bluuebunny/crossref_metadata_2025_split huggingface dataset:
RECURRENT COMPLEX INGUINAL HERNIA: ROBOTIC TAPP
Authors: Villalobos R , Maestre Y , Barranquero A G , Gas C , Semeraro C , Escartin A 
Published: May 2024

Abstract

Background
Inguinal hernia is a prevalent pathology that the only definitive treatment is a surgical approach. Many techniques were described but minimally invasive surgery (MIS) is the most recommended. Despite this recommendation, patients that present a recurrent inguinal hernia become very complex to approach with MIS. A robotic approach has emerged as an ideal option to perform this type of case. We present a video of a recurrent complex left inguinal hernia using a Da Vinci robotic approach. This patient had a previous Nyhus approach and a second surgical revision because of a great postoperative hematoma.

Method
A Veress needle was used to create the neumoperitoneum. After that, an 8 mm robotic trocar was introduced just above the belly bottom, then 2 equidistant 8 mm trocars on the right and another one on the left were placed. The trocars were numbered 1, 2, 3 and 4 from the left to the right. The number 4 was used to pull the tissue and to expose the defect. Number 1 was used for the bipolar fenestrated, number 2 for the camera and number 3 for the scissors and needle driver.

Results
After a partial dissection of the hernial sac, a big defect was found. The remaining sac was sutured to decrease the cavity. A 15 × 20 cm Dynamesh IPOM was placed and fixed in Cooper´s ligament and the rectus muscle. Finally, the peritoneum was closed using a 2–0 barbed suture.

Conclusion
MIS using a robotic platform is feasible, ergonomic and it allows to reconstruct and repair very complex inguinal hernias.
NAVIGATING RECURRENT PARASTOMAL HERNIA: A LAPAROSCOPIC SUGARBAKER APPROACH
Authors: Wannberg M , Hansske B 
Published: May 2024

Abstract

Aim
To highlight challenges and adverse outcomes in parastomal hernia patients.

Material and Methods
A 62-year-old woman with recurrent parastomal hernia underwent 8 laparotomies and 5 parastomal hernia procedures. Complications from a fundoplication resulted in a gastric bypass and jejunostomy. Chronic diarrhea led to a sigmoid stoma. Emergency surgeries included incisional hernia repair, laparotomies with mesh removal, and stoma revision. Referral to a specialist center resulted in a Rives-Stoppa and sublay procedure. Subsequent recurrence led to our center. A history of adhesions prompted an onlay approach with an elastic funnel mesh. A CT scan later diagnosed another recurrent parastomal hernia.

Results
Employing a laparoscopic approach, abdominal access was gained from the right flank using a 5-millimeter optic access port. Dissection of multiple adhesions preceded stoma visualization. The small bowel was mobilized, and hernia defect approximation was done with slowly resorbable continuous sutures. A Sugarbaker procedure with a 15 × 15 cm mesh and absorbable tackers was performed. The patient was discharged one-day post-surgery, with no evidence of recurrence at the three-month follow-up.

Conclusions
A laparoscopic approach, even in an adherent abdomen, proved feasible. Lateralization of the stoma during the initial surgery is preferable, and centralization of parastomal hernia patients in specialized centres is crucial for optimal management. Multidisciplinary treatment conferences should be considered for these complex cases to ensure comprehensive care. This case emphasizes the importance of a systematic approach and the potential effectiveness of the Sugarbaker technique in managing recurrent parastomal hernias.
ADDRESSING CHRONIC PAIN AFTER LAPAROSCOPIC IPOM REPAIR: A CASE OF SUCCESSFUL TACKS AND MESH EXCISION WITH RIVES-STOPPA RECONSTRUCTION
Authors: Barranquero A G , Maestre González Y , Gas Ruiz C , Raich M S , García-González L , Codina-Corrons L , Olsina Kissler J J , Villalobos Mori R 
Published: May 2024

Abstract

Introduction
Chronic pain following laparoscopic intraperitoneal onlay mesh (IPOM) repair with permanent tack fixation affects up to 13.8% of patients (Asaf Kahn et al. [2018]). In our case, this was addressed through the excision of the mesh and tacks, followed by abdominal wall reconstruction using a Rives-Stoppa repair.

Case Presentation
A 61-year-old woman presented with chronic abdominal pain following laparoscopic IPOM with permanent tack fixation in October 2021. Her EuraHS QoL score was 46/80 (excluding restrictions during sports), with a notable 21/30 "pain at the site of the hernia.” A CT scan revealed no evidence of hernia recurrence, 41 metallic tacks in the abdominal wall, and bilateral inguinal hernia.
The surgical intervention commenced with a midline laparotomy through the previous 20 × 30 cm mesh, which was excised en-bloc with the tacks. Subsequently, a bilateral retrorectus dissection was performed, addressing both inguinal hernias. The posterior layer was progressively closed, leaving a 9 × 9 cm defect that was bridged with a 9 × 15 cm biosynthetic polyglycolic acid/trimethylene carbonate mesh. Later, a 20 × 45 cm polyvinylidene fluoride (PVDF) retromuscular mesh was placed, and the anterior layer was completely closed.
The postoperative period was uneventful. At the one-month follow-up, the patient exhibited significant improvement in "pain at the site of the hernia" with a 9/30 score, still somewhat limited by postoperative pain, resulting in a EuraHS QoL score of 37/80.

Conclusion
Permanent tacks can contribute to chronic pain. An optimal repair requires the complete excision of the tacks and proper abdominal wall reconstruction.
SHOULD WE REPAIR DIASTASIS WHEN IS ASSOCIATED TO PRIMARY VENTRAL HERNIA?
Authors: Bosch G , Bravo A , Pérez M , Juvany M , Riba L , Carrancho A , Galindo J , Pereira J A 
Published: May 2024

Abstract

There is low consensus about rectal diastasis concomitant with a primary ventral hernia. However, the new EHS guidelines recommend joint repair in one time. In our group, in cases of asymptomatic diastasis D1–D2 associated with ventral hernia, only the hernia is repaired. The aim of this study is to analyze the impact of concomitant diastasis on preperitoneal ventral hernioplasties.

Methods
An observational single-center retrospective analysis was performed. We analyzed primary ventral hernia preperitoneal repairs in our hospital from 2017 to 2022. Two groups were compared according to the presence of concomitant diastasis recti or not. We performed a descriptive analysis; comparative univariate analysis for complication and recurrence and risk factors analysis.

Results
From 743 ventral hernia repairs a total of 663 (89,2%) preperitoneal open hernia repairs were performed. 57 (8,6%) patients had diastasis. The diastasis recti group had no statistically significative difference with the control group except more global comorbidity 215 (35.5%) vs. 32 (56.1%); p = 0,002 and more previous hernia repair 22 (3.6%) vs. 7 (12.3%) p = 0,008. There were 2 reoperations (0.3%), 7 readmissions (1.05%), and 1 death (0.15%). There were no differences in terms of global complications 92 (15,2%) vs. 10 (17,5%) p = 0,37 and recurrence was also similar in both groups. In the multivariate analysis any factor risk was found.

Conclusions
In our series, diastasis associated to ventral hernia repair seem not to impact in hernia repair outcomes and recurrence. So, diastasis repair should carefully take into account when repairing an associated ventral hernia in order to not increase complications.
COMPLEX CASE OF OPEN ABDOMEN CLOSURE WITH MESH MEDIATED FASCIAL TRACTION TECHNIQUE AND RECONSTRUCTION OF THE ABDOMINAL WALL IN CASE OF LOSS OF SUBSTANCE
Authors: Capoccia Giovannini S , Stabilini C , Rubartelli A , Carlini F , Longo G , Morelli N , Minuto M , Varaldo E , Ansaldo G , Bruno A , Drago B , Fanti F , Patania G , Mkrtchyan M , Frascio M , Camerini G 
Published: May 2024

Abstract

Aim
Our aim is to present the clinical case of an Open abdomen delayed closure with Mesh Mediated Fascial Traction (MMFT) and complex abdominal wall reconstruction.

Material and Methods
We report a case in which was combined the MMFT with a complex abdominal wall reconstruction due to loss of substance.

Results
A 34 years old male after suicide attempt was submitted to an emergency laparotomy for retroperitoneal hematoma determining colonic perforation and disruption of the insertion of rectus abdominis muscles (RAM) to the pubic bone resulting in a loss of substance in the lower part of the abdomen. A sigmoidectomy, a lateral ileostomy and open abdomen was performed. After 9 days was planned the closure. There was a divarication of RAM of 14 cm in width, loss of substance above the arcuate line, exposure of inguinal ligaments bilaterally and a massive adhesion syndrome of small bowel.
The massive soft tissue edema and stiffness of abdominal wall made impossible the closure of the skin. A MMFT technique was used for the medialization of the RAM. 3 cm was gained for each revision, every 48 hours and in 6 procedures the abdomen was closed. For the reconstruction of the lower part of the abdomen a biosynthetic mesh 9 × 15 cm was placed intraperitoneally and over it was implanted a macroporous mesh secured with the onlay mesh placed over the RAM.

Conclusions
Closure of open abdomen with MMFT technique is useful but availability of materials and expertise are required for complex cases.
PECULIARITIES OF MESH FIXATION DURING TAPP IN PATIENTS WITH INCARCERATED INGUINAL HERNIA
Authors: Feleshtynskyi Y , Onyshko M , Vatamaniuk V 
Published: May 2024

Abstract

Background
Aim of the study is to increase the effectiveness of TAPP in incarcerated inguinal hernias by fixing the mesh with glue combined with an antiseptic. Experimental study.

Method
Analysis of surgical treatment of incarcerated inguinal hernias with TAPP was carried out in 92 patients, aged from 30 to 75 years, average age 50 + 1.2 years. Only males were included. In the first group, 47 patients polypropylene mesh was fixated using an adhesive composition of polyurethane glue with the antiseptic decamethoxin. The peculiarity of mesh fixation was that glue was applied to the entire surface of the mesh. In the second group of 45 patients, mesh fixation was performed with the absorbable tacks.

Results
In the early postoperative period, among the patients of the first group, seroma was observed in 3 (6.3%) patients, infection of the wounds was not observed, chronic postoperative pain was diagnosed in 1 (2.1%) patient. Among the patients of second group seroma of the implantation site occurred in 14 (31.1%), infection in 4 (8.8%). Long-term results were studied from 1 to 36 months in 40 patients of group I and 41 patients of group II. Recurrences were found only in 4 (9.7%) patients of the 2nd group, which was due to infection of the area of the mesh implant, which was removed.

Conclusion
Mesh fixation with an adhesive composite during TAPP in patients with pinched hernias, compared to traditional fixation by tacks, reduces the likelihood of seroma, infection.
HERNIA RECURRENCE, CHRONIC PAIN AND INFECTION IN PATIENTS UNDERGOING OPEN REPAIR OF VENTRAL HERNIA OR DIVARICATION OF RECTUS ABDOMINUS WITH MONOFILAMENT POLY-4-HYDROXYBUTYRATE MESH: A RETROSPECTIVE, PATIENT-REPORT CASE SERIES
Authors: Field M , Molesworth C , Kaplan E 
Published: May 2024

Abstract

Aim
To report rates of patient-reported hernia recurrence, chronic pain and re-operation for surgical site infection (SSI) in patients who underwent open repair of ventral hernia or divarication of rectus abdominus using monofilament Poly-4-hydroxybutyrate (P4HB) mesh.

Method
Multi-centre, retrospective case series using prospectively collected anonymous patient-reported outcomes. Inclusion criteria: diagnosis of Spigelian, incisional or umbilical hernia or divarication of rectus abdominus; open repair using resorbable P4HB monofilament mesh.
Primary outcome: recurrence rate using Ventral Hernia Recurrence Inventory (VHRI). Secondary outcomes: (1) chronic pain using a modified item from Ventral Hernia Pain Questionnaire (VHPQ); (2) rate of re-operation for SSI.

Results
Twenty-four of 42 (57%) eligible patients participated: 54% of participants were female and 75% were aged ≥50 years.
On VHRI, 13% of participants reported their hernia had come back, 25% felt or saw a bulge, 46% reported physical symptoms or pain at the site. On the VHPQ modified item, 79% of participants reported either no pain or pain that can easily be ignored, the remaining 21% reporting higher levels of pain. Three participants (13%) reported having a follow-up procedure for SSI.
Female participants reported higher rates of pain or symptoms at the site, levels of pain and follow-up procedures for SSI.

Conclusions
Recurrence rates for patients with ventral hernia or rectus abdominus who underwent open repair with P4HB mesh were broadly similar to previously published ventral hernia recurrence rates. Female participants experienced higher rates and levels of pain, and more frequent follow up procedures for SSI.
POLY4 HYDROXYBUTYRATE MESH: LONG-TERM RESULTS FROM A SINGLE INSTITUTION
Authors: Fra D , García Galocha J L , Peña M J , López Antoñanzas L , Charef L , del Campo M , Torres A 
Published: May 2024

Abstract

Aim
The aim of this retrospective review is to analyze long term results with Poly 4 hidroxibutirate (P4HB) mesh in our institution. The main end point was recidive and its factors asociated.

Material and Methods
During the period between May 2015 and December 2021, 93 patients with abdominal wall complex defects were operated on, using P4HB mesh at our third-level institution in Spain. Several variables were analyzed to identify any factors related to recurrence. Multivariate statistical analysis was employed to identify independent factors.

Results
Out of the total cases, 26 were excluded due to insufficient follow-up time. The majority of patients were women (54%) with a mean age of 65. Midline incisional hernias were predominant (80.2%), and 80.6% were elective procedures. The most frequently used surgical technique was supra-aponeurotic repair (84.78%). Postoperative wound infection was 12.9%, and the hernia recurrence rate was 11.94%. Significant independent risk factors for recurrence included concurrent malignant neoplasm, para-stomal hernia, and postoperative complications.

Conclusions
P4HB is a long-term absorbable biosynthetic material. One of the possible adverse effects is a higher recurrence incidence. In our study, we observed an 11% recurrence rate, which is similar to when we use other materials. In particular, concurrent malignancy, para-stomal hernia, and postoperative complications emerged as statistically significant factors contributing to recurrence. As a result, we might say that P4HB meshes would be a useful tool in these situations in which leaving a permanent mesh could be a problem because of the high risks of complications related to them.
ROBOTIC-ASSISTED INGUINAL HERNIA REPAIR WITH A NEW ROBOTIC SYSTEM: A PROSPECTIVE MULTICENTRE CLINICAL INVESTIGATION
Authors: Gantner L , Mignot H , Pochhammer J , Grieder F , Breitenstein S 
Published: May 2024

Abstract

Aim
Robot-assisted transabdominal preperitoneal inguinal hernia repair (rTAPP) is established as safe and feasible with various robotic platforms. This prospective clinical study (NCT05873582) evaluated a new robotic system, consisting of an open platform with a sterile surgeon’s console, two robotic instrument arms, and one robotic endoscope arm.

Material and Methods
Three centres in France, Germany and Switzerland participated in the study. Safety and clinical performance data were collected perioperatively up to 30 days for both unilateral and bilateral inguinal hernia repair.

Results
Fifty patients underwent rTAPP for inguinal hernia (33 unilateral, 17 bilateral). Mean age was 60 years (±15) and BMI 25.7 kg/cm2 (±3.3). All surgeries were successfully completed with robotic assistance, with one conversion to laparoscopy due to trocar positioning. No intra-operative complications, device deficiency, or adverse events of Clavien-Dindo Grade III to V occurred. The mean skin-to-skin operative times were 55 min (±14) for unilateral, 95 min (±22) for bilateral hernia. The mean docking time was 4 min (±2). Robotic console time were 34 min (±12) for unilateral, 68 min (±21) for bilateral hernia. Patients were discharged within 1 day, while 26 discharged on the day of the procedure. The mean duration to return to normal activities was 8.1 days.

Conclusions
Our rTAPP experience with this new robotic system confirms feasibility and safety. The performance was similar to comparative devices on the market, positioning this new robotic system as an advantageous tool in inguinal hernia repair.
HERNIA MESH EXPLANTATION FOR MESH INGUINODYNIA AND ALLODYNIA. WHY IS HERNIA MESH SO PAINFUL?
Authors: Garvey J F W , Atmore B 
Published: May 2024

Abstract

Introduction
Chronic pain after mesh repair for abdominal wall hernia is an indication for the removal of mesh and reconstruction by a non-mesh technique.

Materials and Methods
In a consecutive series over 19 years, 128 patients had mesh removed to relieve chronic pain. This open method of mesh removal relies on confirming normal anatomical landmarks. The superior and inferior leaf of the External oblique aponeurosis are raised, the spermatic cord is identified and retracted. The mesh is gently dissected off the Internal oblique from lateral to medial, taking care in preserving the vas, and accompanying vessels. Adherent ilio-inguinal, iliohypogastric and genitofemoral nerves are removed with the mesh. The resultant recurrent hernia is repaired by Moloney darn, a tension-free tissue repair.

Results
128 consecutive patients have been treated by mesh explantation and immediate reconstruction on average 6 years after implantation. Resolution of symptoms was experienced very shortly after the mesh removed. Preperitoneal mesh particularly Kugel patch has been the most difficult to remove. Meshes have been submitted for histological examination and the findings are usually chronic granulomatous foreign body reaction. Few complications have been encountered with a follow-up period ranging from 6 months to 15 years, the most common being the failure of explantation to alleviate inguinal pain in the long-term.

Conclusion
All hernia patients should be afforded informed consent including discussing the potential long-term consequences of chronic groin and abdominal pain.
THE SAFE INTRODUCTION OF ROBOTIC SURGERY INTO A BUSY HERNIA PRACTICE; PATIENT OUTCOMES AND LEARNING CURVE
Authors: Hayward R , Alhadad Z , Smith J J , Muirhead L J , Qiu S , Warren O J 
Published: May 2024

Abstract

Background
The use of robotics in hernia surgery is increasing. Continuous, real-time outcome analysis is vital to inform and protect patients, and enable cost-benefit decisions.

Method
Prospective data capture on patients undergoing robotic hernia repair during one surgeon’s introduction of robotics into their high-volume practice.

Results
In the year 2023, 60 hernia repairs were performed robotically: 29 ventral (transabdominal retromuscular umbilical prosthetic n = 12, parastomal Sugarbaker n = 5, transabdominal preperitoneal (TAPP) n = 4, extended totally extraperitoneal n = 4, component separation/transversus abdominis release n = 3, intraperitoneal onlay mesh n = 1); 28 inguinal (TAPP); 3 combined inguinal/ventral. 45 patients (76%) were male, median age 67.
Median blood loss was 10 ml, with no blood transfusions. 3 operations (5%) were converted to open. 23 operations (38%) were day-case. There were 2 readmissions; 1 patient returned to theatre and sadly died with pathology unrelated to his hernias.
52 patients (87%) had complication-free recovery. 4 complications were Clavien-Dindo (CD) grade I (urinary retention n = 3, persistent numbness n=1). 2 complications were CDII (pneumonia n = 1; superficial infection n = 1). 2 patients had infections requiring drainage (CDIII). There were no mesh explanations or early recurrences (median follow-up 3 months).
Overall median console time was 52 minutes (IQR 38–71). For the first 14 inguinal repairs, median console time was 49 minutes. This decreased to 37 minutes for the following 14 repairs (p &lt; 0.001).

Conclusion
Length of stay, complications, re-admission and recurrence rates are within acceptable parameters, supporting the feasibility of introducing robotic hernia surgery into practice. A learning curve is demonstrated, with rapid significant improvement in operative duration.
EQUAL PROCEDURAL COST OF ROBOT-ASSISTED AND LAPAROSCOPIC VENTRAL AND INCISIONAL HERNIA REPAIR. A NATIONWIDE DATABASE STUDY
Authors: Henriksen N A , Christoffersen M W , Marckmann M , Jensen K K 
Published: May 2024

Abstract

Background
The use of the robotic platform for ventral hernia repair has increased in the last decades, however, it has been criticized for being too expensive. The aim of this was study was to compare the procedure-specific cost of robot-assisted and laparoscopic ventral and incisional hernia repair including cost of procedure-related readmissions and reoperations within 90 days postoperatively.

Methods
This was a nationwide database study including 554 robot-assisted ventral and incisional hernia repairs matched 1:1 on hernia type and defect size with laparoscopic repairs.
The primary outcome was the total cost per procedure in Euros including the cost of a robotic approach, extra ports, mesh, tackers, length of stay, length of readmission, and operative reintervention.

Results
For a robot-assisted approach, the mesh was most often placed in the retromuscular position 75.6% (419/554), whereas the mesh was placed in the intraperitoneal position 76.9% (426/554), P &lt;0.001. Likewise, a self-fixating mesh was used significantly more in the robotic group 68.1% (337/554) compared with fixation with tackers in the laparoscopic group 67.3% (373/554), P &lt;0.001. The length of stay was significantly shorter and readmission rate significantly lower for robot-assisted repairs (0.5 days and 7.0%) compared with laparoscopic repairs (1.2 days and 12.5%), P &lt;0.001. The mean total cost of all robot-assisted ventral and incisional hernia repairs was 1,342 euro compared with 1,519 euro for laparoscopic repairs, P = 0.594.

Conclusion
The procedural cost of a robot-assisted ventral and incisional hernia repair is comparable to the cost of a laparoscopic approach.