bluuebunny/crossref_metadata_2025_split huggingface dataset:
TAPE REPAIR. TRANSABDOMINAL PARTIAL EXTRAPERITONEAL REPAIR FOR LAPAROSCOPIC REPAIR OF SUPRAPUBICS HERNIAS
Authors: Sánchez-Ramírez M , Valera Z , Naranjo J R , Morales-Conde S 
Published: May 2024

Abstract

Background
TAPE is suitable for laparoscopic repair of Suprapubic hernias where lower margin is within 5 cm from pubic arch. These hernias are known to occur after transverse or low vertical incisions in gynecological, urological or bowel related surgery. The repair of suprapubic hernias is as such difficult due to absent posterior rectus sheath, proximity to urinary bladder and essential neurovascular structures.

Method
After creation of pneumoperitoneum, the position of the ports is decided on the basis of the location of the suprapubic defect. 12 mm and Two additional ports of 5 mm are made on the lateral abdominal wall, mainly on the left flank to assess the hernial defect, previous scar and perform adhesiolysis. This allows space for adequate prosthetic overlap. The hernial content is completely reduced to expose the fascial borders of the defect. A peritoneal flap is dissected starting close to one anterior superior iliac spine (ASIS) and extended to the contralateral ASIS. The flap is inferiorly dissected till space of Retzius so that pubic arch and Cooper’s ligaments on either side are completely exposed. Medially, dissection is meticulous and carefully done avoiding any sort of iatrogenic injury to the urinary bladder. Close the defect with continuous suture with barbed suture of 1. A composite mesh (GORE® SYNECOR) of the appropriate size is chosen so that an overlap of at least 5 cm is achieved around the defect. The lower margin of the mesh must extend below the pubic arch by 1–2 cm to a low firm fixation to Cooper’s ligaments bilaterally with tackers CapSure™Permanent fixation. The rolled mesh is passed through a 12 mm port is spread inside the abdomen in a manner so that the surface with adhesion barrier faces the abdominal viscera. Spiral tacks are used to fix the mesh at two points on the Cooper’s ligaments on both sides. Circumferential fixation is also done at the mesh margins and around the margins of the hernial defect in the manner of double crowning. The peritoneal flap raised initially is made to reperitonealize the maximum possible part of the mesh.

Results
The main advantage of TAPE technique is suitable mesh overlap of more than 5 cm from the distal margin of the hernial defect. The fixation of the lower mesh margin to the Cooper’s ligaments on either side increases the strength of repair. The procedure does allow part of the mesh to remain in the extraperitoneal space. Since polypropylene meshes can be safely used, it allows to minimize the cost of procedure.

Conclusion
Laparoscopic repair of suprapubic incisional hernias is a safe and effective treatment option that offers several advantages over traditional open surgery. With careful patient selection and appropriate surgical technique, most patients can expect a successful outcome with low rates of recurrence and minimal complications.
A MULTIDISCIPLINARY TEAM APPROACH TO ABDOMINAL WALL RECONSTRUCTION: ASSESSING THE RESULT OF COMBINED HERNIA AND PLASTIC SURGERY TECHNIQUES
Authors: Alsannaa F , Almadani J , Alajaji T , Alobaysi S , Alnefaie F 
Published: May 2024

Abstract

Aim
To evaluate short-term outcomes of patients undergoing abdominal wall reconstruction (AWR) via a combined surgical management approach involving complex abdominal hernia repair and concurrent body contouring procedures performed by general and plastic surgery teams.

Material and Method
A retrospective review was conducted of patients who received AWR between 2021–2024 that utilized a combined surgical technique. Procedure included abdominal wall reconstruction along with tissue expander insertion, abdominoplasty, or panniculectomy based on individual patient needs.
Eight cases were included in our study, one case with skin loss due to flap necrosis from previous abdominoplasty (Figure 1), one case post deep inferior epigastric perforator (DIEP) flap procedure and previous abdominoplasty, and the rest were with excess skin (Figure 2).
Primary outcomes were surgical complications, hernia recurrence, and patient satisfaction.

Result
Among our cases who underwent AWR, eight cases underwent a combined surgical management approach with follow up from up to 16 months.
Our short-term results are favourable and revealed high patient satisfaction with no evidence of hernia recurrence and excellent cosmetic outcome.

Conclusion
A combined surgical management and multidisciplinary team approach found to be a promising and encouraging that allows the involved teams to share their different experiences and techniques in order to provide a high quality of care and remarkable patient satisfaction.
ROBOTIC ENHANCED VIEW TOTAL EXTRAPERITONEAL REPAIR (eTEP) WITH ENDOSCOPIC POSTERIOR LINEA ALBA RECONSTRUCTION (EPLAR) FOR INCISIONAL HERNIA: EARLY RESULTS FROM 34 CASES
Authors: Bauer R C , Pradella C , Schupp L , Rosenblum I , Schenkluhn B , Eucker D , Rosenberg R , Lamm S H 
Published: May 2024

Abstract

Background
Laparoscopic incisional hernia repair offers advantages compared to open surgery. However, laparoscopic reconstruction of the linea alba is technically demanding and may be facilitated by the robotic approach. In this study, we present our experience with robotic eTEP with EPLAR for incisional hernia repair.

Method
A standardized robotic system was utilized. After preparing the retrorectus space, EPLAR was conducted with long-term absorbable barbed suture in a running fashion and a macroporous, nonresorbable mesh was introduced. Perioperative data were prospectively recorded in a register. One year follow-up was conducted using a standardized questionnaire.

Results
From January 2022 to September 2023, robotic eTEP with EPLAR was performed in 34 patients (41% female) with incisional hernias. Hernia width was W1 (&lt;4 cm) in 38% of cases, W2 (4–10 cm) in 56% and W3 (&gt;10 cm) in 6%. The mean operation time was 161 minutes. There were no intraoperative complications. The median length of stay was three days (range, 2–7 days). Postoperative complications occurred in four patients (one pulmonary embolism, one seroma, two cases of urinary retention). No reoperations were necessary. One year follow-up has been completed in 11 patients, with 90% reporting being free of pain.

Conclusion
In our setting, robotic eTEP with EPLAR demonstrated favorable outcomes with no surgical site infections and excellent cosmesis. EPLAR may result in better abdominal core stability than other techniques using mesh placement with or without defect closure, as well as providing better ergonomics for the surgeon.
FASCIAL TRACTION AS AN ALTERNATIVE TO POSTERIOR COMPONENT SEPARATION IN PATIENTS WITH HISTORY OF PERITONEAL SURGERY – A CASE REPORT
Authors: Gajda Escudero J , Sánchez López J D , Ferrero Celemín E , Rodriguez Haro C , Hernández O’Reilly M , Mellado Sánchez I , Peck García C , Picardo Nieto A L 
Published: May 2024

Abstract

Aim
The aim of this communication is to present an alternative to posterior component separation for midline incisional hernia repair in patients with a history of peritoneal surgery.

Material and Methods
We present the case of a 62-year-old female patient with a history of stage IV rectal cancer who underwent ultra-low anterior resection, hysterectomy and resection of peritoneal implants. Subsequently the patient presented peritoneal progression, so she underwent peritonectomy with HIPEC. She came to our office presenting a M3-M5W2 eventration with a 10 cm defect, very symptomatic.
Given the history of peritonectomy, the performance of a Transversus Abdominis Release (TAR) was discarded, opting for repair using a fascial traction device and the performance of a Rives-Stoppa technique. To facilitate traction, botulinum toxin was injected into the abdominal muscles.

Results
A Rives-Stoppa technique was performed with placement of a retromuscular polypropylene mesh. The defect was closed by means of a fascial traction device, applying 14–16 kg of force for 25 min. The anterior fascia was closed without bridging nor tension.
The patient presented no complications in the immediate postoperative period and was discharged on the 2nd postoperative day. At 11 months the patient presents good general condition, with a continent abdomen and no signs of recurrence.

Conclusions
Peritoneal surgery is an increasingly used therapy in patients with late-stage cancers. These procedures may preclude the performance of techniques involving posterior component separation. The use of fascial traction devices is a viable alternative for abdominal wall repair in patients with a history of peritonectomy.
PREOPERATIVE USE OF BOTULINUM TOXIN AND PROGRESSIVE PNEUMOPERITONEUM IN L3 INGUINAL HERNIA WITH LOSS OF DOMAIN – A CASE REPORT
Authors: Gajda Escudero J , Martínez Alegre J , Sánchez López J D , Rodriguez Haro C , Hernández O’Reilly M , Mellado Sánchez I , Peck García C , Ferrero Celemín E , Vaquero Pérez M A , Picardo Nieto A L 
Published: May 2024

Abstract

Aim
The aim of this communication is to present a case of preoperative progressive pneumoperitoneum (PPP) and injection of botulinum toxin type A (BT) in a patient with a L3 inguinal hernia and loss of domain.

Material and Methods
We present the case of a 74-year-old patient with a L3, non-reducible, right inguinal hernia with loss of domain. An abdominal CT scan was performed, showing a hernial orifice of approximately 6.6 × 5.4 cm containing mesenteric fat, ileum and part of the bladder inside.
Given the size of the hernia, PPP and BT and was proposed to increase intra-abdominal pressure prior to surgery.

Results
Botulinum toxin is injected into the rectus abdominis, transverse and oblique muscles. An intraperitoneal catheter is placed, through which 1000 cubic centimeters of pneumoperitoneum are introduced daily until reaching 9000 cc.
Open hernioplasty is performed according to the Litchenstein technique, reducing the hernial content in its entirety. A polypropylene mesh is placed. Intra-abdominal pressure was monitored and measured at 9 mmHg before surgery, 12 mmHg during the procedure, and 15 mmHg after the procedure.

Conclusions
In patients with large L3 hernias and loss of domain, reduction of the herniated content have the risk of producing an abdominal compartment syndrome. There are several techniques to maintain an appropriate intra-abdominal pressure prior to surgery, such as BT or PPP, although their use is mainly described for midline hernias. The use of BT and PPP may be a useful therapy in the treatment of large inguinal hernias with loss of domain.
TAILORED APPROACH TO ABDOMINAL WALL RECONSTRUCTION: LESSONS FROM A COMPLEX HERNIA CASE
Authors: Gaspar Reis S , Sobrino Brenes L , Llosa Pérez J , Pérez Huertas R , Ramon Naranjo Fernández J , Morales-Conde S 
Published: May 2024

Abstract

Background
Complex abdominal hernias present challenges in surgical practice, necessitating innovative strategies for successful reconstruction of the abdominal wall.
We aim to elucidate the intricacies of reconstructing the abdominal wall in a complex hernia case, addressing preoperative considerations, intraoperative techniques, and postoperative outcomes.

Method
Presentation of a case of complex abdominal hernia through the case description, presentation of complementary diagnostic exams, and photographic documentation of the surgical steps.

Results
We present the case of a 49-year-old male patient with a history of obesity and multiple surgical interventions due to anorectal agenesis, including a previously closed colostomy. He was referred to our center due to a complex incisional hernia. Clinical examination and CT imaging revealed an umbilical hernia (M3W1, European Hernia Society Classification (EHSc)), and a left paramedian hernia (M3M4W3, EHSc), along with multiple retracted scars.
The patient underwent a preoperative preparation program for obesity and abdominal wall prehabilitation with Botulinum Toxin. Four weeks after, he underwent abdominal wall reconstruction via laparotomy. The reconstruction involved posterior wall repair using the "small bites" technique, placement of a self-gripping mesh in a sublay position, and closure of the anterior aponeurosis using the same technique. The recovery proceeded without complications, and the patient was discharged on the 3th postoperative day.

Conclusion
This case highlights the importance of a thorough diagnostic and surgical approach in managing complex abdominal hernias. It also emphasizes the need for individualized preoperative strategies and advanced surgical approaches to ensure favourable outcomes for patients with complex abdominal hernias.
INCISIONAL HERNIA AFTER LIVER TRANSPLANTATION: LONG TERM OUTCOMES AND EVALUATION OF QUALITY OF LIFE AFTER HERNIA REPAIR
Authors: Gumus T , Korucuk E 
Published: May 2024

Abstract

Background
Incisional hernia development after liver transplantation is observed in approximately 40% of patients. Patient-related factors such as smoking, obesity, comorbidities, immunosuppressive therapy and patient-independent factors such as mesh and suture material used are effective in the development of hernia. In our study, we aimed to investigate the risk factors, long-term outcomes and quality of life after hernia repair in patients operated for incisional hernia after liver transplantation.

Method
Among 220 patients who underwent liver transplantation in our center between October 2018 and October 2023, 15 patients who underwent surgery for post-transplant incisional hernia were included in the study and retrospectively reviewed. Mercedes incision was present in all patients, and the same mesh and suture were used in hernia repair. EuroQol-5D scale was used as a quality of life test.

Results
Of the patients included in the study, 10 (66.7%) were male and 5 (33.3%) were female. The mean age at hernia repair was 60.26 years. The mean BMI was 56.73. 10 patients (66.7%) were smokers. 9 patients (32.1%) were on tacrolimus, 7 patients (43.8%) on everolimus, 14 patients (93.3%) on mycophelonate mofetil, 7 patients (43.8%) on prednol. When the time between transplantation and hernia operation was evaluated, a statistically significant difference was found between everolimus users and non-users (p = 0.001). The mean hernia development time was 29.0 months in the everolimus group and 42.0 months in the non everolimus group.

Conclusion
In our study, similar to the literature, we found that mTOR inhibitor drugs shortened the duration of hernia development and recurrence could be prevented with drug regimen modification. In addition, it was observed that patients defined their health status better and their quality of life improved after hernia repair in transplant patients.
USE OF PROGRESSIVE PREOPERATIVE PNEUMOPERITONEUM ON A PATIENT WITH A COMPLEX INCISIONAL HERNIA
Authors: Marolt U , Šturm M , Einfalt M , Gorjanc J , Genc M , Potrč S 
Published: May 2024

Abstract
The incidence of complex incisional hernias is increasing due to increasing number of major abdominal surgeries being performed, damage control surgery with open abdomen, and delayed abdominal wall closure. Also advances in intensive care, an ageing population, and the obesity epidemic are influencing the number of complex incisional hernias. Incisional hernia repair has evolved steadily over time, from open onlay mesh techniques or open IPOM to gold-standard Rives-Stoppa hernioplasty, and minimally invasive laparoscopic procedures to component separation techniques recently for very big hernias. At the same time, due to the inadequate results of modified surgical techniques and mesh placement methods in complex incisional hernias, new methods of extending the length of the abdominal wall emerged. These extension methods are progressive preoperative pneumoperitoneum (PPP), tissue expanders, and botulinum toxin A (BTA). In this article, we report our experience with the use of BTA, PPP, and the transversus abdominis release separation technique (TAR) on a patient with a complex incisional hernia with loss of domain. In our opinion, PPP should be considered in conjunction with BTA for incisional hernias with loss of domain, as it may facilitate primary closure, reintroduction of hernia sac contents into the abdomen, and reduction of complications after surgery.
PATIENT MANAGEMENT AND TREATMENT WITH PERINEAL HERNIAS. OUR EXPERIENCE
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
Secondary perineal hernias is a defect of the pelvic floor originating after pelvic surgery. We present our experience in management and treatment of this kind of hernias.

Material and Methods
We have a short group of patients operated on for perineal hernia secondary to abdominoperineal rectum amputation by same surgeon, same method and same kind of mesh.

Results
We have operated five patients, (three men and two women) with symptomatic perineal hernias since 2021. All of them were diagnosed by physical examination and CT. We prefer perineal approach (Martijnse technique) because it is a less invasive technique and we can fix mesh exactly where we want. We use a mesh double-sided fixed in four cardinal points and perineal drain. We haven´t had any postoperative complications. Actually, four of them are asymptomatic, one patient suffered a stroke five months later and died.

Conclusions
Perineal approach is a safe method to repair perineal hernias avoiding abdominal injuries and fixing mesh in correct position.
AN HORROR MOVIE: A COMPLEX VENTRAL HERNIA AFTER A SEVERE CASE OF NECROTISING FASCEITIS
Authors: Melo Pinto D 
Published: May 2024

Abstract

Introduction
We present a case of a 58-year-old woman with history of severe sepsis after a perinatal abscess. This necrotising fasciitis lead to a partial destruction of the abdominal wall and required multiple surgical debridement (with partial removal of recuts muscle), colostomy and hyperbaric treatment. After controlling the infectious process, we performed a progressive surgical closure with a planned ventral hernia with phasic prosthesis and dermoepidermic graft.

Methods
This patient had her follow up appointment to prepare for reconstructive surgery with weight loss and biofeedback. She did a CT that demonstrated a ventral hernia (89 × 90 mm) between recuts muscle and transversus. This hernia classified as M2-M5+W3 on the right and L4+W3 on the left. We used adjuvant therapy with botulinum toxin and subcutaneous expansor.

Results
The reconstruction was performed in two steps. First, we performed a colostomy closure with no complications. After one week we performed an abdominal wall reconstruction with transversus abdominal release. Due to some skin necrosis and risk of infection identified during surgery we decided to differ the closure with a prosthesis with double layer (one reabsorbable and one synthetic) and a dermoepidermic flap.

Conclusion
Complex abdominal wall hernia are difficult cases to treat due to anatomical changes and infectious complications associated. New materials are being developed that can help to overcome some difficulties that we face.
RE-LAPAROSCOPIC REPAIR OF RECURRENT INGUINAL HERNIA FOLLOWING PREVIOUS LAPAROSCOPIC APPROACH: OPTIMISED DISSECTION IS THE KEY
Authors: Moollan Y , Badiani S S , Tsakanov S , Rajkomar K , Berney C R 
Published: May 2024

Abstract

Aim
Re-laparoscopic repair of recurrent inguinal hernia following previous laparoscopic approach can provide similar clinical outcome when completed with the appropriate level of surgical experience. Our objective was to evaluate the feasibility and safety of redo laparoscopy, and document any unexpected new perioperative findings potentially overlooked during initial surgery.

Material and Methods
The clinical data of all patients who underwent re-laparoscopic repair (TEP or TAPP) for post-laparoscopic inguinal hernia recurrences between October 2011 and November 2023 was retrieved from a prospectively maintained institutional database.

Results
Twenty-nine patients (4 females), mean age of 50.9 years old, were retrospectively reviewed. Thirty-three pre-operative diagnosis of inguinal hernia recurrence were made. TAPP technique for redo was the preferred approach in 23 patients (79.3%). Inadequate mesh placement during the first repair was the main factor contributing to recurrences. No intraoperative complications were encountered and there were no conversions to open.
Fifty-one groin hernias were repaired, including 33 recurrent inguinal hernias, nine primary inguinal hernias on the contralateral side, and nine new incidental defects found in six patients (three femoral, one Laugier’s, one pre-vascular, four obturator hernias). Five of them were identified on the same side of previous laparoscopic repair. Four of those hernias were found in three female (75%) and five in three male patients (12%). We did not record any postoperative complication.

Conclusions
Re-laparoscopic repair of recurrent inguinal hernia post laparoscopy is safe and allows simultaneous treatment of incidental new defects, including those probably overlooked during the initial procedure from suboptimal groin dissection.
ENVIRONMENTAL SUSTAINABILITY OF ABDOMINAL WALL SURGERY – INGUINAL HERNIA: A STUDY PROPOSAL
Authors: Paiva de Oliveira G , Maillo C 
Published: May 2024

Abstract

Background
Inguinal hernia surgery is a common surgical procedure worldwide, with over twenty million surgeries being performed annually. However, healthcare delivery contributes significantly to pollution, accounting for 5 to 8% of greenhouse gas emissions in developed countries. This project aims to evaluate the environmental effects of inguinal hernia surgery throughout the patient's journey and identify opportunities for optimization.

Method
This study involves a process-based, multicenter evaluation of ten consecutive patients undergoing inguinal hernia surgery. It examines three key phases: preoperative, intraoperative, and postoperative. Critical variables for each phase were identified and measured according to established guidelines. Boundaries were set to include all relevant and achievable information.

Results
A structured form was developed with specific fields and detailed instructions for each phase. Preoperative data includes the number of consultations, commutes, and exams. Intraoperative data encompasses the number of personnel involved, the volume of anaesthetic gas used, and the quantification of surgical waste. Postoperative data includes the number of wound care treatments, consultations, and commutes. Direct emissions and primary and secondary process activity data will be measured, such as waste management, energy consumption, and commute estimation.

Conclusion
Environmental sustainability is increasingly recognized as crucial across all human activities, including healthcare. With the global population exceeding 8 billion, prioritizing health without considering environmental impact is no longer acceptable, especially if it does not provide significant value. Abdominal wall surgery, given its prevalence, offers an opportunity to optimize resources and reduce the environmental impact of healthcare.