bluuebunny/crossref_metadata_2025_split huggingface dataset:
PERINEAL HERNIA REPAIR: MULTICENTRE COMPARATIVE ANALYSIS OF SYNTHETIC MESH VERSUS MESH COMBINED WITH TISSUE FLAP
Authors: Kreisel S I , de Jong D L C , Burger P J W A , Hompes R , Nienhuijs S W , Verhoef C , Musters G D , Tanis P J 
Published: May 2024

Abstract

Aim
Surgical techniques for perineal hernia repair have evolved over time. Presently, synthetic mesh repair is the preferred technique, but recurrence rates are high. This study aimed to compare the outcomes of adding a tissue flap to the mesh with mesh-only repair.

Method
Between 2006 and 2022, patients who underwent perineal hernia repair with synthetic mesh or mesh combined with tissue flap were retrospectively identified from three referral centres. Primary endpoint was recurrent perineal hernia.

Results
Seventy-nine patients were included, of which 65 patients underwent mesh-only repair and 14 patients mesh with flap repair. Postoperative perineal wound complications occurred in 23% in the mesh-only group and in 21% in the mesh with flap group. Meshes were solely explanted within the mesh-only group (n = 3). There were no flap failures in the mesh with flap group. During a median follow-up of 54 months, recurrent perineal hernia occured in 27/65 (42%) after mesh-only and in 2/14 (14%) after mesh with flap repair (p = 0.06). Time to recurrent hernia was median 14 months. Failed mesh only repair was successfully treated by crossover to mesh with flap in 4/4 patients.

Conclusion
Mesh combined with tissue flap repair of a perineal hernia seems more effective than synthetic mesh-only repair. These findings have to be confirmed in larger series.
LAPAROSCOPIC VENTRAL HERNIA REPAIRS IPOM 35 CONSECUTIVE CASES WITH BIOSYNTHETIC MACROPOROUS PTFE MESH: OUR INITIAL EXPERIENCE
Authors: Latham L , Soldini G , Casali A , Antonini I , Intelisano A , Musolino C , Scalambra S M 
Published: May 2024

Abstract

Introduction
The laparoscopic intraperitoneal onlay mesh (IPOM) technique for the repair of incisional and parastomal hernias has increasingly gained popularity since its first description in 1993. The main advantage in comparison with the open approach is the reduced incidence of wound complications and the lower recurrence rate.
Meshes used for laparoscopic approaches must induce strong and rapid incorporation on the parietal side and they should also prevent adhesions on the visceral side.
Biosynthetic macroporous ptfe meshes are innovative solutions for advanced reconstruction in the repair of hernias and abdominal wall soft tissue deficiencies that may require the addition of a non-absorbable reinforcing or bridging material.
These meshes offer 4 main solutions in the wall hernia repairs: they facilitate wound healing, support rapid vascularization, minimize need for removal and enable single-stage repair.

Materials and Methods
In our center from 15th of January 2023 till 31st of December 2023 we performed 35 laparoscopic abdominal wall hernia repairs with laparoscopic intraperitoneal onlay mesh (IPOM) using biosynthetic macroporous ptfe mesh, 21 for incisional hernia and 14 for primitive hernia. 31 were ventral defects (17 M3, 10 M2, 4 multiple hernia defects) and 2 were subxyphoidal (M1), 1 lateral iliac defect (L3) and 1 suprapubic (M5), 20 women and 15 men.
The median age of the patients was 58 yrs old, the median size of the defect was 3.5 cm length × 3 width cm, the median size of the meshes was 15 cm lenght × 15 cm width, the median operating time was 60 minutes.
All the meshes were positioned with a double crown of tacks: the inner crown with absorbable tacks and the outer crown with non absorbable tacks.

Results
No intraoperative complications were detected, post operative complications were: a trocar hernia with small bowel incarceration that lead the patient to surgery, no prolonged pain or discomfort was detected.
The median time of hospitalization was 1 day.

Discussion
The new biosynthetic macroporous ptfe mesh shows to be more flexible with good memory that enable an easy unrolling, facilitating its placement and, most of all, seems to positively impact on the post operative quality of life.
USE OF CYANOACRYLATE GLUE AS AN ALTERNATIVE FOR PERITONEAL DEFECT CLOSURE IN MINIMALLY INVASIVE INGUINAL HERNIA REPAIR BY TEP APPROACH
Authors: Licardie E , Navarro-Morales L , Moreno-Suero F , Suárez-Grau J M , Morales-Conde S 
Published: May 2024

Abstract

Aims
Laparoscopic approach to inguinal hernia has a great future as a gold standard' procedure given its advantages over the open approach. Regarding the TEP approach, one of the biggest 'fears' is repairing an accidental opening of the peritoneum in the surgery. An Endoloop can be used for closure, however, if the defect is too large it forces us to suture it. We present an alternative for closure of such holes.

Methods
A male patient with diagnosis of bilateral inguinal hernia who underwent repair by TEP approach. In the first surgical technique introducing the balloon to dissect the pre-peritoneal space in order to be able to approach the inguinal spaces, a very firm adherence of the peritoneum to the area of the vas deferens is observed, which when the balloon dissection is performed produces a laceration of the peritoneum and an important defect that must be repaired.

Results
Continued by dissecting and identifying the anatomical landmarks to determine the area of dissection and their location with respect to the hernial defect. The anatomical spaces are dissected and the hernial sac is freed from the rest of the structures and placed the mesh. Before going to the contralateral side, the orifice is closed with cyanoacrylate glue. It is not necessary to use sutures for this closure, checking its tightness and security in order to continue.

Conclusions
We believe that the use of cyanoacrylates for the closure of holes in the peritoneum during the TEP-approach can be a useful and efficient resource.
INCISIONAL VENTRAL HERNIA REPAIR TRENDS IN THE LAST DECADE: AN ACHQC NATIONWIDE DATABASE ANALYSIS
Authors: Lima D L , Kasakewitch J P G , Nogueira R , Keisling S , Phillips S , Sreeramoju P 
Published: May 2024

Abstract

Aim
This study evaluates the trends in incisional ventral hernia repair (IVHR) techniques and their outcomes over ten years in the United States.

Material and Methods
A retrospective review of IVHR from the Abdominal Core Health Quality Collaborative (ACHQC) database (a US Nationwide hernia registry) was conducted from January 2013 to December 2022. Adult patients who underwent incisional ventral hernia repair using different techniques and with 30-day follow-ups were included.

Results
22,434 patients were included after applying inclusion and exclusion criteria. The use of the robotic approach increased from 8.0% (2013–2015) to 36.4% (2019–2022), while the open technique decreased from 69.9% to 55.9%. Median Mesh/hernia width increased over time from 2.5 (IQR 1.9–3.4) to 2.7 (IQR 2–3.7) (p &lt;0.001), along with median mesh width from 17 cm (IQR 13–17) to 19 cm (IQR 12-30) (p &lt;0.001). There is a decreasing trend of biologic mesh use from 4.98% to 2.6%. Regarding mesh positioning, retromuscular repair increased from 52.2% to 63.1%, preperitoneal decreased from 12.6% to 11.6% and intraperitoneal decreased from 34.4% to 23.9% (p &lt;0.001). 30-Day readmission, recurrence, SSI (Surgical Site Infection) and reoperation across groups were the same. There was a decrease in SSO (Surgical Site Occurrence) over time from 15% to 10% (p &lt;0.001).

Conclusion
This study highlights a significant trend toward MIS techniques in IVHR over the last decade. This shift is accompanied by consistently minimal intraoperative complications using bigger meshes in larger defects. There is a decrease in SSO rates and biologic mesh usage.
ROBOTIC SURGERY AS A TOOL FOR INCREASED DEXTERITY IN MINIMALLY INVASIVE HERNIA SURGERY – AN ANALYSIS OF TRENDS AND BASELINE COMPARISON OF 10 YEARS OF MIS VENTRAL HERNIA REPAIRS IN THE UNITED STATES USING THE ACHQC DATABASE
Authors: Lima D L , Nogueira R , Kasakewich J , Balthazar da Silveira C A , Dias Rasador A C , Malcher F 
Published: May 2024

Abstract

Aim
To evaluate the dexterity in Minimally invasive ventral hernia repair (VHR) in the last 10 years in the United States utilizing the Abdominal Core Health Quality Collaborative (ACHQC) database.

Materials and Methods
A retrospective review of prospectively collected data from the ACHQC database was performed to include all adult patients that underwent laparoscopic and robotic VHR in the last 10 years. Univariate analysis was performed to compare outcomes from laparoscopic and robotic-assisted approaches across preoperative, intraoperative and postoperative outcomes in two different periods in time.

Results
ACHQC database identified 15,437 patients that underwent VHR. Patients were divided into four groups: Laparoscopic 2013–2017 (Lap1) (n = 2,535), Robotic 2013–2017 (n = 1,806) (Robot1), Laparoscopic 2018–2022 (n = 2,063) (Lap2), and Robotic 2018–2022 (n = 9,033) (Robot2). Median Hernia width was higher in the Robot2 (4 cm IQR 2–6) when compared to the lap2 group (3 cm IQR 2–5) (p &lt;0.001). Retromuscular repair was higher in the Robot2 group when compared to Lap2 group (n = 3201; 37.6% versus n = 68; 4.2%) and to the Robot1 group (n = 419; 24.7%) (p &lt;0.001). Fascial closure was higher in the Robot2 group when compared to Lap2 group (n = 8649; 96.5% vs. n = 1359; 67.3%) and to the Robot1 group (n = 1736; 96.1%) (p &lt;0.001). There was no difference in SSI between groups and SSO/I was lower in the Robot2 group when compared to Lap2 and Robot1 groups. Readmission rate was lower in the Robot2 group when compared to Robot1 (2.6% vs. 2.9%, p = 0.009).

Conclusions
Robotic approach was associated with more technically challenging repairs with lower complication rates over time.
PSEUDO HERNIA A RARE PRESENTATION OF A SKELETAL FLUOROSIS
Authors: Lodha M 
Published: May 2024

Abstract
Pseudo hernia is a bulge of the abdominal wall due to weakness of the muscle of the abdominal wall, the main differential diagnosis of the pseudo hernia is the hernia, which differ from the hernia is that there is diffuse swelling and bulge and such there is no defect to palpate, it can happen after spinal trauma, nerve injury to abdominal wall and pressure on the nerve.
Our case presented as a bulge on the lumber reason with obvious no past history of any surgery, on CT scan we found that there is sclerosis of the bone of the vertebral region, which was suspected probably as a skeletal sclerosis leading to the nerve pressure and muscle weakness.
In our region skeletal fluorosis is quite common in past, we conduced nerve conduction study also which did not reveal any anomaly although.
HYBRID LAPAROSCOPIC REPAIR OF COMPLEX ABDOMINAL WALL HERNIAS WITH TRANSABDOMINAL PARTIALLY EXTRA-PERITONEAL (TAPE) MESH FIXATION: PRELIMINARY RESULTS
Authors: Mahmood S , Moollan Y , Badiani S S , Rajkomar K , Berney C R 
Published: May 2024

Abstract

Background
There are two conventional approaches to abdominal wall hernia repairs which aim to achieve anatomical restoration. Open approaches have the advantage of complete hernial sac excision and more freedom with mesh placement. In comparison, laparoscopic approaches benefit by shorter hospital stays, less post-operative pain and fewer post-operative complications. Recently a hybrid approach which combines the two techniques has gained popularity.
Our aim was to validate if such hybrid approach can still achieve the same benefits, irrespective of hernia size, age, and BMI, with acceptable low complication and recurrence rates.

Method
The medical record of all patients who underwent hybrid laparoscopic hernia repair (HLHR) from 2017 to 2023 was retrieved from a prospectively maintained institutional database and retrospectively analysed. Intra- and post-operative complications, as well as hernia recurrence at 6 months were assessed.

Results
There were 37 patients (21 females: 56.8%) with a mean age of 66 years and BMI of 34.2 kg/m2 who underwent hybrid hernia repair. Thirty-four (91.9%) were incisional hernias, of which 50% were recurrent. Mean hernia size was 96.8 cm2. Twelve (32.4%) patients had preoperative chemical component separation with botulinum toxin A (BTA); this group had a significantly higher BMI and hernia size compared to no BTA (37.7 vs. 32.5; P=0.048; 174.5 cm2 vs. 59.5 cm2; P=0.0002). There was no intra-operative, but eight (21.6%) minor postoperative complications. There was no hernia recurrence at 6 months follow-up.

Conclusions
HLHR with TAPE mesh fixation is safe with satisfactory outcome, irrespective of hernia size and BMI.
ABDOMINAL SKIN NECROSIS FOLLOWING RIVES AND ANTERIOR COMPONENT SEPARATION TECHNIQUE
Authors: Martínez Alegre J , Sánchez López J D , Ferrero Celemin E , Vaquero Pérez M A , García-Sancho Téllez L , Picardo Nieto A L 
Published: May 2024

Abstract

Aim
Skin necrosis is a complication that we can find after abdominal wall surgery. In this paper we show how we treated this complication.

Material and Methods
Male 69 years with M2-4W3 abdominal wall hernia. Preoperatively we applied botulinum toxin in both sides. We perform Rives eventroplasty closing posterior fascia with monofilament 2/0 small bites and reticular mesh 20 × 15 cm. Due a high tension we perform an anterior component separation only in left side to get free tension close.
After 72 hours our patient present dyspnea, abdominal pain and transfer to intensive care. After 48 hours we could see skin necrosis at the right side of laparotomy, paradoxically where we didn´t anterior component separation.

Results
After stabilization by intensive care we perform surgical debridement of all necrotic tissue and applied a negative pressure wound therapy on this side. One month later, in collaboration with plastic surgeon, we could close skin defect.

Conclusion
Skin necrosis is a severe complication in abdominal wall repair surgery. Negative pressure wound therapy and multidisciplinary treatment were necessary for successful management.
OUTCOMES OF CONCURRENT PANNICULECTOMY AND HERNIA REPAIR IN A SINGLE SURGEON’S ABDOMINAL WALL RECONSTRUCTION PRACTICE
Authors: Mead B , Holland A , Lorenz W , Scarola G , Ku D , Hollingsworth R , Augenstein V 
Published: May 2024

Abstract

Background
Concurrent panniculectomy (CP) with hernia repair allows patients to have removal of their redundant skin and excess overlying fat in addition to herniorrhaphy. While providing excellent cosmesis and patient satisfaction, concerns have historically included longer operative times, higher rates of wound complications and infection. This study analyzed the rates of postoperative complications in patients undergoing CP with abdominal wall reconstruction (AWR).

Methods
A prospectively maintained institutional database was queried for patients who underwent both hernia repair and CP. All patients had the same fellowship trained surgeon, between 2017 and 2023. Primary outcomes included wound complications and hernia recurrence rates.

Results
A total of 149 patients were identified; 75.8% were female, mean age was 57.3 ± 12.2 years, median BMI was 32.2 kg/m2 (IQR:28.4, 36.5), 30.9% had diabetes, 14.8% were immunosuppressed, and 5.4% were smoking. Prehabilitation resulted in a median preoperative weight loss of 11.7 lbs (IQR:21.7, 1.0). Median hernia size was 216.0 cm2 (IQR:150.0, 300.0), and 97.3% were ventral hernias. Median mesh size was 900.0 cm2 (IQR:471.2, 1050.0), 57.7% were biologic, and 98.7% of all repairs had preperitoneal mesh placement. Intraoperatively, 83.2% of cases were clean or clean-contaminated. Median operative time was 134.5 minutes (IQR:110.0, 176.0). Postoperative wound complications included seroma requiring intervention (11.4%), cellulitis (7.4%), wound infection (6.0%), intraabdominal abscess (6.0%), wound breakdown (3.4%), hematoma requiring intervention (3.4%), and mesh infection (1.3%). Hernia recurrence rate was 2.0% over a median follow-up time of 16.4 months (IQR:5.7, 41.1).

Conclusion
CP with AWR does not compromise wound morbidity or hernia recurrence. Despite significant patient comorbidities, rates of postoperative wound morbidity were low.
RECURRENCE AFTER IMPLEMENTATION OF AN UPDATED INTRAOPERATIVE PROTOCOL FOR TOTALLY EXTRAPERITONEAL (TEP) INGUINAL HERNIA REPAIR IN A HIGH-VOLUME CLINIC – A RETROSPECTIVE COHORT STUDY
Authors: Meuzelaar R R , de Vries J J , Burgmans J P J , Schiphorst A H W 
Published: May 2024

Abstract

Background
Recurrence rate after inguinal hernia (IH) repair is low, however, it remains an important postoperative outcome due to its adverse impact on quality of life. Therefore, modifiable risk factors should be explored and adjusted to reduce recurrence rate. Consequently, recommendations to the intraoperative protocol for totally extraperitoneal (TEP) repair were implemented in a high-volume hernia clinic. The present, retrospective cohort study assessed reoperation for recurrence-like complaints after the adoption of this protocol, which recommended fixating mesh in large, direct defects and thoroughly reducing lipomas.

Method
All patients receiving IH repair between January 1, 2013 and October 25, 2023 were studied retrospectively. Only elective TEP repairs in adult individuals were included. Subsequently, the cohort was divided into two groups, depending on when their TEP repair had been performed, pre- or post-implementation. The primary outcome was reoperation for recurrence-like complaints after initial TEP repair. Secondary outcomes were mesh fixation and lipoma reduction.

Results
In total, 14.536 IH repairs were performed in the studied period, of which 12.878 TEP repairs in 12.507 patients were included. Pre-implementation, 0.97% of the patients were reoperated, compared to 0.65% in the post-implementation group (p = 0.70). A significant increase of mesh fixation was observed (p &lt;0.001) post-implementation. Lipoma reduction was similar between both groups (p = 0.32).

Conclusion
The adoption of the updated intraoperative protocol for TEP repair demonstrated a declining trend of reoperations for recurrence-like complaints, which was not statistically significant. Additionally, this study illustrates how internal quality analysis may be used to enhance surgical care.
LAPAROSCOPIC TOTALLY EXTRAPERITONEAL REPAIR OF INGUINAL HERNIAS IN FEMALE PATIENTS: DOES OLDER AGE INFLUENCE INCIDENTAL FINDINGS AND QUALITY-OF-LIFE?
Authors: Moollan Y , Badiani S S , Tsakanov S , Rajkomar K , Berney C R 
Published: May 2024

Abstract

Aim
To investigate the age-related incidence of incidental perioperative findings and differences in postoperative Quality-of-Life using the Carolinas Comfort Scale (CCS), in all female patients undergoing laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

Material and Methods
The clinical data of all female patients who underwent elective TEP repair between September 2009 and December 2023 was retrieved from a prospectively maintained institutional database. The data was divided into two groups (age ≤50 years vs. &gt;50 years old) and analyzed retrospectively.

Results
There were 143 female patients who underwent TEP repair of 176 inguinal hernias with no conversion to open. Forty-one femoral and 33 obturator hernias were incidentally found in 58 patients (40.6%). Patients aged ≤50 years had the same frequency of incidental femoral hernias than those &gt;50 years, but there was a trend towards increased incidence of obturator hernias found in older age group (P = 0.06).
At 2-weeks post-surgery, the average CCS score ratio was 0.14 +/- 0.15 in the younger age group, compared to 0.08 +/- 0.11 in &gt;50 years (P = 0.008). When looking at the eight different domains of the CCS score, younger patients (age ≤50 years) were experiencing significantly more pain when performing activities of daily living (P = 0.017), walking, or standing (P = 0.05), or taking stairs (P = 0.02).

Conclusions
TEP inguinal hernia in older female patients increases the chance of finding an associated obturator hernia. At 2-weeks post-surgery younger patients are experiencing more residual groin pain when performing activities of daily living, walking, or standing, or taking stairs.
TRUE INCIDENCE AND CLINICAL SIGNIFICANCE OF PATENT PROCESSUS VAGINALIS IN MALE ADULTS DURING LAPAROSCOPIC INGUINAL HERNIA REPAIR
Authors: Moollan Y , Badiani S S , Tsakanov S , Rajkomar K , Berney C R 
Published: May 2024

Abstract

Aim
The exact incidence and clinical significance of patent processus vaginalis (PPV) in adult males is unclear. Perception is that PPVs rarely cause symptoms, but there is very limited data regarding its impact on Quality-of-Life (QoL). Our aim was to estimate the occurence of PPV in all adult male and to assess its influence on QoL using the Carolinas Comfort Scale (CCS).

Material and Methods
The medical record of all patients who underwent primary laparoscopic TEP inguinal hernia repair between August 2009 and December 2023 was retrieved from a prospectively maintained institutional database and retrospectively analysed. Data was divided into two groups (PPV vs. no-PPV). Recurrent hernia repairs were excluded.

Results
There were 929 male patients (mean age of 51.9 years) who underwent 1280 inguinal hernia repairs. No intraoperative complications and no conversion to open were encountered. Those with no PPV had significantly more chance of having an associated direct hernia (P &lt;0.0001). After exclusion of all direct hernia repairs in the no-PPV group, the incidence of PPVs was 17.9%.
Preoperative modified CCS (MCCS) was completed in 740 patients. After exclusion of all those treated for a direct hernia, PPV patients were experiencing significantly less pain when laying down (P = 0.007) or exercising (P = 0.001). QoL at 2- and 6-weeks postoperative was comparable between both groups.

Conclusions
The true incidence of PPVs is estimated at 17.9% and seems to prevent the risk of developing an associated direct defect. Patients treated for PPV are less likely to experience pre-operative pain when laying down or exercising.