bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract
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

Abstract

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

Abstract

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

Abstract

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 &lt;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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &gt;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

Abstract

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 &lt;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

Abstract

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.