bluuebunny/crossref_metadata_2025_split huggingface dataset:
CYSTIC INGUINAL LYNFHANGIOMA IN ADULT FEMALE
Authors: Serrano A , Gutiérrez C , Álvarez A , Carreño O , García P , Bueno J , Pous S 
Published: May 2024

Abstract

Background
To present a clinical case of cystic inguinal lymphangioma in an adult female, an atypical site and age of presentation.

Method
A 42-year-old woman was referred for consultation due to persistent pain and swelling in the right inguinal region, with initial suspicion of inguinal hernia. A mobile, irreducible mass without protrusion during the Valsalva maneuver was identified. Faced with diagnostic uncertainty, inguinal ultrasound and magnetic resonance imaging were requested, revealing a cystic lesion indicative of cystic inguinal lymphangioma.

Results
Elective surgery was decided. A right inguinal incision revealed a cystic tumor extending along the inguinal canal from the labium majus to the preperitoneal space. Complete excision was performed, requiring section of the round ligament. Subsequently, closure of the deep inguinal ring was conducted, with the conjoint tendon approximated to the inguinal ligament using a continuous suture of slowly absorbable monofilament. Hernioplasty with self-adhesive polypropylene mesh was employed to repair the inguinal defect. The procedure was carried out in the ambulatory major surgery program. At the one-month post-surgery follow-up, the patient exhibited satisfactory recovery with no signs of clinical recurrence. Histopathological examination of the surgical specimen confirmed the diagnosis of cystic inguinal lymphangioma, with no additional pathological findings.

Conclusion
Cystic lymphangioma is a benign and uncommon malformation of the lymphatic system. It should be considered in cases of inguinal masses with progressive growth whose examination is not consistent with an inguinal hernia. Ultrasound is the imaging test of choice, with definitive diagnosis confirmed by histopathology. Surgery with complete resection is recommended due to the risk of recurrence.
COMPLICATIONS AND THEIR TROUBLE-SHOOTING IN LAPAROSCOPIC eTEP INGUINAL HERNIA REPAIR
Authors: Shaik N , Shrivastava R 
Published: May 2024

Abstract

Introduction and Aim
The field of hernia repair has been revolutionized since the advent of totally extraperitoneal (TEP) repairs. The concept of eTEP (extended view TEP) repairs have further expanded horizons by overcoming the challenges faced in TEP repairs. Although laparoscopic eTEP hernia repairs offer a myriad of advantages, these procedures pose a steep learning curve and may pose complications which maybe difficult to manage.
This study aims to highlight the complications faced during laparoscopic eTEP inguinal hernia repairs at our centre and provide possible trouble-shooting solutions for the same.

Materials and Methods
This is a high volume single-centre, single team prospective observational data of patients undergoing laparoscopic eTEP inguinal hernia repairs from January 2020 to October 2023. We reviewed a total of 252 such patients and collected demographic details, co-morbidities, intra-operative complications and post-operative recovery of the patients.

Results
We have highlighted the possible complications and recommended trouble-shooting approaches to tackle them. The incidence of intra-operative and early complications like early pneumoperitoneum, injury to brick’s artery, injury to inferior epigastric artery, peritoneal rents, urinary retention in our study was 5.15%, 0.02%, 0.003%, 10.3%, 1.9% respectively. Late complications like seroma, hematoma, recurrence showed an incidence of 1.58%, 0.003%, 0.003% respectively. Our cohort did not have any cases of visceral injury (bowel/bladder) or surgical site infection.

Conclusion
It is essential to identify and address complications faced during laparoscopic eTEP repairs to ensure patient safety, improved outcomes and reduced recurrences and surgical site infections. Implementing the suggested troubleshooting strategies may help improve the surgical outcome and in turn postoperative patient well-being and quality of life in patients undergoing eTEP repairs.
PEDIATRIC INGUINAL HERNIA: OCCULT BILATERALITY – AN INDICATION FOR LAPAROSCOPIC REPAIR
Authors: Sinha A , Kamesh S , Rathod K , Pathak M , Jadhav A , Saxena R , Nayak S 
Published: May 2024

Abstract

Aim
The study aimed to ascertain the incidence of contralateral patent processus vaginalis in patients undergoing laparoscopic inguinal hernia repair.

Settings and Design
A retrospective review of our cases of Inguinal Hernia operated by Laparoscopic herniotomy in the Department of Pediatric Surgery was done.

Subjects and Methods
All children who underwent laparoscopic inguinal hernia repair at AIIMS Jodhpur, India, during the period of Sept 2016–2023 were retrospectively studied. Parameters studied included age, gender, side of the hernia, incidence of contralateral patent processus vaginalis and recurrence rates. As per departmental protocol, all patients who had occult bilaterality were repaired in the same sitting after the repair of the presenting side.

Results
A total of 255 patients were included in the study. The mean age was 44.4 months and varied from 0 months of age to 192 months. Ligation of the sac was performed after or without division, depending on the operating surgeon's preference. The follow-up varied from 3 months to 7 years, with a mean of 3.8 years. 10 patients had a bilateral inguinal hernia at diagnosis, with left-side inguinal hernia in 95 and right-sided hernia in 150 patients. Out of the 245 patients with unilateral inguinal hernia, a contralateral patent processus vaginalis was found in 48 patients (19.5%). We had 7 recurrences in the cohort (2.7%). No recurrence was seen on the contralateral side, which was closed during the primary procedure. All recurrences occurred in patients between 1 and 3 years of age. Two patients had large inguinoscrotal swellings at presentation and 2 patients had spinal dysraphism along with inguinal hernia.

Conclusion
Bilateral inguinal hernia is universally accepted as an indication to repair a pediatric inguinal hernia through laproscopic route. However, there is often a debate regarding whether laproscopic inguinal hernia repair has a role in managing unilateral inguinal hernia. Our results show that out of our cohort of 244 patients with unilateral inguinal hernia, approximately one fifth of the patients have patent processus vaginalis on the contralateral side. This can be easily repaired in the same setting via laparoscopy without increasing the morbidity and preventing future recurrences to the contralateral side. Take home message Laparoscopic repair of Pediatric inguinal hernia has very acceptable success rates and should be the preferred way to tackle inguinal hernias in children, especially since around a fifth of the patients have contralateral patent processus vaginalis.
A SYSTEMATIC REVIEW AND META-REGRESSION OF FACTORS AFFECTING INCISIONAL HERNIA RATES IN MIDLINE INCISIONS OVER A 10-YEAR PERIOD
Authors: Smith L , Coxon-Meggy A , Gwilym B , Lukaszewicz A , Mckenna M , Osinkolu I , Bosanquet D , Torkington J 
Published: May 2024

Abstract

Aims
The Incisional hernia (IH) rate after midline incisions was reported to be 12.8% in a systematic review of literature published in 2015. With updated guidance on abdominal wall closure techniques, the landscape of abdominal wall closure has changed. We aimed to update this literature to assess any change in the rates and any new identifiable risk factors for IH in midline incisions.

Methods
We undertook a systematic review of literature according to PRISMA guidelines and registered on PROSPERO. All papers reporting IH rates in midline incisions with primary suture closure between April 2013 — October 2022 were included. Papers with two or more arms suitable for inclusion were extracted independently.

Results
Sixty three papers (21 RCTs, 36 cohort studies and 6 case-control studies), comprising 18,126 patients were included. The mean IH rate was 16.8% at a weighted mean follow up of 31.3 months. Meta-regression identified two study level variables that correlated with an increase in IH rates (Use of radiology for diagnosis of IH and inclusion of patients undergoing a contaminated procedure) and one operative variable that corresponded with a decrease in rates (Small bites closure technique).

Conclusions
The Incisional hernia rate in midline incisions reported in the literature have increased over the last decade. A change in detection method and an increase in patient complexity may account for the majority of risk, suggesting standardisation of trial technique is essential in IH prevention trials. Small bites technique is associated with a significant reduction in IH rates, and future work should focus on strengthening the evidence base around this technique.
EXTENDED TOTALLY EXTRAPERITONEAL (eTEP) VENTRAL HERNIA REPAIR: INITIAL RESULTS
Authors: Souto R , Barreira A , Carracha M , Figueiredo J , Branco A , Costa P , Cabeleira A 
Published: May 2024

Abstract

Background
Extended totally extraperitoneal ventral hernia repair (eTEP-VHR) is gaining increasing popularity due to its improved postoperative outcomes. Recent evidence suggests that minimally invasive retromuscular dissection and mesh placement has better outcomes than other mesh positions, lowering the rates of hernia recurrence and surgical site occurrences. We present the initial results from eTEP-VHR implementation at two non-robotic surgical departments.

Method
Retrospective analysis of all consecutive patients submitted to eTEP-VHR between June 2022 and November 2023 in two centers by the same surgical team. Data were analyzed for operative details and perioperative complications.

Results
15 patients underwent eTEP-VHR. 3 cases required a transversus abdominis release. No intraoperative complications were recorded. Median length of stay was 1,5 days. After a median follow-up of 9 months, there were 0 recurrences, 2 cases of uncomplicated seroma, 0 mesh infections and 0 cases of chronic pain.

Conclusion
Implementation of eTEP seems to be safe and a good alternative to ventral hernia repair in selected cases, allowing for excellent postoperative outcomes, even in non-robotic centers.
LIDOCAINE PLASTERS AS A NON-INVASIVE ALTERNATIVE TREATMENT OPTION IN CHILDREN WITH ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME (ACNES)
Authors: ten Have T , Zwaans W A R , Scheltinga M R M , Roumen R M H 
Published: May 2024

Abstract

Background
Chronic abdominal pain in children can sometimes be attributed to Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), a typical abdominal wall neuropathic pain entity. Not only the diagnosis but also the treatment poses various challenges. Usually, treatment starts with tender point injections, which are considered minimally invasive. Nevertheless, these injections can be quite burdensome for children, who might even refuse them. However, the alternative, surgical neurectomy, is far more invasive. The use of Lidocaine 5% medicated plasters, used successfully in various neuropathic pain conditions, might offer a non-invasive alternative for children with ACNES. This retrospective case series aims to evaluate the effectiveness and tolerability of lidocaine plasters in children with ACNES.

Method
Children under 18 diagnosed with ACNES, and treated with lidocaine medicated plasters from December 2021 to December 2022, were included. Treatment outcomes, including pain reduction and complications, were extracted from electronic patient records.

Results
Twelve of the sixteen children diagnosed with ACNES started the lidocaine plaster treatment. Mean age was 13 years (F:M ratio 3:1). The lidocaine plaster treatment resulted in lasting pain reduction in three patients, with two achieving a pain free status. Temporary pain reduction was noted in five patients. The last four patients experienced no pain relief during plaster treatment. One patient reported a skin rash, which disappeared a few days after not applying the plaster.

Conclusion
Lidocaine plasters might be considered as a non-invasive treatment option for children with ACNES, providing significant pain relief in a substantial portion of them.
LAPAROSCOPIC eTEP APPROACH TO VENTRAL HERNIAS: SHORT-TERM OUTCOMES
Authors: Trujillo J , Gómez J R , Concejo P , Montenegro M A , Schenone F , Jezieniecki C , Montes M , Herreros J , Martín del Olmo J C 
Published: May 2024

Abstract

Aim
Ventral hernias are a pathology with a high incidence within general surgery. Repair techniques have been evolving, and the minimally invasive approach to this type of pathology is currently on the rise due to the advantages offered by the minimally invasive surgery (laparoscopic or robotic): less postoperative pain, SSI, seromas, length of stay (LOS) and faster return to routine daily activities. We present our series of patients with ventral hernias treated by laparoscopic eTEP approach.

Material and Methods
Prospective study where we analyzed our database of patients with ventral hernias (primary and secondary) undergoing abdominal wall surgery using laparoscopic eTEP approach, during the period August-2021 to December-2023. We present our short-term outcomes.

Results
A total of 65 patients underwent laparoscopic eTEP surgery (men: 54.8%, age: 64 (RIQ: 43–73years)). LOS: 1.48 ± 0.62 days. Pathological history: diabetes mellitus (19.4%), arterial hypertension (45.2%), dyslipidemia (51.6%), smoking (25.8%), alcohol consumption (13.3%), cardiovascular disease (12.9%). ASA Classification: I (32.3%), II (45.2%), III (22.6%). BMI: 30.6 ± 4.68 kg/m2. Overweight: 11 (35.5%) and obesity: 17 (54.8%).
Primary hernias: 26.7% and incisional hernias: 61.3%. Location: midline: 87%, lateral: 13%, supraumbilical: 58.1%, umbilical: 87.1% and infraumbilical: 25.8%. Hernia width (EHS classification): W1:12.9%, W2:80.6% and W3:6.5%, transverse hernia diameter: 6.5 ± 2.1 cm, hernia length size: 6.1 ± 4.4 cm. Associated with diastasis:77.4%, diastasis width: 4.9 ± 1.7 cm. Associated with inguinal hernia:19.4%.
Type of laparoscopic surgical technique performed: Rives-Stoppa: 77.4%, unilateral TAR: 16.1%, bilateral TAR: 6.5%. Number of trocars used by procedure: 4(RIQ:4-5). Preoperative botulinum toxin: 22.6%. Posterior sheath closure: 74.2%. Mesh fixation type: Glutack 16.1%, Tisseel 61.3%, no fixation 22.6%. Mesh type used: Low density wide-pore polypropylene 35.5%, PVDF-Mesh 58.1%, PVDF-IPOM mesh 6.5%. Mesh size: width 18(RIQ:16–22 cm) and length 28(RIQ:25–30 cm). Drainage: 4,8%. Surgical time: 165(RIQ:120–185 min).
Global and serious complications (CD≥III): 12.9% and 1.6%, Re-IQ due to incarcerated hernia due to posterior sheath dehiscence: 1.6%. No intraoperative complications. Clinical seroma: 9.7% and ultrasound seroma: 41.6% that resolved completely spontaneously during the first and second postoperative months. No cases of hematoma or surgical wound infection. Until the current follow-up we have not had any recurrence.

Conclusions
The laparoscopic eTEP approach of ventral hernias has a low rate of global complications, despite being our first cases performed. It also has low rates of postoperative pain and shorter LOS. We can conclude that in our Hospital the laparoscopic eTEP approach is a safe, efficient and effective technique.
LONG TERM QUALITY OF LIFE FOLLOWING LAPAROSCOPIC INGUINAL HERNIA REPAIR WITH MESH. A TEN-YEAR, SINGLE SURGEON SERIES FROM NEW ZEALAND
Authors: Wehipeihana E , Moss D 
Published: May 2024

Abstract

Aim
To provide objective analysis of quality of life for patients after laparoscopic inguinal hernia surgery (LIHS) with mesh from 2013 to 2022.

Material and Methods
This study is a retrospective audit of outcomes from ten years of LIHS by a specialist hernia surgeon working in public and private practice in South Auckland, New Zealand. Data were collected by screening digital clinical notes and surgeon records, with a representative sample of patients contacted to provide feedback on quality of life indicators using the Carolinas Comfort Scale (CCS).
The first five years of this data have been previously published. This study completed the ten year data set with analysis of the subsequent five years of patient outcomes, including revisiting a representative sample of previously contacted patients to update their quality of life outcomes. Statistical analysis was performed in Microsoft Excel.

Results
More than 500 patients met our inclusion criteria. Recurrence rate in this cohort was &lt;1%, with no conversions to open surgery, no adhesion related admissions or mesh explant procedures. The essential CCS criteria showed fewer than 6% of patients experienced sensation of mesh presence, pain or movement limitation, with no severe or disabling symptoms reported.

Conclusions
This homogenous series describing outcomes from a single surgeon shows that LIHS with self-adhesive mesh is a minimally morbid procedure with high patient satisfaction in this cohort with long follow up.
PFANNENSTIEL HERNIA – AN UNDER DIAGNOSED PATHOLOGY OFTEN OVERLOOKED AND POTENTIALLY PREVENTABLE
Authors: Zanellato A , Sunny A , Tulloh B 
Published: May 2024

Abstract

Objective
Pfannenstiel incision was described in 1900 and is widely used for C-section. Obstetricians tear the rectus muscles and posterior sheath apart and don’t reapproximate this layer. As consequence, it leaves a gap between both recti which allows herniation of abdominal contents between the anterior rectus sheath and muscle. The aim was describing this defect and its characteristics as well as propose an awareness strategy to avoid symptomatic patients being dismissed after “normal” scan or physical examination.

Method
A prospective observational study was conducted on 32 patients, between January 2019–2024. Data collected (history, examination, and relevant investigations) was entered in a proforma, tabulated, and analysed.
Most of patients presented with discomfort, swelling, intermittent nausea and all reported a bulge. Distension was noted in 42%. On physical examination all had some degree of asymmetry. However no cough impulse or palpable defect was detected. They were mainly diagnosed on CT scans (77%) although some radiology reports denied the presence of a hernia because the anterior sheath was intact. The rest were found incidentally at laparoscopy for unrelated conditions. Most defects were repaired with sutures while larger defects were repaired with mesh. Two patients presented with small bowel obstruction.

Conclusion
Pfannenstiel hernia is atypical with unique anatomic features and the radiological signs may be subtle. Increased awareness by surgeons and radiologists should avoid this condition being missed. It may be preventable by attention to closing the posterior layer at the index operation.
VACUUM-ASSISTED FASCIAL CLOSURE IN THE MANAGEMENT OF OPEN ABDOMEN. THE OPTIMAL FOAM’S POSITION
Authors: Zanellato A 
Published: May 2024

Abstract
Often surgeons face complex situations when leaving the abdomen open temporarily is the best and quickest option that save lives. In 1986, a novel therapy using negative pressure with marlex mesh cover by op-site wound dressing, called the “sandwich technique” was described by Schein. This case report significantly changed the management of open abdomen. Several trial were performed with different meshes (Polypropylene, Dexon, Gore-Tex, Polyethilene, Poliglactin) in combination with silicone bags, or not, with high mortality and high rate of massive hernias but promising results. On 90’s the term planned hernia was widely used. Miller in 2004 demonstrate that was possible vacuum-assisted fascial closure (VAFC) which enables late fascial closure in open abdomen patients up to a month after initial laparotomy by substituting the surgical towels with polyurethane sponge and attached a special drain and pump for liquid aspiration. Complication rates did not differ from patients with planned hernia, and the need for future abdominal wall reconstruction was avoided. Following this pre-packed dressing system was introduced. Some authors combined VAC with the Bogotá bag and others with mesh. The system was designed to actively manage the open abdomen by removing fluid and helping reduce visceral oedema. The system evolved to the advanced model when they fenestrated the foam increasing the medial traction, but can fascial traction be improved? The author presents in this video how the position of dressing can improve medial traction and closure.
SUITABLE MESH FOR ADULT GROIN HERNIA TEP REPAIR BASED ON PELVIC 3D-CT SCAN MEASUREMENTS
Authors: Zuiki T , Oki J , Ui T , Hayakawa S 
Published: May 2024

Abstract

Background
The totally extraperitoneal (TEP) repair for groin hernia, performed at Yuki Hospital between 2006 and Dec 2023 on 542 patients, could avoid complications associated with entering the peritoneal cavity. Recurrence occurred in seven patients due to the use of small-sized mesh. The purpose of this study is to identify suitable mesh sizes for TEP repair.

Method
206 consecutive patients (104 males, 102 females) who underwent abdominal CT scans were included. The Pelvic bone structures were reconstructed using 3DCT scanning, and the curved length from the pubic tubercle to the anterior iliac spine was measured by a radiologist. This length corresponds to the actual length covered by the mesh during laparoscopic TEP groin hernia repair.

Results
Patient ages ranged from 18–86 years, median 70. The curved length from the pubic tubercle to the anterior iliac spine averaged 163.6 ± 10.9 mm for male and 160.0 ± 7.7 mm for female, demonstrating a correlation with height (male: 167.2 ± 7.6 cm, correlation coefficient (r) = 0.68, female: 153.2 ± 7.2 cm, r = 0.50). We usually utilize a standard 10.8 × 16 cm 3D large size mesh in TEP repair, which covers 98% of the average curved length for male.

Conclusion
The curved length from the pubic tubercle to the anterior superior iliac spine can be preoperatively estimated using 3D CT scans. The large size 3D mesh (10.8 × 16 cm) appears to be suitable for most Japanese adults undergoing TEP repair for groin hernia.
Acidic fibroblast growth factor inhibits reactive oxygen species-induced epithelial–mesenchymal transdifferentiation in vascular endothelial cells via the miR-155-5p/SIRT1/Nrf2/HO-1 pathway to promote wound healing in diabetic mice
Authors: Zhang Yue , Hei Fenghui , Xiao Yujie , Liu Yang , Han Juntao , Hu Dahai , Wang Hongtao 
Published: May 2024

Abstract

Background
Diabetic chronic wounds are among the most common and serious complications of diabetes and are associated with significant morbidity and mortality. Endothelial-to-mesenchymal transition (EndMT) is a specific pathological state in which endothelial cells are transformed into mesenchymal cells in response to various stimuli, such as high glucose levels and high oxidative stress. Acidic fibroblast growth factor (aFGF), which is a member of the fibroblast growth factor family, possesses strong antioxidant properties and can promote the differentiation of mesenchymal stem cells into angiogenic cells. Therefore, we investigated the role of aFGF in EndMT in diabetic wounds and analysed the underlying mechanisms.

Methods
A diabetic mouse model was used to verify the effect of aFGF on wound healing, and the effect of aFGF on vascular endothelial cells in a high-glucose environment was examined in vitro. We examined the expression of miR-155-5p in a high-glucose environment and the miR-155 downstream target gene SIRT1 by luciferase reporter assays.

Results
aFGF promoted wound closure and neovascularization in a mouse model of type 2 diabetes. In vitro, aFGF inhibited the production of total and mitochondrial reactive oxygen species (ROS) in vascular endothelial cells and alleviated epithelial–mesenchymal transdifferentiation in a high-glucose environment. Mechanistically, aFGF promoted the expression of SIRT1 and the downstream targets Nrf2 and HO-1 by negatively regulating miR-155-5p, thereby reducing ROS generation.

Conclusions
In conclusion, our results suggest that aFGF inhibits ROS-induced epithelial–mesenchymal transdifferentiation in diabetic vascular endothelial cells via the miR-155-5p/SIRT1/Nrf2/HO-1 axis, thereby promoting wound healing.