bluuebunny/crossref_metadata_2025_split huggingface dataset:
eTEP RIVES-STOPPA VS. TOTAL VISCERAL SAC SEPARATION (TVS) TECHNIQUE: DIFFERENCES BETWEEN TWO MINIMALLY INVASIVE SUBLAY APPROACHES FOR MIDLINE HERNIAS
Authors: Robles Bardales C J , Ginestà C , Domínguez P , Guillaumes S , Hidalgo N J , Costa D , Morales X , Pera M 
Published: May 2024

Abstract

Background
Minimally invasive abdominal wall surgery is rapidly evolving, with techniques like IPOM, TAPP and TEP increasingly being used. The latter one allows for a laparoscopic retromuscular mesh placement but often requires extensive fascial dissection. In contrast, the European Hernia Society suggests an open preperitoneal repair for smaller hernias. Recently, a different laparoscopic preperitoneal approach has been described, being essential to understand the differences between both planes.

Methods
A 67-year-old female patient, with no comorbidities, consulted for multiple primary ventral hernias confirmed by CT scan. Another 57-year-old woman, with previous multiple pregnancies, presented with an umbilical hernia. Both with concomitant rectus diastasis. The first underwent an eTEP Rives-Stoppa, whereas the other one, a Total Visceral Sac Separation (TVS) technique; either with a down-to-up approach.

Results
eTEP allowed for three M2-3W1-2 hernias reduced, the retromuscular plane dissected and the defects repaired before mesh placement; operative time (OT) was 120 minutes. In the TVS technique, an M3W1 hernia was repaired following and dissecting a wide preperitoneal space. Incidental peritoneal opening was corrected with a running barbed suture and the defect closed with a trans-fascial repair; OT was 65 minutes. No immediate post-operative complications were reported.

Conclusions
Differences between a preperitoneal and retromuscular approach for hernia repair are highlighted. Patients with W1 hernias could benefit from a TVS approach, being less invasive, and having advantages such as reduced abdominal wall trauma, potentially faster recovery and fewer postoperative complications, making it a suitable option for these hernias.
THE THT (TRENTINO HERNIA TEAM) TECHNIQUE STANDS OUT AS A REPRODUCIBLE AND HIGHLY EFFECTIVE OPTION FOR REPAIRING INCISIONAL HERNIAS
Authors: Segismundo J J , Ong R A , Cruz E 
Published: May 2024

Abstract

Background
A 37-year-old woman, with a BMI of 27, underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) three years ago through a midline incision. She presented with intermittent bloating and abdominal pain, accompanied by a protruding mass near her umbilicus. A CT scan confirmed the presence of an incisional hernia in the umbilical region, with herniated bowel. The treatment plan involved hernia repair surgery using the Trentino Hernia Team Technique, which included the development of the retromuscular space and insertion of a mesh.

Method
The procedure began with the insertion of optical and working ports on the left side of the abdomen. A diagnostic laparoscopy was performed, revealing dense and extensive adhesions, which were then lysed laparoscopically. Subsequently, the umbilicus was incised, and the anterior rectus sheath was also incised to access the retrorectus space. Blunt dissection of this space was carried out on all sides. The two rectus sheaths were stapled together cranially and caudally. A single port was placed in the umbilicus to aid in further dissection of the retrorectus space, allowing accommodation for the 15 × 15 cm mesh. The mesh was then placed in the retrorectus space and secured using histoacryl glue. Finally, the anterior rectus sheath was closed primarily at the level of the umbilicus.

Result
The patient was hospitalized for a total of three days. There were no observed instances of seroma, hematoma, or necrosis in the umbilical area. Postoperative pain was minimal due to the laparoscopic nature of the procedure.

Conclusion
This approach provides a repair with minimal tension, facilitating the strengthening of the abdominal wall by reconstructing the linea alba. The application of a 15 × 15 cm mesh over the defect greatly diminishes the likelihood of recurrence. Moreover, the retrorectus placement of the mesh is preferable to intraperitoneal placement, particularly in cases of iPOM (intraperitoneal onlay mesh).
LAPAROSCOPIC APPROACH TO INGUINAL BLADDER HERNIA
Authors: Serrano A , Gutiérrez C , Reguero C , Carreño O , García-Pastor P , Bueno J , Ruiz J L , Pous S 
Published: May 2024

Abstract

Background
To present an infrequent case of inguinal bladder hernia (IBH) in an adult patient, as well as its minimally invasive approach.

Method
A 67-year-old obese male patient, with a medical history of bilateral hernioplasty by open approach, presented a history of lower urinary tract symptoms, urgency urinary incontinence and recurrent urinary tract infections of months of evolution. The clinical examination revealed a left inguinoscrotal hernia that was irreducible to palpation. Renal function was normal and Prostate Specific Antigen (PSA) level was 1.19 ng/ml. Ultrasonography showed no significative prostatic hypertrophy or hydronephrosis. Cystoscopy and cystography revealed a left IBH and suspected a bladder diverticulum associated. Computed tomography dismissed ureteral involvement.

Results
A scheduled surgery was decided. Surgical exploration found a direct left inguinal hernia containing almost ¾ parts of the bladder. No bladder diverticulum was observed. The next step was hernia reduction, which involved some technical difficulties. Hernia repair was performed by laparoscopic trans-abdominal pre-peritoneal hernioplasty (TAPP). Polyvinylidene fluoride (PDVF) mesh was used and fixed with non-absorbable tackers. The bladder integrity was confirmed with the instillation of saline solution through a urinary catheter. The patient was discharged without complications on the first postoperative day.

Conclusion
Inguinal bladder hernias are an uncommon condition that can often be difficult to diagnose. Furthermore, they constitute a surgical challenge since iatrogenic injuries and complications are possible. Perioperative imaging can help to make a diagnosis with certainty and to prevent misleading. The treatment of this pathology can be safely performed through laparoscopic approach and with less comorbidities than open surgery.
INCISING POSTERIOR WALL OF INGUINAL CANAL MAKES TAPP FOR LARGE HYDROCELE OF CANAL OF NUCK EASIER
Authors: Sharma N 
Published: May 2024

Abstract
We wish to share our video of TAPP for a large Type 1 Hydrocele of the canal of Nuck. The salient point we wish to share with the audience is that incising the posterior wall of the inguinal canal makes the operation easier if the cyst is large.
In this video, we first show the large cyst visible on laparoscopy. We have omitted the standard peritoneal incision and dissection of the flap for TAPP because the video had to be kept below 4 minutes.
We demonstrate how we approached the incision of the posterior inguinal wall without rupturing the cyst and later extended this incision.
This step made the dissection of the most distal part of the cyst much easier than if we had not incised the posterior inguinal wall.
We have omitted to show the closure of the posterior inguinal wall and mesh placement and flap suturing in this video, which was routine.
SUBCUTANEOUS ONLAY LAPAROSCOPIC APPROACH (SCOLA) MESH REPAIR FOR UMBILICAL HERNIA AND DIASTASIS RECTI: TECHNICAL DESCRIPTION
Authors: Tohmeh M , Kassar S , Kassir R 
Published: May 2024

Abstract
Diastasis recti (DR) refers to the stretching and thinning of the Linea alba and the separation of muscular borders by more than 2.2 cm1, clinically manifesting as a central bulging of the Linea alba1. It leads to an increased risk in hernia recurrence after hernia repair, often linked to underlying wall weakness2,3.
Various methods exist for ventral hernia repair, with the laparoscopic or open sublay approach that are technically demanding, causing significant abdominal scars. The intraperitoneal mesh technique employs a costly mesh and poses ergonomic challenges for DR plication2. Simultaneous treatment of DR and hernia repair with or without a mesh is typically performed during abdominoplasty, this technique yields unsatisfactory aesthetic outcomes for individuals lacking excess abdominal skin1. The SCOLA technique combines sub-cutaneous laparoscopic abdominal hernia repair with concurrent DR plication and onlay mesh fixation. SCOLA addresses the limitations associated with other hernia repair techniques, being minimally invasive, ergonomically favourable, utilizing an onlay mesh to reduce recurrence rates, with low risk of bowel injury or obstruction. Moreover, SCOLA delivers excellent aesthetic outcomes for patients not in need of excess skin resection1,2. However, it has its post-operative complications like seroma formation, hematoma, surgical site infections, and recurrence1,3.
SCOLA technique proves a safe and effective option when applied to non-obese individuals without excess skin, averse to transverse abdominal scars, and with small umbilical or midline hernias, particularly when associated with DR.
We will present the surgical technique that we performed in one of our patients.
LAPAROSCOPIC EXTENDED TOTALLY EXTRAPERITONEAL (e-TEP) TECHNIQUE FOR LATERAL VENTRAL HERNIA REPAIR: STEP BY STEP
Authors: Trujillo J , Gómez J R , Concejo P , Montenegro M A , Schenone F , Jezieniecki C , Martín del Olmo J C 
Published: May 2024

Abstract

Aims
Ventral hernias are one of the most common pathologies in general surgery, however, lateral hernias are not so common, so their minimally invasive approach is not yet very popular, much less through the laparoscopic eTEP approach. The surgical technique for repairing this type of hernia is ideally a neuromuscular or preperitoneal technique, which is a good technique due to the more anatomical position of the mesh and lower rates of complications and recurrences in the short and long term. In the following video we present the usefulness and steps to follow to perform a laparoscopic e-TEP approach to treat lateral abdominal hernias.

Methods
Video-case presentation.

Results
43-year-old male patient. Pathology history: laparoscopic right nephrectomy. Physical examination: right lateral hernia EHS: L2W2 (8–9 cm). CT scan: 8 × 9 cm lateral hernia with small bowel inside the hernial sac without obstruction signs. 4 weeks ago 400UI botulinum toxin (according Ibarra-Hurtado technique) was placed in the abdominal wall in order to reach a better abdominal wall reconstruction. We decided to perform a laparoscopic extraperitoneal technique (eTEP).
We use 4 ports (2 × 12 mm, 2 × 5 mm) to perform the surgery. The surgery begins dissecting the right retromuscular space using a dissector balloon. We placed the other ports and complete a lateral dissection until the neurovascular bundles, at this point we continue with the TAR procedure, in this case of hernias we performed it up-to-down transecting the lateral posterior rectus sheath and complete the dissection of the preperitoneal space. We continue the dissection towards the pubis, and finally we complete the dissection of the hernial sac, we open the sac and reduce all its contents and release the adhesions, completing a complete dissection of the preperitoneal space until reaching at least an overlap of 5 cm per side. The next step is the closure of the posterior sheath using V-Lock 2-0 and the closure of the anterior sheath (hernial defect) using Stratafix 0. We measure the space placed and place an 18 × 30 cm Dynamesh CICAT mesh fixed with fibrin and without drainage.
The patient presented a satisfactory evolution without complications and was discharged in 1°POD.

Conclusions
The minimally invasive e-TEP approach is a good and effective option in cases of lateral ventral hernias, as in the case presented, without increasing the incidence of postoperative complications and with good postoperative recovery, little postoperative pain, short hospital stay and faster return to routine activities and work life, and lower health care costs.
ABDOMINAL WALL RECONSTRUCTION AFTER EXCISION OF A GIANT DESMOID TUMOUR
Authors: Tuñón-Féquant C I , López-Monclus J , Blázquez-Hernando L A , Robin-Valle de Lersundi A , Muñoz-Rodríguez J , Medina-Pedrique M , Avilés-Oliveros A , Crespo-Álvarez M A , García-Ureña M A 
Published: May 2024

Abstract

Introduction
Desmoid tumors are histologically benign proliferations of stromal cells that grow slowly and infiltratively, but may be locally aggressive. They arise from musculoaponeurotic stromal elements. Due to poor response to systemic medical treatment, radical resection and reconstruction should be performed.

Material and Methods
We present the case of a 24-year-old female patient with abdominal and thoracic tumours, diagnosed in Bangladesh as an endometrioma. She had an increasement of them during her pregnancy. A complementary study was performed showing 4 masses which were biopsied with the result of low-grade mesenchymal tumour.

Results
After multidisciplinary consensus, a two-stage surgical approach was adopted. First, the thoracic-retroperitoneal mass was removed.
Botulinum toxin was then administered to the contralateral side, followed by abdominal surgery. En bloc excision of the entire mass was performed, which was infiltrating the left rectus, obliques and transverse muscles. A dissection of retromuscular preperitoneal disection from central tendon to both Cooper ligaments and from left psoas muscle to the right quadratus lumborum was planned. Then, subsequent reconstruction of the abdominal wall with the combination of absorbable and giant synthetic mesh with reimplantation of muscles into an area of 13 × 10 that was left as a bridge. Only fixation to Cooper ligaments were made. A second synthetic mesh covering the bridge was also implanted as bridge reinforcement. The patient was discharged uneventfully on the 7th postoperative day.

Conclusions
Radical resection with immediate mesh reconstruction is a safe procedure and can provide definitive cure without functional disability for patients with anterior abdominal desmoid tumours.
HYBRID SURGERY FOR GIANT L2-4W3 INCISIONAL HERNIA: E-TEP AND LAPAROSCOPIC MADRID-PCS
Authors: Vaello V , Martínez C , Avilés A , Urbani A , Medina M , Casanova A , Morejón S , García-Ureña M A 
Published: May 2024

Abstract

Objective
To present a hybrid laparoscopic/open technique for the repair of a giant incisional hernia.

Methods
A 79-year-old patient with a large L2-4W3 incisional hernia following a left nephrouretherectomy was treated with a hybrid laparoscopic/open approach following injection of botulinum toxin A. The initial stage involved an endoscopic totally extraperitoneal (e-TEP) approach. Subsequently, the dissection was extended laterally by sectioning the posterior rectus sheath (PRS) entering pre-transversalis fascia space cranially and preperitoneal space caudally to the hernia. The procedure was then converted to an open approach for final dissection of the hernia sac, lysis of adhesions, and mesh placement in our standard technique: a BioA mesh serving as a scaffold and a large polypropylene mesh that enveloped the abdominal wall (taco conformation). The patient experienced no complications and was discharged on the 5th postoperative day.

Results
The hybrid laparoscopic/open approach provided the advantages of minimally invasive surgery, including reduced postoperative pain and improved recovery, enabling direct visualization and safe dissection of critical structures for our modification of posterior components separation. The open conversion enabled a complete dissection of the hernia sac, lysis of adhesions, and secure mesh placement.

Conclusion
The hybrid laparoscopic/open approach offers a viable option for repairing giant incisional hernias, particularly when a purely minimally invasive approach is not feasible due to the extent of the defect. The combination of minimally invasive dissection and open access for critical structures provides a balance between the benefits of both techniques.
ROBOTICALLY ASSISTED TOTALLY EXTRAPERITONEAL MIDLINE INCISIONAL HERNIA REPAIR AFTER OPEN CYSTECTOMY
Authors: Vogel R , Heinzelmann F , Büchler P , Mück B 
Published: May 2024

Abstract

Introduction
This case report describes a 72-year-old male patient who underwent robotically-assisted total extraperitoneal hernia repair. The patient had a history of complete cystectomy with orthotopic neobladder reconstruction and temporary colon diversion via transversostomy through midline laparotomy four years prior. The transversostomy was relocated six months before the current operation, when the patient presented in our outpatient department with a midline incisional hernia. A CT scan revealed a E2, M2, M3, M4 hernia, with an orifice measuring 6 × 20 cm. This case illustrates the feasibility of robotically-assisted total extraperitoneal repair even after open cystectomy with resection of the ligamentum umbilicale.

Methods
The initial entry into the retroperitoneal space was achieved through the right upper rectus sheath. The initial phase of the operation was conducted endoscopically. Following the creation of the left retro rectus space, three 8 mm robotic ports were strategically placed along the left semilunar line, and the robotic system was docked. The retzius space was completely developed extraperitoneally using the robotic system, irrespective of the previous surgical procedure. Subsequently, a cross-over maneuvre was executed through an incision of the posterior rectus sheath on the contralateral side. After developing the retrorectus space on the contralateral side, the former stomasite reached the lateral border of the right posterior rectus sheath. To fully overlap the hernia site, a partial right-sided transversus abdominis release was performed. Following this, an uncoated synthetic mesh (18 × 32 cm) was placed, ensuring sufficient overlap of the hernia site.

Results
The postoperative phase was uneventful and the patient was discharged on the second postoperative day. No complications occurred.

Conclusion
Robotic assisted totally extraperitoneal hernia repair is offers a suitable approach for treatment of midline hernias even following partial resection of the peritoneum and the ligamentum umbicale.
TOTAL EXTRAPERITONEAL ENDOSCOPIC INGUINAL HERNIOPLASTY (TEP). DEALING WITH THE ROUND LIGAMENT
Authors: Zárate Gomez J , Peinado Iríbar B , Supelano Eslait G , Álvarez de Sierra P , Gil López J M , García Munar M , Lechuga Alonso I , Merello Godino J 
Published: May 2024

Abstract

Background
International guidelines recommend the laparoendoscopic approach to treat inguinal hernia in women. When performing this technique we have to deal with the round ligament of the uterus and the doubt arises: to divide or not to divide. The peritoneum may be intensely attached to the round ligament and its dissection may be technically challenging. There is no specific statement or consensus on this matter included in the guidelines.

Method
Video presentation: three different options to manage the round ligament during TEP inguinal hernioplasty.

Results
Management options regarding the round ligament of the uterus:
Division: the round ligament is dissected proximally to avoid injuring the genital branch of the genitofemoral nerve. Place 5 mm endoclips close to the peritoneum before dividing it.
Dissection: The round ligament is usually difficult to liberate from the peritoneal sac. Care must be taken to preserve the peritoneal sac integrity.
Open the peritoneum: To save the round ligament, the peritoneal sac can be cut to obtain a flap followed by closure of the defect with 5 mm endoclips.

Conclusion
There is no consensus regarding the round ligament of the uterus’ preservation in TEP surgery, this matter needs further evaluation. We describe three valid management options, but we recommend preservation over division. Nevertheless, sometimes the ligament needs dividing in order to perform a proper repair with mesh placement. If this is the case, the surgeon must have the genital branch of the genitofemoral nerve in mind to avoid chronical postoperative pain.
IS MINIMALLY INVASIVE HERNIA REPAIR SAFE IN PATIENTS WITH PREVIOUS PROSTATE SURGERY?
Authors: Abad Moret R , Salido S , Zapata C , Gutiérrez E , de Mora Á , Piñero S , Fondevila C , Guevara-Martínez J 
Published: May 2024

Abstract

Aim
Laparoscopic inguinal hernia repair after previous radical prostatectomy is considered complex due to the subsequent preperitoneal fibrotic reaction. For this reason, it has been considered a contraindication, and many surgeons have opted for open surgery. The aim of this study is to describe the outcomes of inguinal hernia repair after previous prostate surgery in our center.

Patients and Methods
We retrospectively analyzed a total of 566 patients who underwent inguinal hernia repair during a 1 year period (from May 2022 to May 2023). Patients with previous radical prostatectomy were identified, and outcomes of laparoscopic versus open hernia repair techniques were compared.

Results
Twenty-three patients with prior prostate surgery were identified, among whom four underwent minimally invasive repair (MIS) (17%; 2 TEP and 2 TAPP). Longer mean operative time was observed in the MIS group (100 min) compared to the open surgery (67 min). There were no MIS to open conversions. Perioperative complications included 1 bladder injury and 2 seromas in the MIS group, and 1 hematoma and 1 recurrence in the open group.

Conclusions
MIS for inguinal hernia after prostate surgery remains infrequent in our experience. Although MIS hernia repair after prostatectomy is considered safe, potentially serious complications may arise, and care must be taken regarding patient selection and operative management.
RARE CASE OF OBSTRUCTING SIGMOID CARCINOMA ENCOUNTERING WITHIN A SCROTAL HERNIA
Authors: Alifanov D , Alifanova E , Krajinovic K 
Published: May 2024

Abstract

Aim
To present our experience with treatment of obstructing sigmoid carcinoma encountering within a scrotal hernia and to find out the best approach for oncological bowel resection and simultaneous hernia repair in this situation.

Materials and Methods
We want to report about our case and to present a current literature review from PubMed and Google Scholar database, performed in January 2024.
In our case we chose to perform a conventional oncological left-sided colon resection with anastomosis via median laparotomy. During the operation an en-bloc left-sided orchiectomy was needed for oncological reasons. The suture repair for a scrotal hernia was performed because of contamination. The patient has uneventful postoperative course and was discharge from hospital on the postoperative day 9.

Results
Scrotal hernia is a common surgical condition. It's quite rare — less than 0,4% of the cases in which colon adenocarcinoma presents within a inguinal hernia sac. A literature search on inguinal hernias containing a primary colon carcinoma revealed 29 cases. Scrotal hernia associated with obstructing sigmoid carcinoma is even more rare.

Conclusions
A surgeon may encounter a challenging scenario requiring both an oncologic resection and a repair of a large hernia in contaminated field. Thus, it is important to be prepared to realize the difficulties and to apply the correct treatment of both conditions.