clinical suspicion. An abdominal CE-CT scan can assist in detecting strangling ileus caused by incarceration. Emergency laparoscopy is recommended for strangling ileus and a laparoscopic technique may be feasible following an early diagnosis. Laparoscopy has increased in recent years and, unless there are obvious signs of perforation or necrosis, it may be used in strangling hernia cases. If there is any doubt regarding complications, we should not be hesitant to convert to a laparotomy.
ROBOT-ASSISTED NISSEN FUNDOPLICATION WITH THE NEW HUGOTM ROBOTIC ASSISTED SYSTEM: FIRST WORLDWIDE REPORT WITH SYSTEM DESCRIPTION, DOCKING SETTINGS AND VIDEO
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

Background

Robotic surgery has gained worldwide acceptance over the past decade, with several studies showing that this technique is safe and feasible.

Methods

We describe the first robot-assisted Nissen fundoplication for hiatal hernia performed with the new HugoTM RAS (Robotic assisted surgery) system (Medtronic, Minneapolis, MN, USA) in Spain. The innovation of this system is the open surgical console with a 3D-HD display, a system tower and four independent arm carts.

Results

The surgical procedures were completed without conversion. No intraoperative complications or tech- nical failures of the system were recorded. The operative time was 97 min, the docking time was 3 min, and the length of hospital stay was three days.

Conclusions

This case report shows the safety and feasibility of Nissen fundoplication for hiatal hernia with the HugoTM RAS system and provides relevant data that may assist early adopters of this surgical platform.
SUGARBAKER TECHNIQUE FOR AN UNUSUAL CASE OF ILEAL CONDUIT EVENTRATION
Authors: Font M , Díaz R , Farré R , Guariglia C , Pardo S , Caraiman M , Valderrama S , Collera P
Published: May 2024

Background

We present a clinical case of peristomal eventration of ileal conduit repaired with a sugarbaker technique.

Methods

A 56 years-old man, with overweight (BMI 30 kg/m2), hypertension and surgical history of radical cystectomy and Bricker reconstruction due to urothelial carcinoma.

During oncologic controls, he was diagnosed of a infraumbilical and peristomal eventration. The patient had discomfort and was referred from the urology clinic, Elective surgery was programmed after the CT scan confirmed the eventration suspicion of occupation by the colon.

Results

A peristomal eventration with the cecum and distal ileum inside. The content was carefully reduced and dissected, paying special attention to the mesenteric side to avoid ureteral lesions and devascularization. The size of the eventration was adjusted by using 0 barbed suture. Afterwards, an intraperitoneal mesh was placed around the stoma fixed with tackers.

The post-operative period occurred without complications, and on the 2nd day, he was discharged from the hospital.

Conclusions

The repair of patients with ileal conduits’ eventrations can be a true challenge due to altered anatomy and the possibility of injuring the ureters, so the laparoscopic approach offers a great advantage for evaluation and repair of these unusual cases.
LAPAROSCOPIC REPAIR OF INCARCERATED FEMORAL HERNIA AND FOLLOW UP REVIEW 9 MONTHS LATER DUE TO LAPAROSCOPIC REPAIR OF OMPHALOCELE
Authors: Fotiadis P , Papalos C , Permekerlis A , Tepelidis C , Gemousakaki E , Kouridakis P
Published: May 2024

Introduction

Abdominal wall hernias are an extremely common condition in surgery. It is estimated that 2/3 of all of them appear in the groin region. Femoral hernias represent 3% of all hernias in the inguinal region. As for femoral hernias, it is diagnosed at a rate of 22%–34% of all inguinal hernias in women, as opposed to 1.1% in men. They often show incarceration, in a percentage of 32%–39% of patients.

Purpose

A video presentation of an interesting case of incarcerated femoral hernia and the laparoscopic approach as an emergency treatment. Also there is a review of the operated area 9 months later due to a laparoscopic omphalocele repair.

Material and Methods

A 45-year-old woman presented to the ED due to abdominal pain of sudden onset, accompanied by episodes of vomiting and inability to eat. Clinical examination showed bulge below the inguinal ligament. An upper lower abdominal CT scan was performed which indicated an incarcerated femoral hernia. The patient underwent a laparoscopic repair with mesh. The patient's postoperative period was considered uneventful and she was discharged on the 4th postoperative day. 9 months later the same patient underwent a laparoscopic omphalocele repair and the operated site of the femoral hernia was reviewed.

Results and Conclusions

In patients with incarcerated femoral hernia, laparoscopic repair is an effective method of surgical repair.
OBTURATOR HERNIOPLASTY WITH TAPP TECHNIQUE FOR STRANGULATED HERNIA
Authors: Fra D , García Galocha J L , Peña M J , Gámez M , Gallardo A , Charef L , López Antoñanzas L , Torres A
Published: May 2024

Introduction

Obturator hernias are a rare entity, accounting for 0.04% of all hernias. They are almost exclusive to women, especially in the seventh and eighth decades of life. Diagnosis is often delayed, and the most common presentation is incarceration.

Clinical case

We present the case of a 78-year-old woman with no significant surgical history who came to the Emergency Department with a 72-hour history of intestinal obstruction. Abdominal CT scan revealed findings consistent with an incarcerated right obturator hernia.

Urgent surgical treatment was decided, and a TAPP hernioplasty was performed.

The procedure started with the placement of a supraumbilical Hasson trocar and two additional 5 mm trocars on both sides. The non-dilated bowel loop was followed to locate the hernial orifice, which contained a loop of small intestine that was released, showing no signs of ischemia. The peritoneal flap was created, and with traction and counter-traction maneuvers, the hernial contents were reduced. A polypropylene mesh in plug form was placed, and the flap was closed with non-absorbable barbed material.

Conclusions

Due to the rarity and challenging diagnosis of obturator hernias, it is essential to consider them, especially in cases of intestinal obstruction in elderly women, particularly those without previous surgeries.

Currently, the preferred treatment for repair is laparoscopic approach. Given the location of this hernia in the pelvis, laparoscopy allows clear visualization of the hernia contents and subsequent treatment, including assessing the viability of the incarcerated or strangulated intestine if present.
RIGHT INGUINOSCROTAL HERNIA WITH IRREDUCIBLE SIGMOID NEOPLASM: ONCOLOGICAL RESECTION AND CONCOMITANT COMPLEX ROBOTIC HERNIA REPAIR
Authors: Galiana-Montiel C
Published: May 2024

Concomitant colorectal and hernia surgery is controversial due to the risk of infection in clean-contaminated or contaminated environments and morbidity, even in case of minimally invasive surgery. Occasionally, we may encounter patients with symptomatic inguinoscrotal hernia and colorectal cancer.

We present a case of a 65 years-old male patient with a dolicosigmoid neoplasm found inside a large irreducible right inguinoscrotal hernia. Both complex procedures were performed by laparoscopy assisted by the robotic platform DaVinci. The uniqueness of this procedure lies in a modified trocar position (cranial than standardized) to allow their use for both complex procedures. After hernia reduction, a standard robotic TAPP with polypropylene mesh was performed at first to reduce the possibility of mesh contamination. Two more trocars were added under direct vision respecting the peritoneal flap to perform an oncological sigmoidectomy. Surgical specimen was removed through the minimally enlarged transrectal incision of the left flank trocar, avoiding a Pfannenstiel incision that affected the previously repaired area.

The patient was discharged 3 days after surgery and no complications or recurrence were reported 1 year after the procedure. In conclusion, the minimally invasive simultaneous approach of both complex procedures is safe and has a beneficial impact on patient’s morbidity and satisfaction, avoiding two separate surgical procedures and the risk of hernia complications between them.
CONTRALATERAL (eTEP) INGUINAL HERNIA REPAIR IN A PREVIOUS LEFT eTEP INGUINAL HERNIA SURGERY: TECHNIQUE & MITIGATION STRATEGY
Authors: Gandhi J , Chaudhari S
Published: May 2024

Background

Endoscopic Totally Extraperitoneal (eTEP) inguinal hernia repair has gained popularity as a minimally invasive technique with favorable outcomes. However, encountering a contralateral hernia in a patient with a history of eTEP inguinal hernia repair presents a unique surgical challenge.

Objective

This case report aims to describe the successful management of a contralateral inguinal hernia in a patient with a previous left-sided eTEP inguinal hernia repair, highlighting the technical nuances and outcomes of the contralateral eTEP approach.

Methods

An elderly gentleman presented with a symptomatic right inguinal hernia 1.5 years after having undergone a left eTEP inguinal hernia repair. After a comprehensive preoperative evaluation, including imaging studies, the decision was made to perform a contralateral eTEP inguinal hernia repair.

Results

The contralateral (Right) eTEP inguinal hernia repair was successfully performed from the left side approach technique. The surgical technique involved meticulous dissection, identification of anatomical landmarks, and placement of an anatomical mesh. Intraoperative and postoperative complications were carefully monitored. The patient experienced a smooth recovery and was discharged on postoperative day 1.

Conclusion

Contralateral inguinal hernia repair following a previous eTEP procedure can be safely and effectively performed using the eTEP approach. This case underscores the adaptability and versatility of the eTEP technique in addressing recurrent or contralateral hernias. Further studies and larger case series are warranted to validate the generalizability of this approach and assess long-term outcomes.
ROBOTIC RETROMUSCULAR ABDOMINAL WALL REPAIR USING AN INVERTED TEP (iTEP) APPROACH: RESULTS OF THE FIRST 100 PATIENTS
Authors: Geers J , Abasbassi M , Venken R , Olivier F
Published: May 2024

Background

In 2022, our technique of robotic retromuscular abdominal wall repair (RAWR) for ventral hernias, using an inverted totally extraperitoneal repair (iTEP)-approach, was first described. Up until this day, this technique is used in the robotic treatment of all ventral hernias with rectus diastasis. The aim of the study is to analyse surgical outcomes and to report the results of the first 100 patients.

Method

A retrospective analysis of a prospectively maintained database was performed, including all consecutive patients who underwent a robotic RAWR using the iTEP-approach. Patients’ characteristics, intra- and postoperative parameters were studied. Follow-up time was calculated from the date of surgery up until study closure in January 2024.

Results

Between December 2019 and January 2024, 100 patients (female/male 39/61, median age 62 years, range 20–90) were treated using the iTEP-approach. In 58 patients (58%), the indication was an incisional hernia. Median operating time was 135 minutes (range 65–300). The median length of stay was 1 day (range 1–4). No intraoperative complications were observed. One patient (1%) required reoperation for a small bowel internal herniation due to a rupture of the posterior rectus sheath. In two patients (2%), conversion to a laparotomy was necessary due to extensive adhesions. There were no recurrences or mortality with a median follow-up of 14 months (range 0–49).

Conclusion

For defects in the upper abdominal region, a robotic RAWR with an iTEP-approach appears to be safe and feasible. Long-term follow-up is still needed to evaluate late recurrence rate.
LAPAROSCOPIC TRANSABDOMINAL LUMBAR HERNIOPLASTY: MAIN TECHNICAL STEPS AND MESH FIXATION WITH CYANOACRYLATE
Authors: Hoyuela C , Rovira M , Caballero D , Navarro J , Pierres M , Cubel M , Astete S , Muñoz C
Published: May 2024

Background

Mesh atraumatic fixation for hernia repair avoids tissue damage, reducing the risk of bleeding and acute postoperative pain. The objective of this video is to describe the main steps of the laparoscopic transabdominal repair of a primary lumbar hernia, focusing on the mesh fixation with cyanoacrylate.

Method

A 66-year-old woman (BMI 34 kg/m2) presenting with a 7 cm. lipomatous right lumbar tumor, which causes mild discomfort and occasionally changes in size with movement. CT and MRI confirmed upper lumbar hernia of 7 × 6 cm (Grynfelt hernia).

Surgical technique

Patient in supine decubitus with marked left lateralization. The procedure was performed using three trocars. The parietal peritoneum is opened, identifying a 3 cm. hernia defect containing perirenal fat. After widening the space, a 15 × 10 cm. PVDF mesh (Endolap 3D® Dynamesh), is placed in an extraperitoneal fashion and fixed with a double crown of cyanoacrylate drops (Glubran®). Once the proper hemostasis was verified, reperitonization was completed and the 12 mm trocar was sutured to minimize the risk for herniation. Any drain was used.

Results

Operating time: 70 minutes (performed on an outpatient basis) Postoperative period was uneventful. Maximum postoperative pain VAS: 2/10. The patient remains asymptomatic, with no bulging or recurrence on CT scan after 12-months follow-up. The patient satisfaction was high (score: 10/10).

Conclusion

Lumbar hernia can be treated successfully and efficiently by minimally invasive approach. Mesh fixation with cyanoacrylate is safe and reduces the risk of hemorrhage and acute postoperative pain, facilitating outpatient procedures.
PERINEAL HERNIA: A PERINEAL GENU PECTORAL APPROACH WITH FLAP AND NON-ABSORBABLE MESH REPAIR TECHNIQUE
Authors: Khalil H , Berthelot J , Codjia T
Published: May 2024

Background

A perineal hernia is a protrusion of an organ or an intra-peritoneal tissue through a defect of the pelvic floor, which occurs after extended perineal surgeries. The incidence of perineal hernia is poorly documented. To date, there is no gold-standard technique. Numerous surgical approaches are described: abdominal (laparotomy or laparoscopy), perineal and combined approach, using flap, mesh or both for perineal hernia repair. We hereby describe a perineal approach with flap and non-absorbable mesh repair technique.

Method

The patient is lying in genu pectoral position. A gluteal Y-like incision is performed with subcutaneous dissection of the hernia sac with anterior bladder dissection and dorsal dissection to the coccyx, which allows a reduction of the hernia contents. Then a dissection of subcutaneous flaps from the gluteus maximus muscle (GMM) is performed. Peritoneal closure is performed with exclusion of the perineal cavity. Detachment of the lower third of the GMM from the sacrum and release of the pedicled gluteus flap is made. The mesh covering the perineal defect extensively is fixed with a 2 cm overlap to the pubis, then to the coccyx, and laterally the mesh on the sacral-tuberosity ligament, the ischium, the coccygeal muscle and the ischio-pub branch. Gluteal flaps are fixed to the coccyx and pubis for mesh adequate coverage. A preventive negative pressure wound therapy is placed over the skin closure. The patient shows no evidence of recurrence after 2 years follow-up.
ROBOTIC TOTAL EXTRAPERITONEAL (rTEP) INGUINAL HERNIA REPAIR: A PRAGMATIC APPROACH
Authors: Kumbhar U
Published: May 2024

Background

There has been an evolution in inguinal hernia surgery from open, laparoscopic to the current robotic approach. A recently published meta-analysis supports robotic surgery as a safe, effective, and viable alternative for Inguinal hernia repair. Like laparoscopic hernia repair, robotic surgery has trans-abdominal preperitoneal (rTAPP) and total extraperitoneal (rTEP) approaches. However, most of the studies are confined to the rTAPP approach, and there is minimal published data on the rTEP approach.

Rationale

A total extraperitoneal approach has various advantages, like non-violation of the peritoneal cavity, less chances of paralytic ileus, and lower seroma formation and infection. However, multiple difficulties exist in performing rTEP inguinal hernia repair, creating the preperitoneal space, ergonomics, and the site of robotic port placement. Thus, most robotic surgeons perform rTAPP inguinal hernia repair.

Novelty

An extensive literature search found no resources for the rTEP surgical technique. Hence, we developed a method of rTEP inguinal hernia repair based on the experience of the laparoscopic TEP repair collaborated with the robotic surgery principles.

Here, I present a video demonstrating the steps of rTEP inguinal hernia repair in a 47-year-old female patient with a left-sided direct inguinal hernia.
MINIMALLY INVASIVE APPROACH TO STRANGULATED VENTRAL HERNIA AND USE OF ICG FLUORESCENCE ANGIOGRAPHY IN EMERGENCY SURGERY
Authors: Licardie E , Moreno-Suero F , Navarro-Morales L , Bellido-Luque J , Morales-Conde S
Published: May 2024

Aims

One of the main mid- and long-term complications after abdominal surgery is the occurrence of an eventration. The minimally invasive approach (MIS) to midline hernias currently one of the least used techniques in the emergency department. One of the great advantages of the laparoscopic approach to a strangulated ventral hernia (VH) is to be able to adequately assess the viability of the intestinal loops. The use of ICG can help to objectively assess adequate intestinal blood supply.

Methods

A 72-year-old woman with previous umbilical hernia operation, BMI: 44. Came to the ER with abdominal pain related to umbilical prolapse. CT-showed a diastasis of the rectum and a VH of approximately 4 cm containing a distal ileum loop with signs of distress in the hernial sac and the loops with liquid at that level.

Results

We observe a VH with dilated bowel loops and distressing fluid inside which is reduced with atraumatic maneuvers and graspers. A midline V-H is identified with a 4 × 5 cm defect (M3W1). Direct closure of the defect was performed with a non-absorbable barbed suture. Adhesiolysis and then a PVDF mesh is placed and fixed with absorbable tacker and cyanoacrylate glue. Affected intestinal loop is identified and fluorescence angiography with ICG is performed to confirm the adequate viability of the intestinal loops.

Conclusions

We believe that MIS to abdominal wall complications in the emergency setting is feasible and provides the advantages of laparoscopy in addition to being able to explore the abdominal cavity with support of ICG.
ROBOTIC TAPP FOR VENTRAL HERNIA REPAIR
Authors: Lodha M , Sharma N , Karthik N , Abhijeet
Published: May 2024

Background

TAPP repair of ventral hernia is increasingly being practised because of the natural barrier provided by the peritonium, which prevents adhesion formation between bowel and mesh.

Method

We present a video of a robotic TAPP ventral hernia repair. After painting and drapping the part, pneumoperitoneum was created by the help of the varress needle at site of the palmer’s point, then robotic scope was introduced, diagnostic laparoscopy was done, omentum reduced from hernial site, with the help of the other two port, scissor dissection of the peritoneal flap was made all around approximately 7–10 centimeter so as to acomodate a 15 × 15 cm. size prolene mesh, on raising peritoneal flap we identified they were multiple defect, defects were closed and a prolene mesh was fixed with help of suture under the posterior rectus sheeth, later flap was sutured with the help of the suture. Port were closed.

Result

Postoperative patient did well and went home after first postoperative day.

Conclusion

Robotic TAPP is a very good technique for new learner who are not very good with suturing, robot give advantage for suturing and raising the flap for TAPP procedure.
MANAGEMENT OF A CENTRAL RECURRENCE AFTER A POSTERIOR COMPONENT SEPARATION REPAIR IN A GIANT SUBCOSTAL HERNIA
Authors: Lopez-Monclus J , García de León L R , Munoz-Rodriguez J M , Grillo Marin C , Rodriguez Fernandez M , Gil Cidoncha L , Martin Rodrigo P , Blazquez Hernando L A , Valle de Lersundi A R , Medina Pedrique M , Garcia-Urena M A
Published: May 2024

Aim

Central recurrences after posterior component separation due to mesh failure are exceptional. We present our approach to solve this complex situation.

Material and Methods

59 years old male patient with previous diabetes type II and arterial hypertension. He underwent an open cholecystectomy due to a septic shock secondary to a perforated acute cholecystitis. Wound infection in the po period. After one year follow-up he developed a giant subcostal hernia with a 15 × 20 cm defect. We repaired this incisional hernia with a Madrid posterior component separation with a double mesh technique. After 18 months follow up the patient developed a central recurrence, so a new surgery was proposed. A new preperitoneal retromuscular dissection was performed, creating a new preperitoneal pouch to locate a new absorbable + permanent 25 × 30 meshes. The disrupted previous mesh was partially removed and closed above the new meshes.

Results

No immediate postoperative complications. Discharged in the third postoperative day without any complications. No recurrence after 18-month follow-up.

Conclusion

Central recurrences following the failure of a Madrid posterior component separation repairs can be managed with the re-dissection of the preperitoneal retromuscular space.
SUPRAPUBIC HERNIA AFTER PELVIC TRAUMA – TAPP AS DAY SURGERY
Authors: Martins F , Pinto C , Magalhães C
Published: May 2024

The authors present a video of a surgical treatment, of a Suprapubic Hernia, after a Pelvic Trauma.

It was a male patient, 52 years, ASA II, that 10 years ago had a Pelvic Trauma, with fracture of the Pelvis.

He was evaluated because of left groin pain and non-reductible suprapubic swelling.

The patient was submitted to a TAPP approach and discharged the same day, with no complications.
LAPAROSCOPIC REPAIR OF MORGAGNI HERNIA
Authors: Morejón Ruiz S , De Luca M , Avilés Oliveros A , Medina Pedrique M , Casanova A , Cruz A , García-Ureña M A
Published: May 2024

Aim

Morgagni hernia, a congenital defect of the diaphragm typically found retrosternally on the right side, though occasionally bilateral, is rare in adulthood and old age, often presenting with subtle abdominal symptoms. Advancements in laparoscopic techniques have facilitated minimally invasive repairs, reducing morbidity and expediting recovery.

Materials and Methods

We describe a 69-year-old patient without significant medical history, diagnosed incidentally with Morgagni hernia during evaluation for recurrent retrosternal pain. Abdominal computed tomography confirmed the diagnosis, leading to laparoscopic repair with synthetic material reinforcement.

Results

The patient underwent laparoscopic surgery without intraoperative complications and experienced uneventful postoperative recovery, resulting in discharge within days. Follow-up revealed no hernia recurrence or significant complications.

Conclusions

In elderly patients with Morgagni hernia and subtle thoracic or abdominal symptoms, laparoscopic repair provides a safe and effective treatment option. Our case underscores the successful application of minimally invasive techniques, emphasizing the importance of patient selection and expertise in advanced laparoscopy for favorable outcomes and swift recovery.
EXPLORING THE DOWN TO UP RIVES eTEP TECHNIQUE: MANAGING RECURRENT MIDLINE INCISIONAL HERNIA WITH PRIOR PREPERITONEAL MESH PLACEMENT
Authors: Munoz-Rodriguez J M , Lopez-Monclus J , Román García de León L , Blazquez Hernando L A , Robin Valle de Lersundi A , Medina Pedrique M , Gil Cidoncha L , Martin Rodrigo P , Rodriguez Fernandez M , Garcia-Urena M A
Published: May 2024

Background

To demonstrate the efficacy of the "down to up" Rives eTEP technique in the surgical management of recurrent midline incisional hernias with a history of prior preperitoneal mesh placement.

Methods

A 76-year-old woman with a midline incisional hernia, previously repaired using preperitoneal mesh three years ago, presented with a recurrent hernia, classified as M2-3 W2 by the European Hernia Society and confirmed by computed tomography. An endoscopic abdominal wall repair with defect closure was performed.

Beginning with the insertion of the Hasson trocar into the right retrorectal space, the procedure involved meticulous dissection of the suprapubic preperitoneal space and sequential placement of three suprapubic trocars. Comprehensive dissection encompassed both retrorectal spaces and the midline preperitoneal space, including sectioning of the medial edge of the posterior rectus sheath, facilitating unification of all dissected spaces. The pre-existing mesh remained integrated into the posterior sheath. Post-dissection, the posterior and the anterior sheath were closed with a barbed suture. Finally, a 30 × 15 cm polypropylene mesh was positioned in the preperitoneal space without fixation.

Results

The patient experienced an uneventful postoperative recovery, leading to discharge without complications on the first postoperative day. An 18-month follow-up revealed no hernia recurrence.

Conclusions

This intervention successfully demonstrates the application of the "down to up" Rives eTEP technique for recurrent midline incisional hernias with prior preperitoneal mesh placement. As an alternative to open surgery, this approach offers advantages, including low infection rates, reduced postoperative pain, and shorter hospital stays.
RIVES eTEP PROCEDURE FOLLOWING LAPAROSCOPIC REDUCTION FOR CHRONIC INCARCERATED INCISIONAL HERNIA MANAGEMENT
Authors: Munoz-Rodriguez J M , Jiménez Cubedo E , Román García de León L , Lucena de la Poza J L , Gil Cidoncha L , Fernández Rodríguez M , Robin Valle de Lersundi A , Medina Pedrique M , Garcia-Urena M A , Blazquez Hernando L A , Lopez-Monclus J
Published: May 2024

Background

We aim to showcase the effectiveness of the Rives eTEP technique in surgically managing chronically incarcerated midline incisional hernias following laparoscopic reduction of herniated contents.

Methods

A 69-year-old woman, with predisposing factors for surgical wound infection and hernia recurrence (obesity, smoking, diabetes mellitus), presented with a midline incisional hernia, previously managed conservatively with manual reduction during multiple emergency room visits. Preoperative optimization was conducted for a hernia classified as M2-3 W2 by the European Hernia Society. On the scheduled surgery day, the patient presented with a hernia incarcerated for several days. Exploratory laparoscopy was performed to reduce hernia contents (omentum), followed by trocar reorientation to access the retromuscular plane for endoscopic abdominal wall repair with defect closure. After laparoscopic intraperitoneal reduction, trocar insertion in retrorectal space cause a tear in the posterior rectus sheath and create a pneumoperitoneum. This prompted a shift in dissection initiation to the right retrorectal space, achieving extensive dissection before performing the crossover to the left side to counteract pneumoperitoneum effects. Closure of both posterior and anterior layer was accomplished using barbed sutures, followed by placement of a 30 × 18 cm polypropylene mesh in the retromuscular space without fixation.

Results

The patient experienced an uncomplicated postoperative recovery, with discharge on the second postoperative day. A 12-month follow-up revealed no hernia recurrence.

Conclusions

Exploratory laparoscopy for hernia reduction enables avoidance of inadvertent intestinal injuries and allows for adaptation to the retromuscular plane via eTEP. Extensive retrorectal space dissection is advisable to prevent undesired pneumoperitoneum consequences.
CONTINUOUS FASCIAL TRACTION SYSTEM*: PREVENTING FASCIA RETRACTION OF AN OPEN ABDOMEN
Authors: Peck C , Sánchez D , Gajda J , Martínez Alegre J , Vaquero M A , Ferrero E , García-Sancho L , Rodríguez C , O’Reilly M , Mellado I , Núñez S , Picardo A
Published: May 2024

We report a 45-year-old male patient on whom a laparoscopic gastric bypass was performed without intraoperative complications. On day one post-surgery (PS), the patient showed mild abdominal distension and poor pain control. On day two of PS, the patient presented with acute abdominal distension requiring an urgent surgical revision. The findings of this surgery were small bowel ischemia with neither leakage from anastomosis, nor visible perforations. The patient was transported for a CT scan with an open abdomen showing permeable vessels. The intervention the following day found areas with poor blood flow; a 2 mm leakage on the gastro-jejunal anastomosis was repaired with 3 simple stitches. Because an abdomen primary closure approach wasn’t possible, a continuous fascial traction system* was used. Twelve traction points were placed on the anterior rectus sheath. The traction system allowed for the maintenance of an open abdomen for subsequent revision surgeries without reopening the abdomen wall and also for the prevention of fascial retraction. For control of the open abdomen, the patient was admitted to ICU, and up to four additional revision surgeries were performed resulting in increased blood flow of the small bowel. On day fourteenth PS, the abdomen was successfully primarily closed without the need for component separation techniques. After a 64-day hospital stay, the patient was discharged. At year one follow up, the patient had fully recovered with a 50 kg weight loss and a completely competent abdominal.

*Fasciotens abdomen®
SOMETIMES LESS IS GOOD TOO – LAPAROSCOPIC 2 PORT TOTALLY EXTRA-PERITONEAL (TEP) PROCEDURE FOR GROIN HERNIA REPAIR
Authors: Radhakrishnan S , Baste N
Published: May 2024

(Laparoscopic 2 port TEP procedure for Groin Hernia.)

58 yrs old, male presented with swelling in the left inguinal region since 2 yrs.

No medical comorbidities.

On Clinical Examination – Completely reducible Left Direct Inguinal Hernia.

Ultrasonography Abdomen & Pelvis - S/O 1.2 cm defect in the left inguinal region.

Preoperative labs – Within Normal limits.

Plan – 2 port TEP hernia repair.

Procedure

Supine position under General Anesthesia.

Ports

Left sided Pre – Peritoneal space created.

Dissection done in space of Retzius.

Space of Bogros dissected.

Spermatic cord dissection done. Sac separated and parietalisation of cord structures done.

Sac reduced.

15 × 12 cm Polypropylene mesh inserted and placed to cover the myopectineal orifice of fruchaud.

Hemostasis confirmed.

Pneumo preperitoneum deflated.

Port sites closed and strapping done.

Minimal Blood loss.

No Suction used during procedure.

Post Operative period uneventful. No analgesics used post op.

Discharged on day 2 post op.
eTEP RIVES-STOPPA VS. TOTAL VISCERAL SAC SEPARATION (TVS) TECHNIQUE: DIFFERENCES BETWEEN TWO MINIMALLY INVASIVE SUBLAY APPROACHES FOR MIDLINE HERNIAS
Authors: Robles Bardales C J , Ginestà C , Domínguez P , Guillaumes S , Hidalgo N J , Costa D , Morales X , Pera M
Published: May 2024

Background

Minimally invasive abdominal wall surgery is rapidly evolving, with techniques like IPOM, TAPP and TEP increasingly being used. The latter one allows for a laparoscopic retromuscular mesh placement but often requires extensive fascial dissection. In contrast, the European Hernia Society suggests an open preperitoneal repair for smaller hernias. Recently, a different laparoscopic preperitoneal approach has been described, being essential to understand the differences between both planes.

Methods

A 67-year-old female patient, with no comorbidities, consulted for multiple primary ventral hernias confirmed by CT scan. Another 57-year-old woman, with previous multiple pregnancies, presented with an umbilical hernia. Both with concomitant rectus diastasis. The first underwent an eTEP Rives-Stoppa, whereas the other one, a Total Visceral Sac Separation (TVS) technique; either with a down-to-up approach.

Results

eTEP allowed for three M2-3W1-2 hernias reduced, the retromuscular plane dissected and the defects repaired before mesh placement; operative time (OT) was 120 minutes. In the TVS technique, an M3W1 hernia was repaired following and dissecting a wide preperitoneal space. Incidental peritoneal opening was corrected with a running barbed suture and the defect closed with a trans-fascial repair; OT was 65 minutes. No immediate post-operative complications were reported.

Conclusions

Differences between a preperitoneal and retromuscular approach for hernia repair are highlighted. Patients with W1 hernias could benefit from a TVS approach, being less invasive, and having advantages such as reduced abdominal wall trauma, potentially faster recovery and fewer postoperative complications, making it a suitable option for these hernias.
THE THT (TRENTINO HERNIA TEAM) TECHNIQUE STANDS OUT AS A REPRODUCIBLE AND HIGHLY EFFECTIVE OPTION FOR REPAIRING INCISIONAL HERNIAS
Authors: Segismundo J J , Ong R A , Cruz E
Published: May 2024

Background

A 37-year-old woman, with a BMI of 27, underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) three years ago through a midline incision. She presented with intermittent bloating and abdominal pain, accompanied by a protruding mass near her umbilicus. A CT scan confirmed the presence of an incisional hernia in the umbilical region, with herniated bowel. The treatment plan involved hernia repair surgery using the Trentino Hernia Team Technique, which included the development of the retromuscular space and insertion of a mesh.

Method

The procedure began with the insertion of optical and working ports on the left side of the abdomen. A diagnostic laparoscopy was performed, revealing dense and extensive adhesions, which were then lysed laparoscopically. Subsequently, the umbilicus was incised, and the anterior rectus sheath was also incised to access the retrorectus space. Blunt dissection of this space was carried out on all sides. The two rectus sheaths were stapled together cranially and caudally. A single port was placed in the umbilicus to aid in further dissection of the retrorectus space, allowing accommodation for the 15 × 15 cm mesh. The mesh was then placed in the retrorectus space and secured using histoacryl glue. Finally, the anterior rectus sheath was closed primarily at the level of the umbilicus.

Result

The patient was hospitalized for a total of three days. There were no observed instances of seroma, hematoma, or necrosis in the umbilical area. Postoperative pain was minimal due to the laparoscopic nature of the procedure.

Conclusion

This approach provides a repair with minimal tension, facilitating the strengthening of the abdominal wall by reconstructing the linea alba. The application of a 15 × 15 cm mesh over the defect greatly diminishes the likelihood of recurrence. Moreover, the retrorectus placement of the mesh is preferable to intraperitoneal placement, particularly in cases of iPOM (intraperitoneal onlay mesh).
LAPAROSCOPIC APPROACH TO INGUINAL BLADDER HERNIA
Authors: Serrano A , Gutiérrez C , Reguero C , Carreño O , García-Pastor P , Bueno J , Ruiz J L , Pous S
Published: May 2024

Background

To present an infrequent case of inguinal bladder hernia (IBH) in an adult patient, as well as its minimally invasive approach.

Method

A 67-year-old obese male patient, with a medical history of bilateral hernioplasty by open approach, presented a history of lower urinary tract symptoms, urgency urinary incontinence and recurrent urinary tract infections of months of evolution. The clinical examination revealed a left inguinoscrotal hernia that was irreducible to palpation. Renal function was normal and Prostate Specific Antigen (PSA) level was 1.19 ng/ml. Ultrasonography showed no significative prostatic hypertrophy or hydronephrosis. Cystoscopy and cystography revealed a left IBH and suspected a bladder diverticulum associated. Computed tomography dismissed ureteral involvement.

Results

A scheduled surgery was decided. Surgical exploration found a direct left inguinal hernia containing almost ¾ parts of the bladder. No bladder diverticulum was observed. The next step was hernia reduction, which involved some technical difficulties. Hernia repair was performed by laparoscopic trans-abdominal pre-peritoneal hernioplasty (TAPP). Polyvinylidene fluoride (PDVF) mesh was used and fixed with non-absorbable tackers. The bladder integrity was confirmed with the instillation of saline solution through a urinary catheter. The patient was discharged without complications on the first postoperative day.

Conclusion

Inguinal bladder hernias are an uncommon condition that can often be difficult to diagnose. Furthermore, they constitute a surgical challenge since iatrogenic injuries and complications are possible. Perioperative imaging can help to make a diagnosis with certainty and to prevent misleading. The treatment of this pathology can be safely performed through laparoscopic approach and with less comorbidities than open surgery.
INCISING POSTERIOR WALL OF INGUINAL CANAL MAKES TAPP FOR LARGE HYDROCELE OF CANAL OF NUCK EASIER
Authors: Sharma N
Published: May 2024

We wish to share our video of TAPP for a large Type 1 Hydrocele of the canal of Nuck. The salient point we wish to share with the audience is that incising the posterior wall of the inguinal canal makes the operation easier if the cyst is large.

In this video, we first show the large cyst visible on laparoscopy. We have omitted the standard peritoneal incision and dissection of the flap for TAPP because the video had to be kept below 4 minutes.

We demonstrate how we approached the incision of the posterior inguinal wall without rupturing the cyst and later extended this incision.

This step made the dissection of the most distal part of the cyst much easier than if we had not incised the posterior inguinal wall.

We have omitted to show the closure of the posterior inguinal wall and mesh placement and flap suturing in this video, which was routine.
SUBCUTANEOUS ONLAY LAPAROSCOPIC APPROACH (SCOLA) MESH REPAIR FOR UMBILICAL HERNIA AND DIASTASIS RECTI: TECHNICAL DESCRIPTION
Authors: Tohmeh M , Kassar S , Kassir R
Published: May 2024

Diastasis recti (DR) refers to the stretching and thinning of the Linea alba and the separation of muscular borders by more than 2.2 cm1, clinically manifesting as a central bulging of the Linea alba1. It leads to an increased risk in hernia recurrence after hernia repair, often linked to underlying wall weakness2,3.

Various methods exist for ventral hernia repair, with the laparoscopic or open sublay approach that are technically demanding, causing significant abdominal scars. The intraperitoneal mesh technique employs a costly mesh and poses ergonomic challenges for DR plication2. Simultaneous treatment of DR and hernia repair with or without a mesh is typically performed during abdominoplasty, this technique yields unsatisfactory aesthetic outcomes for individuals lacking excess abdominal skin1. The SCOLA technique combines sub-cutaneous laparoscopic abdominal hernia repair with concurrent DR plication and onlay mesh fixation. SCOLA addresses the limitations associated with other hernia repair techniques, being minimally invasive, ergonomically favourable, utilizing an onlay mesh to reduce recurrence rates, with low risk of bowel injury or obstruction. Moreover, SCOLA delivers excellent aesthetic outcomes for patients not in need of excess skin resection1,2. However, it has its post-operative complications like seroma formation, hematoma, surgical site infections, and recurrence1,3.

SCOLA technique proves a safe and effective option when applied to non-obese individuals without excess skin, averse to transverse abdominal scars, and with small umbilical or midline hernias, particularly when associated with DR.

We will present the surgical technique that we performed in one of our patients.