bluuebunny/crossref_metadata_2025_split huggingface dataset:
UNPREPARED FOR THE EMERGENCE OF A PARASTOMAL BULGE – A QUALITATIVE STUDY INTO PATIENTS' PERSPECTIVES
Authors: Krogsgaard M , Dreyer P , Thomsen T 
Published: May 2024

Abstract

Aim
To investigate patients' experiences of being prepared for the emergence of a parastomal bulge in relation to a stoma.

Materials and Methods
Qualitative interviews with 20 patients participating in five focus groups. Two groups consisted of patients referred for repair of parastomal bulging and three groups were patients receiving non-surgical treatment.

Results
The unforeseen bulge gave rise to increasing concerns and worry about the cause and consequences of the bulging skin. Patients sought explanations in their own lives and suspected that their behaviour or previous illness such as influenza, coughing, and efforts to rehabilitate after surgery, induced the bulge. Missing or conflicting information led to counterproductive behaviour. Patients unknowingly carried on with hard and strenuous work after stoma surgery, a behaviour they would have refrained from had they known about the bulge. Patients found the bulge hard to live with and were disappointed with healthcare professionals due to lack of information on prevention and treatment strategies. When consulting surgeons for advice, patients realized that surgical treatment was a gamble. This helped some patients get on in life while others were left with little hope of change.

Conclusion
Lack of information may lead to mistrust and disappointment with healthcare professionals. Addressing patients’ individual support needs and information needs is important to preserve patient autonomy, satisfaction and well-being. Surgeons and stoma nurses should be aware of the impact of their approach to communicating with patients about parastomal bulging.
THE BENEFITS OF PREOPERATIVE SMOKING CESSATION ON ABDOMINAL WALL RECONSTRUCTION (AWR) OUTCOMES: AN EXAMINATION OF ABSTINENT VERSUS NEVER SMOKERS
Authors: Lorenz W , Holland A , Mead B , Scarola G , Colavita P , Kercher K , Augenstein V , Heniford B 
Published: May 2024

Abstract

Introduction
Wound complications are associated with recurrence and mesh infection. Following our data review and publication reporting smoking significantly increased the rate of complications, we implemented four-weeks of smoking cessation preoperatively. This study aimed to identify if there is an increased risk of wound complications in patients who are abstinent smokers (AS) versus never-smokers (NS).

Method
A prospectively maintained, institutional database was used to identify patients who underwent AWR with preperitoneal mesh. The groups were stratified by smoking status. AS quit at least four weeks prior to surgery. Descriptive statistics and univariate analyses were performed.

Results
Overall, 1,088 patients were evaluated, 305 AS and 783 NS. There were fewer female AS [144 (47.2%) vs. 446 (57%); P = 0.004]. Race, rate diabetes, cirrhosis, and coronary artery disease were similar (P &gt; 0.05). AS were significantly more likely have COPD (8.9% vs. 4.0%, P = 0.001), ASA Class III (51.5% vs. 34.5%, P = 0.009), and more comorbidities (9.6 vs. 4.7, P &lt; 0.0001). Average BMI was higher for NS (31.3 vs. 32.7; P = 0.004).
Operative times were equal. While defect size was different (229 vs. 209.1cm2; P = 0.023), mesh size was similar (850.2 vs. 836.3cm2; P = 0.410). AS had higher wound class (Class III/IV: 25.3% vs. 15.8%, P = 0.003) with more biologic mesh use (31.1% vs. 21.6%, P = 0.003), and more component separations (52.5% vs. 43.8%; P = 0.010).
Length-of-stay was longer in AS (6.6 vs. 6.2 days, P = 0.015). Follow-up time was similar (13.3 vs. 16.8 months; P = 0.218). Rates of post-operative wound outcomes including wound infection (5.2% vs. 7.4%) and mesh infection (1.6% vs. 0.6%) were similar (P = NS) between groups. The recurrence rates were 3% and 2.3% (P = 0.534).

Conclusion
Despite increased patient complexity, defect size, BMI, rate of component separation, and higher wound class, wound-related outcomes for patients AS and NS were equal. Preoperative smoking cessation appears to be an important part of prehabilitation for AWR.
VISCERAL SYMPTOMS IN ABDOMINAL WALL PAIN
Authors: Roumen R 
Published: May 2024

Abstract

Purpose
Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is characterized by neuropathic pain in a predictable, circumscript abdominal area. The diagnostic delay is long, with half of ACNES-affected individuals reporting next to pain, also nausea, bloating, or loss of appetite mimicking some kind of visceral disease. The aim of this study was to describe these phenomena and to determine whether treatment could successfully reverse the visceral symptoms.

Methods
This was a prospective observational study. Adult patients who fulfilled published criteria for ACNES and reported at least one visceral symptom at intake were eligible for the study. A self-developed Visceral Complaints ACNES Score (VICAS) questionnaire that scores several visceral symptoms (minimum 1 point, maximum 9 points) was completed before and after therapy. The success of treatment was defined as at least 50% reduction in pain.

Results
Data from 100 selected (at least one visceral symptom) patients (86 females) aged 39 ± 5 years were available for analysis. Frequently reported symptoms were abdominal bloating (78%), nausea (66%) and altered defecation (50%). Successful pain treatment significantly reduced the number of visceral symptoms, with a VICAS before of 3 (range 1–8) and after of 1 (range: 0–6) (p &lt; 0.001). A low baseline VICAS was associated with successful treatment outcome (OR: 0.738, 95% CI: 0.546–0.999).

Conclusion
Patients with ACNES may report a variety of visceral symptoms. Successful treatment substantially reduces these visceral symptoms in selected patients, indicating a segmental relation between the abdominal wall and the viscera.
SUTURE TECHNIQUES AND MATERIALS FOR FASCIAL CLOSURE OF ABDOMINAL WALL INCISIONS: HOW DO THEY COMPARE IN A SYSTEMATIC REVIEW AND META-ANALYSIS?
Authors: van den Berg R , Visscher L , Menon A G , Deerenberg E B , Tanis P J 
Published: May 2024

Abstract

Background
The aim of this meta-analysis was to evaluate closure of laparotomy using different suture-materials and techniques.

Methods
A literature search was conducted till 11 October 2023. All randomized controlled trials (RCTs) and prospective cohort studies (PCSs) on laparotomy closure were included. The study quality was evaluated using the ROB2 and ROBINS-I checklists. The primary outcome was incisional hernia (IH), and secondary outcomes were fascial dehiscence (FD), combined-FD+IH, and surgical site infection (SSI). Meta-analyses were performed using random-effects models.

Results
A total of 73 RCTs and 26 PCSs were included. Slowly-absorbable suture materials were associated with a lower risk of IH (OR: 0.64; 95%CI: 0.47–0.86) and combined-FD+IH (OR: 0.76; 95%CI: 0.58–0.99) when compared to fast-absorbable sutures (5 studies, 2,262 patients). Non-absorbable suture material was not superior to any other suture material. Continuous-suturing was not superior to interrupted-suturing, neither was mass-closure superior to layered-closure for any of the outcomes. Small-bites technique with a slowly-resorbable suture in the elective-setting resulted in significantly less IHs (OR 0.42; 95%CI: 0.28–0.62), combined-FD+IH (OR 0.39; 95%CI: 0.22–0.72) and SSIs (OR 0.67; 95%CI: 0.52–0.83) compared to a large-bites technique (8 studies, 1,168 patients). In the emergency setting, the continuous Smead-Jones suturing significantly reduced the risks of IH (OR 0.22; 95%CI: 0.08–0.59), FD (OR 0.20; 95%CI: 0.11–0.34), combined-FD+IH (OR 0.08; 95%CI: 0.03–0.19), and SSI (OR 0.45; 95%CI: 0.26–0.79) compared to continuous-suturing (6 studies, 265 patients).

Conclusions
Closure of laparotomies using the small-bites technique is superior to large-bites techniques. In the emergency setting, the Smead-Jones technique seems a valid alternative.
eTEP AND TRANSVERSUS ABDOMINIS RELEASE IN A M5W3 INCISIONAL HERNIA
Authors: Bellido-Luque J , Scammon Duran A , Alpizar-Rivas O , Sanchez Matamoros Marin I , Nogales Muñoz A , Morales-Conde S 
Published: May 2024

Abstract
A 59-year-old female who underwent hysterectomy and exploratory laparotomy secondary to seromucinous ovarian carcinoma presents with discomfort in a partially reducible M5W3 incisional hernia.
The patient is operated using a full endoscopic minimally invasive extraperitoneal approach (e-TEP + TAR). A 2 cm incision on the right subcostal region is made, exposing and opening the anterior rectal sheath (ARS), medializing the right rectus muscle. A dissection balloon is introduced to release the retromuscular space on the right side. A 10 mm trocar is placed in the right flank and a 5 mm trocar in the right iliac fossa.
First, we access the medial posterior rectus sheath (PRS) of the right side, which is then incised, and the preperitoneal dissection is performed doing the crossover above the umbilicus. Once the hernia is completely reduced we connect both the retrorectus space with the preperitoneal spaces on both sides of the hernia.
A modified posterior components separation (TAR) is performed on the left side, sectioning the aponeurosis of the transverse muscle (TM) and accessing the preperitoneal space laterally without sectioning the TM. The posterior and anterior defects are then closed separately using a barbed suture.
A wide pore mesh, covering both retrorectus and preperitoneal spaces is placed and fixated using glue. An aspiration drainage was placed and removed 24 h after surgery. The patient was discharged the day after and no complications, where reported. In the CT scan 6 months after surgery the correction of the defects where confirmed.
MODIFIED LIRA+ AS A LAPAROSCOPIC COMPLEX LATERAL EVENTHROPLASTY
Authors: Font M , Díaz R , Farré R , Sánchez R , Guariglia C , Pardo S , Caraiman M , Valderrama S , Collera P 
Published: May 2024

Abstract

Background
We present a clinic case of a patient with a complex eventration with two anterior onlay repairs due to an open appendectomy years before.

Methods
A 74-year-old man with hypertension and surgical history of open appendectomy and 2 anterior onlay eventhroplasties was consulted for relapse and discomfort of the prior repair. Therefore, a TC was performed, and a large right flank eventration with a small intestine and colon inside and a left inguinal hernia was diagnosed; the patient is proposed for a laparoscopic joint repair.

Results
A posterior rectus sheet plasty was prepared, and a bottom-up closure of the defect was performed, and afterwards reinforced with the posterior rectus sheet plasty, trying to obtain the firmest possible base for the placement of the intraperitoneal mesh, given that the eventration was intermuscular and close to the iliac crest.
Then inguinal hernia repair was performed with TAPP technique, particularly laborious in this case due to the manipulation of the peritoneum.
The postoperative (OP) period occurred without complications and was discharged on the second post op day.

Conclusions
We present a specific case, favourable for a laparoscopic repair, with a repair inspired by a technique used for midline defects. Nevertheless, it is a difficult technique so the learning curve is expected to be longer, and experience is required.
TAPP APPROACH FOR INCISIONAL LUMBAR HERNIA. A VIDEO PRESENTATION
Authors: García Corona M , Sánchez Arteaga A , Moreno Suero F , Bustos Jiménez M , Martínez Nuñez S , Tallón Aguilar L 
Published: May 2024

Abstract

Introduction
Lumbar incisional hernias (LIH) constitute infrequent abdominal wall defects, typically arising as a consequence of traumatologic procedures. The surgical approach to LIH can be challenging due to the absence of specific recommendations for this particular condition.

Methods
This study presents a case report of a LIH resulting from lumbar arthroplasty in a 49-year-old female patient with no prior medical history. The patient reported back pain, and a CT scan revealed a lumbar hernia in close proximity to the iliac bone.

Results
A transabdominal preperitoneal approach (TAPP) was employed, uncovering a lumbar defect measuring 6 × 6 cm with a hernia sac containing the left colon. Procedures included peritoneal sac reduction, defect closure near the iliac bone, and placement of a polypropylene mesh in the preperitoneal position.

Conclusion
The TAPP approach proves to be a viable surgical technique for addressing LIH. It is crucial to acknowledge that closing the hernia defect may pose challenges when the hernia edges involve bony structures.
EXTENDED TOTALLY EXTRAPERITONEAL (eTEP) ASSOCIATED TO TRANSVERSUS ABDOMINIS RELEASE (TAR) IN THE MULTI-RECURRENCE VENTRAL HERNIA
Authors: Gómez Menchero J , Aguilar A , Lara Y , Navarro L , Licardie E , Bellido J , Moreno F , Garcia Moreno J 
Published: May 2024

Abstract

Aim
Minimal invasive surgery of the abdominal wall has evolved in the last years. Endoscopic extraperitoneal approach shows a good vision in the reparation of ventral hernias. Complex hernias can be repaired in this way with a low rate of recurrence and postoperative pain. Our objective is to show the advantages of this endoscopic approach to solve the multi-recurrence ventral hernia.

Methods
A male 58 years old who underwent 3 prior surgeries of a umbilicus hernia (herniorraphy, hernioplasty with polipropilene (PPL) onlay mesh, onphalectomy and new hernioplasty with PPL mesh) is examinated for a new recurrence M2 M3 M4 W3 (following EHS Classification) and a diastasis associated. A Computerized Tomography (CT) is performed to plan the procedure showing a 10 cm width defect. Botuline toxin were applied (Ibarra´s technique) 30 days before planning a totally endoscopic approach (eTEP). We used three ports in the left side of the abdomen (optic 12 mm and BTT 11 mm and 5 mm in the border of the left rectus muscle. A Spacemaker is used to dissect the retrorectus space. Cross over is performed to dissect the contralateral retrorectus space. Three ports are positioned in the right side. A TAR is performed in both sides (Down to up).
Posterior fascia was sutured using a 3.0 barbed suture. Anterior fascia was sutured using a barbed suture 0 to close the defect.
A PVDF mesh (40 × 30 cm) was positioned using an autramatic fixation with cianocrilate.

Conclusion
eTEP is a safe procedure with good results in middle line hernias, even in those cases with large defects. It is possible to associate this technique to prehabilitation using Toxine to get a higher overlap mesh/defect ratio with the mesh. More studies are needed to reach more conclusions.
ROBOTIC-ASSISTED SINGLE DOCKING TAR
Authors: Grimaldi S , Alampi B D A , Morini L , Nicastro V , Marin J N , Ferrari G 
Published: May 2024

Abstract

Background
Transversus abdominis release (TAR) was introduced in 2012 and has emerged as a preferred method for addressing wide and complex ventral hernias. In recent years, it has been explored the role of minimally invasive approach in retromuscular repairs, to permit a minimally invasive anatomical reconstruction and placement of the mesh in an extraperitoneal location.
Advancements in robotic surgery have led to increase the utilization of robotic approach to repair complex ventral hernias, combining the benefits of minimally invasive techniques with TAR. Our aim is to describe our surgical technique of a robotic-assisted single-docking TAR.

Method
Supine patient, we induced pneumoperitoneum with the Veress needle and inserted three 8 mm robotic trocars on the left side. Upon exploration of the abdominal cavity, we found a border incisional hernia in the right flank/iliac fossa (EHS classification: L2-3W7L8) with extensive adhesions. Sectorial TAR extended to the right quadrants. Preparation of the Rives plane on the left, crossover of the midline, and access to the Rives plane on the right. Suturing the defect with barbed long absorbable suture. Placement of a 20 × 30 PVDF mesh fixed with cyanoacrylate glue. Placement of aspirative drainage in the preprosthetic plane.

Results
The patient was discharged on the fifth postoperative day with no complications. Aspirative drainage was removed on the fourth postoperative day.

Conclusions
A robotic-assisted TAR is feasible and safe, helps to perform extensive adhesiolysis, allows for reducing output from drains and therefore earlier discharge, favoring release compared to resection of transverse muscle fibers.
ROBOTIC REPAIR OF A MULTIPLY RECURRENT INGUINAL HERNIA
Authors: Holland A , Lorenz W , Augenstein V 
Published: May 2024

Abstract

Background
This is a 62-year-old male with bilateral inguinal hernias (IH), the left being multiply recurrent after an open, anterior tissue-based approach 30 years ago and recently a robotic Transabdominal Preperitoneal Repair. He recurred within a year and was referred to our hernia center.

Methods
The patient underwent preoperative counselling, and we particularly discussed the risk of converting to an open approach if we could not safely carry out the dissection robotically.

Results
Upon entry, a recurrent left IH and primary right IH were noted. We incised the peritoneum across the abdominal wall and dissected medially, down to the pubis. Although this was a reoperative case, we successfully accessed the preperitoneal plane. On the left, we encountered the prior mesh, which appeared rotated medially and densely adhered to the inferior epigastric vessels, so the decision was made to leave it in place. The lateral preperitoneal dissection was completed, and the cord structures were dissected off the hernia sac.
We repaired the contralateral defect following the same steps. The critical view of the myopectineal orifice was obtained bilaterally, and two pieces of mesh were introduced. Our mesh spanned two centimeters below the pubic tubercle and sat flush without the edges rolling. The mesh was secured at the pubic tubercle, Cooper’s ligament, medially, and at the lateral edge of the preperitoneal flap, protecting the neurovascular structures in the area. The preperitoneal flap was closed with a running absorbable barbed suture.

Conclusions
The patient was discharged postoperatively and is doing well on follow-up.
DUAL MESH, DUAL APPROACH: RUPTURE OF EVENTRATION OF DIAPHRAGM
Authors: Kalikar V 
Published: May 2024

Abstract
Ruptured eventration of diaphragm is a rare entity, with only 3 cases reported in adults till date, all on left side. Surgery is mandatory which consists of returning the affected organs back in place by Adhesiolysis followed by closing the diaphragmatic opening, strengthening the diaphragm by plication and mesh placement. We present the case of a 78-year-old gentleman, sudden onset breathlessness for 2 days. On imaging there was a rupture of the right hemidiaphragm with herniation of intrabdominal contents into the right hemithorax. We managed this patient by a combined thoraco-laparoscopic way reinforcing the defect with a dual mesh.
ADJUVANT TECHNIQUES FOR MINIMALLY INVASIVE INGUINAL HERNIA REPAIR
Authors: Marques-Antunes J , Correia P , Rodrigues E , Magalhães J , Guimarães M , Nora M , Pereira A 
Published: May 2024

Abstract

Background
The characterization of complexity in inguinal hernia lacks precision, yet loss of domain (LOD) serves as a well-defined criterion. Similar to other ventral hernias, treatment efficacy hinges on a pliable abdominal wall and an abdominal cavity capable of accommodating herniated content. Adjuvant techniques employed to attain these objectives are also applicable to inguinal hernias with LOD. Authors present, in video format, the perioperative approach to a case of a large bilateral inguinal hernia repair with loss of domain.

Method
A 58-year-old male presented with a longstanding bilateral inguinal hernia with LOD (Sabbagh &gt; 20%). Preoperative optimization involved cardiorespiratory rehabilitation and adjuvancy, with botulinum toxin A injection and progressive pneumoperitoneum (PPP). Transabdominal pre-peritoneal approach using a single 30 × 10 macroporous polypropylene mesh was performed for bilateral repair.

Results
During preoperative hospitalization for the PPP, patient developed a paroxysmal atrial fibrillation and started anticoagulation. No complications were reported after surgery, with the exception for a bilateral local seroma, and patient was discharged at 4th postoperative day. 6 months later, there was no evidence of complications or recurrence.

Conclusion
Adjuvant techniques play a major role in optimizing patients with complex hernias of the abdominal wall. While the benefits of minimally invasive surgery in inguinal hernias are known, concerns about technical difficulties in large hernias may compromise safety and lead to recurrence. Tailored adjuvant strategies for patient and hernia optimization are essential for effective treatment with long-term successful results.
LAPAROSCOPIC UNILATERAL ETEP WITH PARTIAL TAR
Authors: Shaik N , Shrivastava R 
Published: May 2024

Abstract

Introduction and Aim
Laparoscopic ETEP is an approach that is emerging as an effective management for ventral and incisional hernias. Lateral abdominal wall hernias, although less common than ventral hernias, can progress to a large size and cause significant morbidity. We present a case of lateral abdominal wall incisional hernia managed with a laparoscopic unilateral eTEP (Extended totally extra-peritoneal repair) with partial TAR (Transversus abdominis release).

Case
We present a case of a 52-year-old gentleman who had an incisional hernia at a previous appendicectomy scar, for which an onlay mesh repair was done 5 years ago. He then later developed an incisional hernia. He presented with a bulge on the scar associated with pain since the past 1 year. His CT scan was suggestive of a recurrent incisional hernia -L3W2R1 according to EHS classification.
A laparoscopic unilateral eTEP with partial TAR hernia repair was performed for the patient. He showed satisfactory recovery in the post-operative period with minimal surgical site pain and has been asymptomatic without any recurrences on follow-up for the past 2 years.

Conclusion
Laparoscopic unilateral eTEP with partial TAR maybe a safe and feasible approach for the treatment of lateral abdominal wall hernias.
ROBOTIC MORGAGNI HERNIA REPAIR IN AN INFANT
Authors: Sinha A 
Published: May 2024

Abstract
A nine month old child presented with a history of recurrent respiratory distress and infections and repeated admissions to the hospital. The x-ray of the child demonstrated fluid-filled bowel loops in the thorax. Computed tomography of the chest demonstrated. bowel loops in the anterior mediastinum anterior to the heart. A diagnosis of Morgagni hernia was made. The child was operated via Robot Assisted Repair of the defect. Reduction of contents, excision of the sac and a simple closure of the diaphragm with the anterior abdominal wall was done. A transcutaneous suture was passed from the abdominal skin and through all the abdominal wall layers to anchor the diaphragm to the wall to ensure a secure closure. The suture was buried in the skin. The child recovered uneventfully and is well on follow-up after a year.