bluuebunny/crossref_metadata_2025 huggingface dataset:
LAPAROSCOPIC REPAIR OF NON-MIDLINE VENTRAL HERNIAS: A SINGLE CENTER EXPERIENCE
Authors: Di Flumeri G , Mazzari A , Pedullà G , Tomaiuolo P M C , Sionne F , Crucitti A
Published: May 2024

Background

The laparoscopic intraperitoneal onlay mesh (IPOM) technique for the repair of non-midline ventral hernias (NMVH) is technically difficult and still controversial. The aim of this study is to retrospectively analyze our single center experience in the last 20 years performing the IPOM technique to NMVH.

Method

Between 2012 and 2022, 816 patients with ventral hernia underwent surgery using the IPOM technique, among these 101 were NMVH. We retrospectively analyzed peri- and post-operative complications in terms of clinical data and defect characteristics. Furthermore, NMVH data were compared with those of the midline ventral hernias group (MVH).

Results

Neither the clinical data nor the defect characteristics had a statistically significant impact on peri- and post-operative complications in the NMVH group (P > .05). Post-operative complication rate was 14.8% in the NMVH group and 13.6% in the MVH group (P > .05). Chronic postoperative pain was 2.9% in the NMVH group and 1.6% in the MVH group (P = .03). Recurrence rate was 2.9% in NMVH and 3.5% in MVH group (P > .05).

Conclusion

Laparoscopic IPOM for non-midline incisional hernias is safe and feasible also in our experience. However, it may require the use of specific technical precautions and a more appropriate perioperative framework. Statistical analysis comparing non-midline with midline defects has documented similar rates of conversion and post-operative complications. Chronic postoperative pain has resulted statistically significantly higher in the non-midline group. Instead, the recurrence rate has resulted lower in the non-midline group, although without statistical significance.
WHICH IS THE PLACE OF BIOSYNTHETIC MESH IN COMPLEX ABDOMINAL WALL RECONSTRUCTION?
Authors: Dutu C , Florea I , Albita O
Published: May 2024

Incidence of incisional hernias following midline laparotomy is 20–41% after 2–4 years. CAWR (complex abdominal wall reconstruction) may be needed after due to wound contamination, loss of domain, extraction of intraperitoneal mesh, emergency enterotomies or the component separation or other complication. Biosynthetic mesh reinforcement during CAWR has significantly improved outcomes through the gradual resorption process resulting in a steady decline in mechanical strength with sufficient time to remodel.

Our aim was to review the experience of our team using both polypropylene (PP) mesh and biosynthetic mesh over 12 months. A total of 40 patients with CAWR were examined (21 with PP mesh and 19 with biosynthetic mesh). Age, sex, BMI, comorbidities, mVHWG class, previous recurrence, mesh location, presence of component separation, post-operative complications were collected. The short-term results showed a significant reduction of SSO (surgical site occurrence) and shorter hospitalization when biosynthetic meshes were used. The recurrence at 6 and 12 months was similar in both groups.

The results of this investigation demonstrate that biosynthetic mesh repair provides strength beyond the scope of its resorption profile with positive early outcomes and similar recurrence when compared to PP mesh. Furthermore, the use of a biosynthetic mesh in the context of contamination could offer a viable alternative to a permanent mesh prosthesis.
PROPHYLACTIC BIORESORBABLE ONLAY MESH FOR INCISIONAL HERNIA PREVENTION IN MIDLINE SURGERY – PRELIMINARY RESULTS
Authors: Fortelny R H , Silberhumer G
Published: May 2024

Background

Prophylactic mesh implantation during elective midline laparotomies has to be considered in patients at high risk of developing an incisional hernia. The implantation of a permanent synthetic mesh has been proven based on randomized controlled trials. The effectiveness of bioresorbable meshes with prevention mesh-associated complications in the long term has still to be confirmed.

Method

The design of this a prospective, single-arm, multicenter, across Austria (PROMIS-study) using a bioresorbable prophylactic mesh of poly-4-hydroxybutyrate in onlay position in patients at risk undergoing elective and emergency gastrointestinal surgery by midline incision. The primary endpoint of the study is to detect Surgical Site Infection (SSI) up to the 3-month and incisional hernia in 3 years follow-up.

Results

Up to now 30 patients were included. 73.3% (22/30) underwent colorectal surgery due to carcinoma. The incision length was median 18,5 cm and the size of the applied mesh was median 23 × 8 cm. No perioperative complications were seen. In the 3 months follow up in 3 patients SSI and in 2 patients seroma formation were detected. In the 12-month follow up of 15 pat. (50.0%) no further complications or incisional hernia were seen.

Conclusions

The results of this interim analysis of the PROMIS study obtained a low rate of SSI and seroma formation without an occurrence of an incisional hernia. Compared to the recent systematic review of prophylactic mesh the results of the interim analysis of the PROMIS study can be rated as promising.
CHRONIC POSTOPERATIVE PAIN AFTER PRIMARY INGUINAL HERNIA REPAIR AND THE ROLE OF TRIPLE NEURECTOMY
Authors: Husarova T , Havlova K , Schutz S O , Murin M , Zaruba P , Pohnan R
Published: May 2024

Background

Inguinal hernia repair is one of the most common surgical procedures worldwide. The chronic postoperative pain, defined as pain lasting more than 3 months, is currently one of the most feared complications, with up to 5–0% occurence rate after primary inguinal hernia repair.

Case Report

We present two male patients with chronic postoperative pain after open and laparoscopic hernioplasty with mesh, respectively. After failed conservative therapy and careful diagnostics including magnetic resonance and ultrasound guided block of iliohypogastric and ilioinguinal nerves, both patients were scheduled for laparoscopic triple neurectomy. Surgeries were uneventful and nerves were verified by histopathological examination.

Results

Both patients reported a significant reduction of pain on the first postoperative day and then one month and one year postoperatively. Both patients reported a better quality of life after the surgery and a return to normal daily activities.

Conclusion

Postoperative pain after inguinal hernia repair should be continuously discussed and researched topic among general surgeons given the frequency of the procedure. We discuss the problematics of chronic inguinal pain including diagnostic algorithm, treatment and the necessary multidisciplinary approach to the patient with chronic inguinal pain. We also present triple neurectomy as a last resort modality, desciribing the surgery (open vs. laparoscopic), its advantages and disadvantages.
OPTIMIZING THERAPEUTIC APPROACH FOR EFFECTIVE MANAGEMENT OF EMERGENCY STRANGULATED INGUINAL HERNIA
Authors: Ibagherache R , Bounab C , Seoudi Z
Published: May 2024

Background

Inguinal hernias are a frequent reason for emergency settings. Incarcerated cases carry significant risk of strangulation. The approach to emergency treatment depends on the patient’s and environment conditions. However, the utilization of prosthetics in strangulated hernia treatment is constrained by concerns surrounding complications in a septic environment and the urgent situation. A prospective observational study was followed.

Objective

The aim of this study is to determine whether the utilisation of prothesis in managing strangulated hernias correlates with an elevated incidence of post operative events.

Methods

A total of 223 patients with a strangulated inguinal hernia who underwent surgical intervention. Inclusion criteria encompassed patients aged 15 years and above, admitted on an emergency basis with a strangulated hernia, and categorized as Asa III or lower.

Results

All admitted patients presented with a strangulated inguinal hernia. The average age was 55 years. Occlusive syndrome occurred in 17% of cases. The contents of the hernia sac varied, with 70% being non suffering, 19% containing epiploic content, 6% colonic, and 5% requiring anastomosis resection due to intestinal suffering.

Among 223 patients who underwent hernioplasty using the Lichtenstein procedure, the mortality rate was 0.9%, and the morbidity rate reached 17%. parietal sepsis accounted for 6.72 %, serum related issue for 5.82%, and hematomas for 4.48%, with no reported instances of prosthesis removed.

Conclusion

In light of the result of this study, the consideration to utilize a prosthesis in emergency hernia situations warrants careful evaluation, taking into account therapeutic criteria and prevailing conditions.
NOVEL ENDOSCOPIC APPROACH FOR REPAIR OF INGUINAL HERNIA – TECHNICAL DETAILS AND OUR INITIAL EXPERIENCE
Authors: Khetan M , Kalhan S
Published: May 2024

Techniques for the laparoscopic or endoscopic repair of inguinal hernias available so far are of following types: trans abdominal pre peritoneal repair (TAPP), totally extra peritoneal repair (TEP), intra peritoneal onlay mesh repair (IPOM), reduction of hernia contents and sac with narrowing of deep ring, and the extended view totally extra peritoneal repair (e-TEP) technique introduced by Jorge Daes.

TEP though based on time tested Rives-Stoppa technique has several limitations, with the introduction of e-TEP approach most of the problems faced in TEP approach were deterred.

Ours is a high-volume tertiary care hernia referral center with hernia academy for training young novel surgeons. Since 1994 till August 2018, we were practicing endoscopic repair of inguinal hernias either by TEP or TAPP approaches depending on both operative and patient factors. Between August 2018 and December 2022, we have performed 137 (one hundred thirty-seven) E-TEP inguinal repairs on 90 patients including 47 patients with bilateral defects, all cases were selected randomly. In one patient secondary to obesity and large peritoneal rent, procedure is converted to TAPP.

Our initial experience with enhanced view totally extra peritoneal repair (e-TEP) is satisfactory with acceptable results. We have had no conversion to open procedure in spite of few difficult cases selected. There were no major complications except few small postoperative seromas, which were managed conservatively.

We believe that the e-TEP approach has a place in armamentarium of hernia surgeries for totally extraperitoneal endoscopic repair of inguinal hernias. Resident surgeons and young novel surgeons will definitely find this technique easier to learn and master.
FIRST EXPERIENCE OF JUNIOR SURGEON WITH LAPAROSCOPIC TOTALLY EXTRAPERITONEAL HERNIORRHAPHY: COMPARISON WITH EXPERIENCED SURGEON IN SINGLE INSTITUTION
Authors: Kim D W , Park Y
Published: May 2024

Background/Objective

Laparoscopic totally extraperitoneal (TEP) herniorrhaphy is among the current leading inguinal hernia repair methods. This study aimed to investigate the safety and feasibility of a junior surgeon’s first experience with laparoscopic TEP herniorrhaphy.

Methods

A retrospective review was performed between January 2017 and December 2019 to analyze the medical records of patients with inguinal hernia who underwent laparoscopic TEP herniorrhaphy. The operative outcomes and complications of patients undergoing surgery by an experienced surgeon (group A, n = 100) were compared with those undergoing surgery by a junior surgeon (group B, n = 100).

Results

The mean operative time for group B was significantly longer than that for group A (52.0 ± 15.1 min vs. 60.1 ± 17.4 min; P = 0.03). A statistical difference was also found in the mean postoperative stay (1.1 ± 0.3 d vs. 1.4 ± 0.7 d; P = 0.02) between the two groups. There were 2 and 3 cases of recurrence in these two groups respectively (P = 0.72). Considering the operating time as a variable of learning curve, significant stabilization can be achieved after 30 cases (67.3 ± 17.8 min vs. 53.1 ± 11.1 min; P = 0.02).

Conclusions

The surgical outcomes of laparoscopic TEP herniorrhaphy performed by a well-trained junior surgeon were similar to the outcomes of an experience surgeon.
THE IMPORTANCE OF ANATOMICAL STUDY OF ABDOMINAL WALL FOR GENERAL SURGEONS: A TRANSVERSUS ABDOMINIS RELEASE (TAR) EVENTROPLASTY SERIE
Authors: Laguna Hernández P , Díaz Pedrero R , Córdova García D , Alvarado Hurtado R , Allaoua Mouissaoui Y , Bru Aparicio M , Soto Schutte S , Mañes Jiménez F , Ratia Giménez T , Gutierrez Calvo A
Published: May 2024

Aim

To know the importance of anatomical study of abdominal wall to prevent possible injuries.

Material and methods

Observational, descriptive, retrospective study in our hospital of patients operated using TAR technique (2019–2023). Variables used were demographic, EHS (European Hernia Society) incisional hernia classification and complications after surgery. Anatomical study was performed in cadaverical bodies donated to University.

Results

TAR technique was performed in 13 patients. Medium age was 56 years old, most of them were men (54%). According to the EHS classification, the most frequent incisional hernia was M3 (84.6%), followed by M4 (61.5%) and M2 (53.8%). In our TAR series was W2 (61.5%) and W3 (30.8%) (Graphic 1). All patients were operated by median laparotomy. 46% of the patients had some complication (Table 1): Only one patient operated had flaccidity abdominal wall.

Conclusions

Knowing anatomical structures is important for all surgeons. One of the most important structures for performing a TAR are nerve branches between transversus and inner oblique muscle.

Transversus abdominis muscle goes to 5°–6° ribs and L1–L5 vertebra to iliac crest and goes to medium line (Linea Alba) to cover posterior fase of rectum muscle (except in the inferior part performing Douglas Arc). The most important function is: tigthen abdominal wall, expiration and posture.

Anterior abdominal wall (skin, muscles and parietal peritoneum) is nerved by anterior branches of thoracic nerves (T7–12) and L1. This nerves go by Transversus muscle and inner oblique muscle.

An experienced abdominal wall surgeon could avoid denervation abdominal wall and therefore flaccidity and no aesthetic abdominal wall avoiding a posterior plastic surgery performed.Table 1:Complications after surgery (n = 13).Seroma0 (0%)Abscess2 (15%)Skin necrosis3 (23%)Mesh infection1 (7%)Hematoma0 (0%)Recurrence1 (7%)Celulitis0 (0%)Ileo0 (0%)Tract urinary infection0 (0%)Pneumonia0 (0%)Deep vein trombosis0 (0%)Pulmonary embolism1 (7%)Flaccidity1 (7%)Graphic 1:Patients with TAR eventroplasty classify by EHS Classification.Image 1:Anatomical study of abdominal wall in cadaverical studies.
INGUINAL HERNIA REPAIR: UNDERSTANDING CHRONIC POSTOPERATIVE PAIN
Authors: Lopez Antonanzas L
Published: May 2024

Introduction

Persistent pain following inguinal hernia repair is a significant healthcare problem. Sleep disorders, chronic analgesic use, and preoperative inguinal pain are associated with increased pain sensitivity.

Aim

To assess the rate of chronic postoperative inguinal pain (CPIP) following inguinal hernia repair in patients with preoperative pain, chronic analgesic use, and the role of sleep disturbances.

Methods

Inguinal pain, chronic analgesic use, and sleep disorders in patients undergoing inguinal hernioplasty at our center between August and November 2022 were evaluated. Pain was assessed preoperatively and postoperatively and during follow-up using a VRS-4 and the IPQ questionnaire (sf-IPQ) in 72 patients.

RESULTS

It is evident that 48% of patients with preoperative pain do not experience improvement in pain after hernioplasty (p <0.05), similarly, patients with chronic analgesic intake continue to have CPIP in 46% (p = 0.01) compared to patients without preoperative inguinal pain and no analgesic intake. Preoperative sleep problems are related to the development of CPIP 12 months after surgery (OR 1.25 [95% CI: 1.11–2.01], p = 0.001).

Conclusion

At one-year follow-up, a 4.8% incidence of CPIP is recorded, of which 73.3% are potentially related to surgery, and 26.7% may be due to persistent preoperative pain. Women and patients who have taken sick leave due to this reason are at a higher risk of CPIP. Similarly, sleep disorders may increase the risk of CPIP and contribute to the maintenance of postsurgical pain.
OPERATING ON A GIANT (BELOW KNEE) INGUINO-SCROTAL HERNIA AND RECOMMENDATIONS FOR REPAIR
Authors: Maheshwari G , Dickson Lowe R , Ahmed I
Published: May 2024

Background and Aim

To increase knowledge and understanding about giant inguino-scrotal hernias and share our experience with the European Hernia Society.

Method

A 52-year-old gentleman presented with a symptomatic giant inguino-scrotal hernia which reached the ankle level, with a buried penis. A CT scan showed the sac to contain the right hemicolon, omentum, multiple loops of small bowel, sigmoid colon and the right ureter. The patient was taken through a complex hernia multidisciplinary team (MDT) meeting. A period of prehabiliation was undertaken to optimise the patient for operation. The scrotal skin was cared for to eradicate pressure areas and fungal infection. Pre-operative botox was used for restoration of abdominal domain.

Results

A successful operation was carried out by two experienced hernia surgeons. The surgical approach was inguino-scrotal, with dissection of sac contents and a midline laparotomy to aid reduction of contents with restoration of anatomy into the peritoneal cavity. The large defect was repaired with biological mesh. The patient recovered well post-operatively and was discharged on day 13. The patient continues to do well 20 months post-operatively without recurrence.

Conclusion

In order to carry out this operation we recommended a multidisciplinary approach with careful and meticulous work up. Discussion in an MDT environment should be standard where all approaches can be considered e.g. pre-operative botox. The operation should be carried out by an experienced hernia surgeon and another consultant.
10-YEAR RESULTS OF THE SPANISH INCISIONAL HERNIA SURGERY REGISTRY (EVEREG)
Authors: Olona C , Güell D , Comas J , Pereira J A , Hernández P , Zaragoza C , Cabeza J J , Ferri R , Cabello A , Tallón L , García-Pastor P , López-Cano M ,   Spanish Incisional Hernia Registry Group (EVEREG)
Published: May 2024

Background

The Spanish Incisional Hernia Surgery Registry EVEREG began in 2012 and currently has more than 160 participating centers.

The aim of this study is to evaluate the results of the main variables collected in these 10 years of registry.

Methods

The registered variables are analyzed in the period from its beginning in July 2012 to September 2023. The variables are divided into demographics, characteristics of the hernia, surgery and follow-up.

Results

In 10 years, 14894 cases have been registered. 54.4% women and 45.6% men, with an average BMI of 30.4. 20.2% with type II Diabetes Mellitus, 20-9% smokers and 33.6% with a previous abdominal wall intervention.

The average diameters of the hernias are 6.9 cm transverse and 8.6 cm longitudinal. The most frequent location is M3 (56.4%), M2 (43.3%) and M4 (34.2%). 23.5% relpased and 29.5 % trocar hernias. Open approach was performed in 90.2%. Prosthesis was placed in 97.9% of cases, synthetic in 99.2% of them. The main plane of mesh placement was retromuscular in 37.9%.

In the postoperative period, 12.5% of cases presented some complication, the majority classified as Clavien grades 1 and 2 (74.3%).

Conclusion

The data presented must be analyzed considering that they include the different techniques carried out in the long study period. The creation fo surgical registries allows us to know the real data of the surgery performed ant its analysis is very useful for the personal and general improvement of each procedure analyzed.
THE STRANGULATED LITTRÉ HERNIA IN AN ELDERLY PATIENT. AN INTERESTING AND RARE CASE
Authors: Permekerlis A , Varvara S , Gemousakaki E , Papalos C , Fotiadis P , Kouridakis P
Published: May 2024

Aim

The aim of this study is to report a highly intriguing case of Littré hernia, since there are few articles concerning this specific type of hernia published in the international literature.

Littré’s hernia is a type of hernia where Meckel’s diverticulum is present in the hernia sac. Meckel’s diverticulum, an embryonic remnant of the vitelline duct, is found in around 0.3–2.9% of the general population. It is located at the antimesenteric aspect of the small intestine, typically positioned 30–90 cm away from the ileocecal valve.

Material and Methods

An 88-year-old patient presented in the Emergency Department of 424 General Military Hospital of Thessaloniki with signs and symptoms indicative of a strangulated inguinal hernia. The radiological findings were also consistent with the diagnosis, depicting the presence of ileus.

Results

The patient was transported to the operating room, where examination of the hernial sac revealed the existence of a strangulated, yet vital, segment of the small intestine along with Meckel’s diverticulum. Consequently, resection of Meckel’s diverticulum, as well as appendectomy were performed, followed by the placing of a polypropylene mesh in the orifice of the abdominal wall (Lichtenstein method). The postoperative period was considered uneventful and the patient was discharged on the 7th postoperative day, primarily due to comorbidities.

Conclusion

Littré’s hernias, although rare, can be present as abdominal hernias. Resection of Meckel’s diverticulum, along with repair of the fascial defect is crucial for preventing future complications associated to the diverticulum, such as obstruction, infection, bleeding or herniation.
MINIMALLY INVASIVE SURGERY IN THE MANAGEMENT OF INGUINOSCROTAL HERNIAS. OUR EXPERIENCE
Authors: Riba Combatti L , Bravo A , Navarro A , Gimeno M , Pérez M , Pereira J A
Published: May 2024

Aim

Inguinoscrotal hernias have higher postoperative complication rate, and more general complications than inguinal hernias. The latest European Hernia Society’s guidelines suggest open repair but minimally invasive techniques can be safely employed with low complications rates.

The aim of our study is to analyzed minimally invasive approach of inguinoscrotal hernias in our experience.

Material and Methods

A retrospective analysis of a prospectively maintained Abdominal Wall Unit database from January 2020 to July 2023. All inguinoscrotal hernias classified according to the Kingsnorth´s modified score with H3 or H4 for groin hernia were included. We performed a comparative analysis of open (OPEN group) vs. minimally invasive repair (MIS group). Demographics, comorbidities and hernia characteristics and outcomes were analyzed.

Results

65 cases were included. 50 cases (76.9%) an open repair was performed vs. 15 cases (23%) with minimally invasive surgery (either laparoscopic or robotic surgery). The groups were homogeneous except for a higher rate of recurrent hernias (40% vs. 10%; p = 0.014), bilateral hernias (86% vs. 28%; p = 0.001), associated ventral hernia repair (46,7% vs. 10%; p = 0.004) in MIS group, on the other hand hernias were irreducible more frequently in OPEN group (86 vs. 6,7%; p = 001). No significant statistical differences of outcomes were observed between groups except for longer operation mean time (135 +/-50 vs. 95+/-40 min; p = 0.003).

Conclusions

Minimally invasive approach can be beneficial in cases with bilateral groin hernia, recurrent or with ventral hernia associated repair and be safely employed by experienced surgeons with no added postoperative complication compared to open surgery.
INTRAOPERATIVE FASCIAL TRACTION* AS AN ALTERNATIVE TO COMPONENT SEPARATION IN COMPLEX INCISIONAL HERNIA. PRESENTATION OF OUR FIRST 10 CASES
Authors: Sánchez López J D , Martinez-Alegre J , Ferrero E , García-Sancho L , Vaquero M A , Nuñez S , Rodríguez C , Gajda J , Mellado I , Picardo A
Published: May 2024

Objective

We aim to present the outcomes of our initial 10 cases involving complex incisional hernias (W3 according to the EHS classification) treated with intraoperative fascial traction*. We will delineate patient characteristics, wall defect sizes, preoperative application of botulinum toxin (BT) or progressive pneumoperitoneum (PN), closure technique, and evolution during follow-up.

Material and Methods

From February 2022 we have used intraoperative fascial traction* in 10 cases. Half of the patients were male, with an average age of 59.5 years. In all cases, the defect width was ≥10 cm (average 13.3 cm). Two patients presented loss of domain (Tanaka index >20%). BT was used as an adjuvant in 7 cases, and PN was utilized in 1 case (10%).

Results

Primary closure without the need for component separation (CS) was achieved in all cases. Bridging (5 × 2 cm) was necessary in 2 cases to prevent excessive tension. Average hospital stay was 4.8 days, with only one case of Clavien-Dindo grade 3a complication (cutaneous dehiscence treated with vacuum therapy). After an average follow-up of 10.7 months (0.4–22.4), no clinical recurrence was detected.

Conclusions

In our experience, intraoperative fascial traction* proves to be an effective and safe alternative to CS for treating W3 ventral hernias, exhibiting a lower complication rate and a minimal occurrence of short-to-medium-term postoperative complications and recurrences.

(* = Fasciotens® Hernia® device)
MINIMALLY INVASIVE APPROACH UTILIZING LINEAR STAPLER FOR MIDLINE INCISIONAL HERNIA: STAPLER REPAIR TECHNIQUE
Authors: Sano T , Takuya S , Ueda S , Ando M , Shinohara K , Yasui K , Osawa T , Matsumura T , Fukami Y , Komatsu S
Published: May 2024

Background

We have successfully developed the Stapler Repair Technique (SRT), a straightforward laparoscopic Rives-Stoppa approach employing a linear stapler, and retrospectively evaluated its short-term outcomes to ascertain its safety and efficacy.

Surgical procedure

With a small incision performed near the pubic symphysis, the rectus abdominis muscle is carefully mobilized in a ventral direction. Subsequently, the rectus abdominis muscle and posterior sheath are meticulously dissected using endoscopic techniques along the arch line, enabling precise exposure of the hernia orifice. The hernia orifice is securely closed using a linear stapler, and a mesh is delicately placed within the same space.

Methods

We reviewed the surgical outcomes of 63 patients who underwent laparoscopic midline incisional hernia repair in our department from August 2017 to December 2023, employing our technique.

Results

Among the patients, there were 26 cases treated with intraperitoneal onlay mesh (IPOM), 16 cases with Laparoscopic Trans-Abdominal Retromuscular (TARM), and 21 cases with SRT, with no significant differences in patient background. The surgical time (range) was 94 minutes (50–211) for IPOM, 256 minutes (196–300) for TARM, and 126 minutes (60–224) for SRT; the mesh area (range) was 155 cm² (80–500) for IPOM, 500 cm² (270–780) for TARM, and 391 cm² (300–720) for SRT. The surgical time (P <0.001) and mesh area (P = 0.003) were significantly lower in the SRT group than in the TARM group.

Conclusions

SRT presents a simple and minimally invasive approach. Further accumulation of cases and demonstration of long-term results are necessary.
OUR RESULTS OF RETROPUBIC PROSTATECTOMY AND SIMULTANEOUS PREPERITONEAL INGUINAL HERNIA REPAIR IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA AND INGUINAL HERNIA
Authors: Shaprynskyi V O , Gorovyi V I , Baralo I V , Kapshuk O M , Moraru-Burlesku R P , Dovgan I I , Balatskyi R K , Shaprynskyi Y V , Metashop O S , Taheiev V R
Published: May 2024

The article presents the treatment results of 170 patients with benign prostatic hyperplasia who were treated in 2020–2023 years. All individuals were divided into two groups. The general group consisted of 50 (29.4%) patients with benign prostatic hyperplasia and inguinal hernia, who underwent one-stage retropubic prostatectomy and simultaneous preperitoneal inguinal hernia repair with mesh. The comparison group — 120 (70.6%) patients. The average age of men in the comparison group was 68.0 ± 7.2 years, in the general group — 67.7 ± 6.8 years; the average prostate volume in the comparison group was 94.4 ± 42.3 cm3, in the general group — 93.2 ± 32.7 cm3. The inguinal hernia was found in all 50 patients of the general group, among them in 6 men – on both sides (right side hernia — 32 patients, left side – 24). The average time of prostatectomy in the general group and in the comparison group was the same (82.8 ± 25.6 and 80.8 ± 17.4 minutes) as an intraoperative blood loss (516.2 ± 39.2 and 524.5 ± 44.3). The simultaneous inguinal hernia repair on the one side lasted 55.0 ± 17.4 minutes. Nonurological complications in the general group — in 3 (6%) patients, in the comparison group — in 9 (7.5%); urological complications according Clavien-Dindo took place in 15 (30%) and 40 (33.3%), respectively. The average postoperative inpatient stay in the general group was 9.5 ± 1.8; in the comparison group — 9.8 ± 2.6.

Conclusion

Retropubic prostatectomy and simultaneous preperitoneal inguinal hernia repair with mesh don’t increase immediate urological and nonurological complications that is why these two operations must be combined.
CLINICAL STUDY OF ACQUIRED LARGE ABDOMINAL WALL DEFECT REPAIR WITH MULTI-LAYER MESH BRIDGING TECHNIQUE
Authors: Song Z , Yang J , Gu Y
Published: May 2024

Aim

To investigate the clinical efficacy of double-layer mesh (synthetic + biological) and “sandwich” mesh (synthetic + biological + omentum flaps) bridging techniques for the repair of large abdominal wall defect patients.

Methods

The clinical data of patients with large abdominal wall defect after extensive resection of abdominal neoplasms or patients with acquired large abdominal wall defect underwent multi-layer mesh bridging technique were enrolled. Patients were divided into the double-layer group (group A) and the “sandwich” group (group B).

Results

23 patients underwent successful operation without perioperative mortality and serious complications. The mean abdominal wall defect area was 211.50 ± 91.01 cm2 in group A, 359.82 ± 203.96 cm2 in group B. Mean operation time was 6.92 ± 2.19 hours in group A and 5.18 ± 1.17 hours in group B. There were 6 seromas in group A and 1 in group B. Postoperatively, in group A there was 1 infection, and 3 subcutaneous effusions, whereas in group B, there was 1 hematoma, 1 subcutaneous effusion, and 1 incomplete intestinal obstruction. There was a significant difference in the short-term complication rate between the two groups.

Conclusions

The “sandwich” mesh bridging technique based on an omentum flap is novel and safe, and can effectively reduce postoperative complication rate. This technique can be considered as an alternative repair method for large abdominal wall defect repair and reconstruction.
LYMPHOCYTE/CRP LEVELS IN EMERGENCY OPERATED INCARCERATED HERNIAS FOR PREDICTING THE LEVEL OF ISCHEMIA
Authors: Temel R , Gümüş T , Tunalı S , Ersin S
Published: May 2024

Background

A hernia is defined as a protrusion, bulge, or projection of an organ or a part of an organ through the body wall. Incarcerated or strangulated hernias may present with nausea, vomiting or abdominal pain and emergency surgery may be required.

Method

In our study, 132 patients admitted to the emergency department for incarcerated hernia between the year 2020 and 2022 were retrospectively evaluated. Patients were divided into two groups according to the need for resection; demographic data, WBC, LDH, lactate and Lymphocyte/CRP (L/C) ratios that may be predictive for ischaemia were evaluated.

Results

The mean age of the patients was 67.37 ± 14.52 years, 70 (53%) were male and 62 (47%) were female.47 (35.6%) were operated for incisional hernia; 19 (14.4%) for umbilical hernia, 56 (42.4%) for inguinal hernia and 10 (7.6%) for femoral hernia. Resection was performed in 37 patients (28%); 29 (22%) of them had intestinal resection and 8 (6.1%) had colon resection. Patients were divided into two groups according to resection; no difference was found in WBC, LDH and lactate levels. The mean L/C ratio was 0.30 ± 0.74 in the resection group and 1.43 ± 3.66 in the non-resection group (p <0.001). The L/C ratio was evaluated by ROC analysis. Area under the curve was 70.1% [0.595–0.797]. Cut-off value was calculated and found as 0.0409. Patients were divided into two groups according to cut-off value, it was founded that resection was performed in patients with lower L/C ratio (p <0.001).

Conclusion

In our study, it was statistically shown that the need for resection decreased as the L/C ratio increased. The L/C ratio can be used as a simple, effective and inexpensive method to predict ischaemia in incarcerated hernias.
LONG-TERM OUTCOMES OF TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR USING A SELF-FIXATING MESH
Authors: Tomyak I , Neterdová M , Whitley A , Subrt Z , Bafrnec J
Published: May 2024

Aim

This retrospective study aims to assess the long-term outcomes of transabdominal preperitoneal inguinal hernia repair using a self-fixating mesh in a day surgery setting.

Methods

A retrospective analysis was conducted on patients who underwent transabdominal preperitoneal inguinal hernia repair using a self-fixating mesh between January 2016 and January 2018 at a single surgery center. Patients were contacted via telephone and administered a questionnaire, which included a modified Carolina score, and questions on inguinal pain, hernia recurrence, and complications. Follow-up duration.

Results

The median follow-up duration was 76 months (range 68–92). Recurrence was reported in 3 patients (6%) and chronic groin pain in 4 patients (8%). No cases of mesh migration were reported. Thirty-three patients (66%) returned to their daily activities within 6 weeks, 10 patients (20%) within one week, and 6 patients (12%) after 6 weeks.

Conclusion

Our study shows that transabdominal preperitoneal inguinal hernia repair with a self-fixating mesh is associated with a fast return to normal activities and has excellent long-term results, with a low rate of recurrence and chronic groin pain.
CONTINUOUS DERMIC TRACTION WITH VESSEL-LOOP SHOELACE TECHNIQUE FOR ABDOMINAL WALL DEHISCENCE
Authors: Torres A , Clavell A , Gené C , Segarra A , Malagón P , Carrasco C , Cuadrado M M
Published: May 2024

Background

The aim of this case is to highlight the importance of strict selection criteria and patient optimization for enhancing outcomes in complex abdominal wall surgery.

Methods

A fifty-five year-old woman, with a history of diabetes, hypertension, sigmoidectomy and grade IV obesity (BMI 42.8 kg/m2), was counseled for a midline hernia repair (M2–M4, W3). A posterior separation of components with PVDF and PP mesh placement in the retromuscular space was conducted.

In the immediate postoperative period, the patient developed respiratory failure, due to abdominal compartment syndrome requiring emergent surgery with mesh removal and an open abdomen treated with Abthera® negative pressure therapy (NPT). After two months in the ICU and NPT without aponeurotic retention, the patient was transferred to our center for definitive treatment.

Results

The patient arrived with complete abdominal viscera exposure. While a nutritional and respiratory optimization was performed, continuous and progressive dermic traction using a vessel-loop shoelace technique and NPT were applied in order to achieve a progressive abdominal wound closure.

Finally, when the skin was sufficient, a new surgery was planned to cover the exposed bowels, where only the cutaneous and subcutaneous planes could be closed. A small dehiscence in the M3 region was treated with skin grafting from the thigh. The patient has since returned home with restored quality of life.

Conclusion

Inadequate preoperative selection or optimization can lead to life-threatening consequences for the patient. We should promote intensive nutritional education and firmly avoid performing complex abdominal wall procedures in obese patients.
INGUINAL HERNIA REPAIR: TRANSABDOMINAL PREPERITONEAL (TAPP) VERSUS LICHTENSTEIN HERNIOPLASTY
Authors: Touzi M A , Khefacha F , Saidani A , Belhadj A , Chebbi F
Published: May 2024

Background

Inguinal hernias are one of the most common surgical pathologies in digestive surgery. The classical Lichtenstein repair (LR), long-considered as the gold standard, has been challenged since the 1990s by a minimally-invasive laparoscopic technique (TAPP). The aim of this study was to compare the short- and medium-term postoperative outcomes between LR and TAPP.

Methods

We conducted a cross-sectional study including tunisian patients followed up for inguinal hernia repair in the digestive surgery department, over a period of a year.

The study population was prospectively randomized between January 2020 and December 2020 to receive either LR or TAPP. The main outcome measure was hernia recurrence. Chronic postoperative pain and quality of life were the secondary outcome measures.

Results

Twenty-five patients underwent TAPP repair and 31 underwent LR. The average age of patients was 53.2 years. In the TAPP group, the operative time was significantly longer (p = 0.002) and the recovery was faster (p = 0.005). The LR group had higher visual analogue scale scores in the early postoperative (p <0.001), higher morbidity rate (p = 0.003) and complications such as hematomas (p = 0.022) and seromas (p = 0.043). Chronic postoperative pain was more prevalent in the LR Group than the TAPP group (p = 0.022). Both the LR and TAPP had no recurrences of hernia.

Conclusion

The TAPP procedure, despite the longer operative time, provided patients with postoperative comfort, fast recovery, less complications and reduced postoperative pain.
COMPLEX ABDOMINAL WALL RECONSTRUCTION (CAWR) IN PORT SITE METASTASES (PSM) WITH PERMANENT POLYPROPYLENE REINFORCED TISSUE MATRIX (PPRTM)
Authors: Zanellato A , Ryan N , May J
Published: May 2024

Objective

to report the use of a PPRTM for CAWR after PSMs resection. Our report highlights the possibility of bridging 2 larges defects with a single mesh with no need of myocutaneous flaps that are common reconstructive options for oncologic defects.

Case Report

79F with endometrial cancer presented with several anterior abdominal wall masses. Biopsy confirmed PSMs. Given their isolated nature, the two PSMs on right (9 × 6 cm) and one on left (4 × 3 cm) iliac fossa were resected with a 5 mm margin, resulting in two large bilateral defects. The pre-peritoneal space below acuate to arcuate was dissected to create sufficient space to wrap the abdominal wall with a single piece. On the right side, the gap was significantly bigger, and the therefore a transverse abdominal release (TAR) was performed to create space for overlapping cranially. An 40 × 25 cm was trimmed to cover the space completely. The gaps were partially reapproximated and attached to the mesh. A seroma was drained in the clinic on day 22 post-operatively. Follow-up at six months demonstrated good integrity of abdominal wall with no bulge.

Conclusion

Abdominal wall reconstruction after full thickness PSMs resection is challenging. It can be performed safely and effectively with attention to surgical technique, patients' risk of infection, and type of mesh, avoiding myocutaneous flaps. PPRTM would seem to be an adequate implant to perform the bridging repair, minimize morbidity and recurrence in these high-risk patients.
Biomechanical instability of the brain–CSF interface in hydrocephalus
Authors: Duy Phan Q , Mehta Neel H , Kahle Kristopher T
Published: May 2024

Hydrocephalus, characterized by progressive expansion of the CSF-filled ventricles (ventriculomegaly), is the most common reason for brain surgery. ‘Communicating’ (i.e. non-obstructive) hydrocephalus is classically attributed to a primary derangement in CSF homeostasis, such as choroid plexus-dependent CSF hypersecretion, impaired cilia-mediated CSF flow currents, or decreased CSF reabsorption via the arachnoid granulations or other pathways. Emerging data suggest that abnormal biomechanical properties of the brain parenchyma are an under-appreciated driver of ventriculomegaly in multiple forms of communicating hydrocephalus across the lifespan. We discuss recent evidence from human and animal studies that suggests impaired neurodevelopment in congenital hydrocephalus, neurodegeneration in elderly normal pressure hydrocephalus and, in all age groups, inflammation-related neural injury in post-infectious and post-haemorrhagic hydrocephalus, can result in loss of stiffness and viscoelasticity of the brain parenchyma. Abnormal brain biomechanics create barrier alterations at the brain–CSF interface that pathologically facilitates secondary enlargement of the ventricles, even at normal or low intracranial pressures. This ‘brain-centric’ paradigm has implications for the diagnosis, treatment and study of hydrocephalus from womb to tomb.
Learning of the same task subserved by substantially different mechanisms between patients with body dysmorphic disorder and healthy individuals
Authors: Wang Zhiyan , Tan Qingleng , Frank Sebastian M , Sasaki Yuka , Sheinberg David , Phillips Katharine A , Watanabe Takeo
Published: May 2024

It has remained unclear whether individuals with psychiatric disorders involving altered visual processing employ similar neuronal mechanisms during perceptual learning of a visual task. We investigated this question by training patients with body dysmorphic disorder, a psychiatric disorder characterized by distressing or impairing preoccupation with nonexistent or slight defects in one’s physical appearance, and healthy controls on a visual detection task for human faces with low spatial frequency components. Brain activation during task performance was measured with functional magnetic resonance imaging before the beginning and after the end of behavioral training. Both groups of participants improved performance on the trained task to a similar extent. However, neuronal changes in the fusiform face area were substantially different between groups such that activation for low spatial frequency faces in the right fusiform face area increased after training in body dysmorphic disorder patients but decreased in controls. Moreover, functional connectivity between left and right fusiform face area decreased after training in patients but increased in controls. Our results indicate that neuronal mechanisms involved in perceptual learning of a face detection task differ fundamentally between body dysmorphic disorder patients and controls. Such different neuronal mechanisms in body dysmorphic disorder patients might reflect the brain’s adaptations to altered functions imposed by the psychiatric disorder.
Continuous decision to wait for a future reward is guided by fronto-hippocampal anticipatory dynamics
Authors: Shintaki Reiko , Tanaka Daiki , Suzuki Shinsuke , Yoshimoto Takaaki , Sadato Norihiro , Chikazoe Junichi , Jimura Koji
Published: May 2024

Deciding whether to wait for a future reward is crucial for surviving in an uncertain world. While seeking rewards, agents anticipate a reward in the present environment and constantly face a trade-off between staying in their environment or leaving it. It remains unclear, however, how humans make continuous decisions in such situations. Here, we show that anticipatory activity in the anterior prefrontal cortex, ventrolateral prefrontal cortex, and hippocampus underpins continuous stay–leave decision-making. Participants awaited real liquid rewards available after tens of seconds, and their continuous decision was tracked by dynamic brain activity associated with the anticipation of a reward. Participants stopped waiting more frequently and sooner after they experienced longer delays and received smaller rewards. When the dynamic anticipatory brain activity was enhanced in the anterior prefrontal cortex, participants remained in their current environment, but when this activity diminished, they left the environment. Moreover, while experiencing a delayed reward in a novel environment, the ventrolateral prefrontal cortex and hippocampus showed anticipatory activity. Finally, the activity in the anterior prefrontal cortex and ventrolateral prefrontal cortex was enhanced in participants adopting a leave strategy, whereas those remaining stationary showed enhanced hippocampal activity. Our results suggest that fronto-hippocampal anticipatory dynamics underlie continuous decision-making while anticipating a future reward.
Recognizing ideas generated in a creative task: the roles of the hippocampus and medial prefrontal cortex in facilitating self-generated learning
Authors: Ding Ke , He Ruizhi , Wang Xi , Chen Qunlin , Kenett Yoed N
Published: May 2024

Creative idea generation plays an important role in promoting successful memory formation. Yet, its underlying neural correlates remain unclear. We investigated the self-generated learning of creative ideas motivated by the schema-linked interactions between medial prefrontal and medial temporal regions framework. This was achieved by having participants generate ideas in the alternative uses task, self-evaluating their ideas based on novelty and source (i.e. new or old), and then later being tested on the recognition performance of the generated ideas. At the behavioral level, our results indicated superior performances in discriminating novel ideas, highlighting the novelty effect on memory. At the neural level, the regions-of-interest analyses revealed that successful recognition of novel ideas was associated with greater activations in the hippocampus (HPC) and medial prefrontal cortex (mPFC) during ideation. However, only activation in the right HPC was positively related to the successful recognition of novel ideas. Importantly, the weaker the connection between the right HPC and left mPFC, the higher the recognition accuracy of novel ideas. Moreover, activations in the right HPC and left mPFC were both effective predictors of successful recognition of novel ideas. These findings uniquely highlight the role of novelty in promoting self-generated learning of creative ideas.
JrPHL8-JrWRKY4-JrSTH2L module regulates resistance to Colletotrichum gloeosporioides in walnut
Authors: Mu Yutian , Dong Yuhui , Li Xichen , Gong Andi , Yu Haiyi , Wang Changxi , Liu Jianning , Liang Qiang , Yang Keqiang , Fang Hongcheng
Published: May 2024

Walnut anthracnose (Colletotrichum gloeosporioides) reduces walnut yield and quality and seriously threatens the healthy development of the walnut industry. WRKY transcription factors (TFs) are crucial regulatory factors involved in plant-pathogen interactions. Our previous transcriptome analysis results indicate that JrWRKY4 responds to infection by C. gloeosporioides, but its specific regulatory network and disease resistance mechanism are still unclear. Herein, the characteristics of JrWRKY4 as a transcription activator located in the nucleus were first identified. Gain-of-function and loss-of-function analyses showed that JrWRKY4 could enhance walnut resistance against C. gloeosporioides. A series of molecular experiments showed that JrWRKY4 directly interacted with the promoter region of JrSTH2L and positively regulated its expression. In addition, JrWRKY4 interacted with JrVQ4 to form the protein complex, which inhibited JrWRKY4 for the activation of JrSTH2L. Notably, a MYB TF JrPHL8 interacting with the JrWRKY4 promoter has also been identified, which directly bound to the MBS element in the promoter of JrWRKY4 and induced its activity. Our study elucidated a novel mechanism of the JrPHL8-JrWRKY4-JrSTH2L in regulating walnut resistance to anthracnose. This mechanism improves our understanding of the molecular mechanism of WRKY TF mediated resistance to anthracnose in walnut, which provides new insights for molecular breeding of disease-resistant walnuts in the future.