bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTERFASCIAL BLOCKAGES OF THE ABDOMINAL WALL WITH THE ERAS PROTOCOL IN VIDEOLAPAROSCOPIC SURGERY FOR INGINAL HERNIA
Authors: Lysenko R , Tarasenko K , Osipov O , Cherkun M , Slipukha D , Shiyanovsky R 
Published: May 2024

Abstract

Actuality
Up to 75% of postoperative patients experience pain, while less than half of these patients can note the adequacy of postoperative pain therapy. Inadequate control of perioperative pain leads to medical, economic, and social adverse events. A modern approach to postoperative analgesia is a multidisciplinary ERAS strategy, a component of which is multimodal analgesia, especially with the use of regional nerve blocks.

Goal of the Work
Assessment of the effectiveness of recovery in the early postoperative period of patients who underwent video laparoscopic interventions for inguinal hernias, depending on the use of interfascial blockades of the abdominal wall as part of anesthesiological support of multimodal analgesia.

Materials and Methods
A prospective comparative study of the effectiveness of postoperative recovery of 89 patients after videolaparoscopic interventions for inguinal hernias was conducted. All of them underwent alloplasty according to the transabdominal preperitoneal repair (TAPP) technique in the period 2020–2023. 75.3% were male. Patients had a mean age of 52.3 years and a mean BMI of 29.2.
The patients were divided into 2 groups: in the main group – 46 people (52%) as part of anesthesiological intraoperative support, transversus muscle blocks (TAP-blocks), quadrato-lumbar blocks (QL-blocks) and rectus abdominal muscles sheath blocks were additionally performed; in the comparison group – 42 people (48%) additional interfascial blocks were not performed. The following were evaluated: intraoperative Fentanyl consumption, the need for additional administration of analgesics in the postoperative period, assessment of postoperative pain according to the visual analog scale (VAS), recovery time of motor activity within the ward, the time of discharge from the hospital.

Research results
In the patients of the main group, compared to the comparison group, the following features were noted: under the condition of using interfascial blocks of the abdominal wall intraoperative fentanyl consumption decreased by 2.4 times, the frequency of additional administration of analgesics in the postoperative period was 1.9 times lower, postoperative pain assessment according to VAS was 1.6 times smaller, recovery of motor activity within the ward took place earlier by an average of 5.5 hours, the time of discharge from the hospital decreased by 1.8 times, the average bed-day was 1.2 days.

Conclusions
Interfascial blocks of the abdominal wall are an important component of the ERAS protocol, which have positive medical, social and economic effects.
THE CLINICAL EFFECTIVENESS OF A TEACHING COURSE ON THE USE OF TOTALLY EXTRAPERITONEAL APPROACH FOR INGUINAL HERNIA REPAIRS
Authors: Mackenzie A , Chidambaram S , Howell A M R , Muirhead L , Brewer J O L , Fakih-Gomez N , Smellie J W B , Warren O J 
Published: May 2024

Abstract

Background
There is an increasing shift towards the use of laparoscopic techniques for repair of inguinal hernias, namely the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. Previous work has reported shorter post-operative length of stay (LOS), better pain control and faster return to function with laparoscopic techniques. Hence, we designed and conducted a one-day training course on TEP repairs for senior minimally invasive surgeons. This study aims to assess the clinical effectiveness of the course in changing our unit’s clinical practice and characterise the associated post-operative outcomes.

Methods
This is a single-center retrospective cohort study of hernia repairs performed by six consultant minimally invasive surgeons. All adult patients who underwent inguinal hernia repairs at our hospital between April 2022 – April 2023 were included. The primary outcome measures are the approaches used for each operation and post-operative LOS. Secondary outcome measures were conversion to open, incidence of complications, re-admissions, and re-interventions.

Results
We performed 223 hernia repairs over a 12-month period, with 88 and 135 procedures before and after the intervention, respectively. The mean age of patients was 60.7 (15.2). While the number of open repairs increased by 43% from 67 to 96, the number of TEP procedures increased eight-fold from 4 to 33 (p &lt; 0.05). The number of TAP repairs decreased from 17 to 6 in the same time period. There were two conversions of TEP to open repairs. Post-operatively, the length of stay was lower for TEP than open repairs at 0.27 and 0.42 days, respectively (p &lt; 0.05). The incidence of hematoma/seroma was higher with open repairs (n = 7) than TEP repairs (n = 1). However, all were conservatively managed till resolution, with no re-interventions at follow-up.

Conclusion
The implementation of a teaching course tailored to the surgical expertise of laparoscopic surgeons can update and change local clinical practice, and attain the clinical outcomes reported in literature.
QUALITY OF LIFE, POSTOPERATIVE COMPLICATIONS AND HERNIA RECURRENCE RATE FOLLOWING LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA) TECHNIQUE FOR PRIMARY AND INCISIONAL HERNIA REPAIR
Authors: Marrero Marrero P , Fernández Hernández L , Mon Martín F , González de Vera O , Lorenzo Rocha N , Delgado Plasencia L J 
Published: May 2024

Abstract

Background
Primary and incisional ventral hernias (PVH and IVH) are a common pathology which substantially impact patient’s quality of life (QoL). To date, no studies have been published on the impact of the laparoscopic intracorporeal rectus aponeuroplasty technique (LIRA) on the QoL of patients. The purpose of this study was to evaluate the quality of life (QoL), early postoperative complications and hernia recurrence rate following LIRA for PVH and IVH repair at the six month follow up.

Method
A retrospective review of a prospectively maintained database of all patients undergoing LIRA from August 2022 to May 2023. Data retrieved included demographics, clinical and operative variables. Computed tomography scan was performed before and six months after surgery. QoL was assessed using the EuraHS-QoL scale prior to-and following LIRA.

Results
17 patients met the inclusion criteria. PVH was the most common pathology (70.6%). The median follow-up time was 6 months. There were not hernia recurrence. Pre-operative and post-operative EURAHS-QoL questionnaire scores were available for 100% of patients enrolled in this study and showed significant improvement in pain (11.6 vs. 1.41, p &lt;0.001), restrictions (median of 13.1 vs. 1.35, p = 0.001), cosmetic appearance (10.8 vs. 2.82, p = 0.001) with a Total Score (35.4 vs. 5.59, p &lt;0.001).

Conclusion
Abdominal wall repair using the LIRA approach improves subjective QoL variables with and acceptable post-operative complications and without hernia recurrence in a short-term follow-up. So far, this is the first published study where QoL is evaluated in patients undergoing LIRA.
MESH INFECTION AFTER VENTRAL HERNIA REPAIR: A CASE REPORT
Authors: Medina Manuel E , Del Valle Ruiz S R , González Valverde F M , Rodríguez Lucas J M , Valero Soriano M , Jiménez Moreno I M , Hurtado Vázquez A M , Candel Arenas M F 
Published: May 2024

Abstract

Aim
Mesh infection represents a major health problem, as it increases patient morbidity as well as the rate of readmissions, reinterventions and healthcare costs. The aim of this communication is to present a case of mesh infection which required mesh explantation to raise awareness of the importance of its prevention.

Material and Method
80-year-old woman, obese, hysterectomized, who presented an incisional ventral hernia. Abdominal wall repair was performed by placing an intraperitoneal mesh. The aspiration drain was removed on the third day. She was readmitted a week later due to an abdominal wall hematoma (6 × 7 × 11 cm) that was drained. Empirical antibiotic treatment was established. After six months of wound care with persistence of purulent drainage and a positive culture for Proteus mirabilis, the mesh was removed with a new abdominal wall repair according to Rives-Stoppa technique.

Discussion
The increasing use of prosthetic material has led to an increase in complications associated with it, such as seroma, infection, extrusion or displacement. Once mesh infection is suspected, a culture must be taken, and empiric antibiotic treatment should be instituted, making it essential to perform wound healing treatment with irrigation and drainage. If resolution is not achieved, the mesh can be removed but with a higher risk of complications.

Conclusions
Considering the impact of this complication on the morbidity of patients, as well as on the health system, its prevention is essential. Treatment must be individualized based on the patient's characteristics, the type of prosthesis and the extent of the infection.
THE IMPORTANCE OF DETAILED RECORDS ON INGUINAL HERNIA – OUR EXPERIENCE
Authors: Melo Pinto D , Moreira Marques T , Quintela Silva C , Saraiva P , Guerreiro E , Ferreira F , Correia J 
Published: May 2024

Abstract

Background
Hospital records are essential to standardize information about the similar procedures in different patients as well as to compare findings to what is described in literature. It is also fundamental to carry out retrospective studies. Our department implemented an inguinal hernia record that is carried out in three main points: pre-operative, immediately after surgery and post-operative appointment.

Method
We performed a retrospective study to analyze the records between 2021 and 2022. It was also asked our team to answer a questionnaire about the impact of this new tool in our practice.

Results
During this period records were filled in 78 out of 148 patients (53%), mainly by out Abdominal Wall Unit (67%). In the pos-operative appointment only 34% of patients had their record filled and of those only 46% were completed. The majority of unfilled parameters are regarding procedure complications and follow-up. When asked to our colleagues, 71% found this tool easy to access and it even helps collecting important data for a good clinical history. Nevertheless, 43% did not know about this tool.

Conclusion
In despite of the universal and known advantages of uniformized hospital records, it is fundamental to publicize its existence in order to increase adherence.
ARCUATE LINE HERNIA, A RARELY SUSPECTED LESION. A CASE REPORT
Authors: Menor-Duran P D , Gómez-Torres I , Gamón-Giner R L , Jara-Benedetti G , Queralt Escrig M , Vidal-Escrig N , Alcobilla-Ferrara E 
Published: May 2024

Abstract

Background
Arcuate line hernias are a rare type of hernia, with few cases published in the literature. They consist of a partial or complete fascial defect located at the lower limit of the posterior fascia of the rectus abdominis muscle, and their symptoms are atypical, often requiring imaging tests for diagnosis.

Material and Methods
We present a 71-year-old female patient with left paramedial abdominal pain. Given the suspicion of Spiegel hernia, an abdominal CT scan was performed, revealing a defect at the level of Douglas' arch with small bowel herniation, suggestive of uncomplicated arcuate line hernia.

Results
Scheduled surgery with laparoscopic approach is performed, confirming the diagnosis. Reduction of the small bowel content and peritoneal sac reduction are carried out. Subsequently, an anatomical repair was performed with fixation of the sac to the abdominal wall. Postoperative evolution was favorable, with discharge from the hospital after 24 hours of admission. After 1 year of surgery, the patient has not presented recurrence or any other complication.

Discussion
The presence of this type of hernia should be suspected in cases of retrorectal mass or asymmetry, with atypical pain or digestive symptoms. The preferred test is CT, and the finding of retro-muscular fat or enteric content will provide a presumptive diagnosis. The definitive surgical technique is still under debate, with laparoscopy suggested as the ideal approach. Surgical management described in the literature ranges from open surgery with mesh placement, laparoscopy with or without intra-abdominal mesh, single-port laparoscopic repair, and even robotic surgery.
OUTCOMES OF COMPLEX ABDOMINAL WALL RECONSTRUCTION IN PATIENTS WITH CONNECTIVE TISSUE DISORDERS: A SINGLE CENTER EXPERIENCE
Authors: Messer N , Prabhu A S , Miller B T , Krpata D M , Beffa L R A , Phillips S E , Petro C C , Maskal S M , Ellis R C , Figueiredo S , Fafaj A , Rosen M J 
Published: May 2024

Abstract

Introduction
Individuals diagnosed with connective tissue disorders (CTD) are known to be predisposed to incisional hernia formation. There is a scarcity of data on outcomes for these patients undergoing hernia repair. We sought to describe our outcomes in performing abdominal wall reconstructions in these complex patients.

Methods
We have detected adult patients with CTD undergoing open, elective, posterior component separation with permanent synthetic mesh from January 2018 to October 2022 at the Cleveland Clinic Center for Abdominal Core Health instituted. We evaluated 30-day wound morbidity, perioperative complications, long-term hernia recurrence, and patient-reported quality of life.

Results
Twelve patients were identified. Connective tissue disorders included Marfan’s n = 7 (58.3%), Loeys-Dietz syndrome n = 2 (16.7%), Systemic Lupus Erythematosus n = 2 (16.7%), and Scleroderma n = 1 (8.3%). Prior incisions included three midline laparotomies and nine thoracoabdominal, mean hernia width measured 14 cm, and 9 were recurrent hernias. Surgical site occurrences were observed in 25% of cases, and 16.7% necessitated procedural intervention. All twelve patients were available for long-term follow-up, with a mean of 34 (12–62) months. There were no instances of reoperation or mesh excision. One patient developed a recurrence after having his mesh violated for repair of a new visceral aneurysm. Mean HerQLes scores at 1 year were 70 and 89 at ≥2 years; Mean PROMIS scores were 30.7 at 1 year and 36.3 at ≥2 years.

Conclusion
Ventral hernia repair with TAR is feasible in patients with connective tissue disorder and can be a suitable alternative in patients with large complex hernias.
GROIN HERNIA RECURRENCE AFTER TAPP FOR RECURRENT HERNIA
Authors: Music Medic M 
Published: May 2024

Abstract

Aim
The aim of this study was to investigate our long-term results following TAPP (transabdominal preperitoneal repair) surgery for recurrent groin hernias, following open Lichtenstein surgery. In our institution, TAPP is used to treat recurrent groin hernias. There are many types of meshes and fixation methods that surgeons use to perform TAPP repair (self-fixing mesh, lightweight mesh with tackers, or glue fixation).

Methods
A retrospective analysis of our database system was performed. A total of 40 patients with recurrent, unilateral hernias were treated with TAPP surgery. The median follow-up period was 6 years (4–9 years). Following hernia repair, all patients were interviewed by telephone, and the standard questionnaire was used to assess the quality of their lives. A CT scan and clinical examination were performed if there was any doubt.

Results
Out of 40 patients, 39 responded (97,5%). There were 35 male and 4 female patients. We identified and confirmed 3 recurrences (7,7%). There were no recurrences in the group with self-fixating mesh (0/21), 2 recurrences in the group with lightweight mesh + tacker (2/7), and 1 recurrence in the group with lightweight mesh + glue (1/11).

Conclusions
Long-term analysis showed a high rate of recurrence, but other authors have reported similar results. Our findings suggest that the most effective technique for repairing recurrent groin hernia in TAPP procedures is through the use of self-fixating mesh.
DOES THE ANGLE OF TROCAR INSERTION AFFECT THE FASCIAL DEFECT CAUSED? A PORCINE MODEL
Authors: Paasch C , Meyer J , Hunger R , Krollmann N , Heisler S , Mantke R 
Published: May 2024

Abstract

Introduction
With an incidence of 0–5.2% trocar site hernias frequently occur following laparoscopy. It is unclear to what extent the angle of trocar insertion affects the size of the fascial defect caused. Hence, we performed a porcine model.

Methods
In October 2022, a total of 5 female pigs were euthanized. In alternating order 3 bladeless and 2 bladed conical 12 mm trocars were inserted at an angle of 45° on each side for 60 minutes twice each pig. For this purpose, an epoxy resin handmade cuboid with a central channel that runs at an angle of 45° was used. Subsequently, photo imaging and defect size measurement took place. The results were compared with those of our previously conducted and published porcine model, in which the trocars were inserted at an angle of 90°. Effects of trocar type and angle on defect size were analysed using a mixed model regression analysis.

Results
The bladeless trocars caused statistically significant smaller defects at the fascia than the bladed (23.4 (SD = 16.9) mm2 vs. 41.3 (SD = 14.8) mm2, p &lt;0.001). The bladeless VersaOne trocar caused the smallest defect of 16.0 (SD = 6.1) mm2. The bladed VersaOne trocar caused the largest defect of 47.7 (SD = 10.5) mm2. The defect size of the trocars used at a 45° angle averaged 30.5 (SD = 18.3) mm2. The defect size of trocars used at a 90° angle was significantly larger, averaging 58.3 (SD = 20.2) mm2 (p = 0.007).

Conclusion
When conical 12 mm trocars are inserted at a 45° angle, especially bladeless ones, they appear to cause small fascial defects compared with insertion at a 90° angle. This might lead also to a lower rate of trocar hernias. Bladeless trocars might cause smaller fascial defects than bladed trocars.
EFFECTS OF THE COVID-19 PANDEMIC ON INGUINAL HERNIA SURGERY IN A SINGLE CENTER IN PORTUGAL: ANALYSIS OF EMERGENCY CASES AND TREATMENT PATTERNS
Authors: Paiva de Oliveira G , Oliveira M , Parreira M E , Guimarães S , Melo J , Branco A , Luz C 
Published: May 2024

Abstract

Background
The COVID-19 pandemic triggered substantial shifts in healthcare priorities, redirecting resources to address unprecedented emergency needs. Concerns about how COVID-19 might affect surgical outcomes prompted our investigation, given the complex interplay of factors across diverse healthcare settings. Our study sought to understand the impact of emergency declarations on the treatment of inguinal hernias, examining changes in elective versus emergent surgeries, as well as variations in surgical techniques and care settings.

Method
Analyzing five years of data (2019–2023) from a single institution in Almada, Portugal, we collected demographic and procedural information, comparing patients treated during the pandemic's confinement period (March 18, 2020, to April 30, 2021) with those treated before and after this period.

Results
Of the 1764 identified patients, 1004 underwent surgery elsewhere, leaving 760 for analysis. While only 2.9% required emergency surgery, some elective cases were labeled as "delayed urgencies" or "high priority," suggesting potential influences of emergencies on elective treatment decisions. Before the pandemic, 4.3% underwent emergency surgery, dropping to 1.1% during the emergency period, and rising to 3.1% afterward, though these changes lacked statistical significance. Laparoscopic surgeries increased gradually, while ambulatory procedures decreased, likely due to local restrictions rather than COVID-19.

Conclusion
Our findings echo previous research indicating a decrease in emergency surgeries contrary to expectations. However, data biases may exist, highlighted by an uptick in patients receiving surgery within 15 days, possibly reflecting shifts in healthcare accessibility rather than direct COVID-19 effects.
LONG-TERM OUTCOME OF COMPLEX ABDOMINAL WALL RECONSTRUCTIONS WITH CROSS-LINKED ACELLULAR DERMAL MATRIX – A 23 YEAR SINGLE CENTRE EXPERIENCE
Authors: Pecorella I , Davies J , Patel K , Giordano P 
Published: May 2024

Abstract

Aim
To review the clinical outcomes of complex abdominal wall reconstructions (AWR) with cross-linked acellular dermal matrix1 (CADM) implants over 23 years and how the indications to its use may have changed overtime.

Materials and Methods
Retrospective analysis of patients who underwent complex abdominal wall hernia surgeries with the use of CADM between September 2000 to June 2023, including elective and emergency procedures.

Results
95 procedures were performed in 88 patients. 24% of patients had 1 or 2 comorbidities, 66% had at least 3 comorbidities. BMI was 30 or above in 75% of patients. Overall, 27 (31%) procedures were performed as an emergency, 73% of which were performed since 2020. Fascial closure was achieved in 60% of patients; however, in the emergency group, fascial closure was 10%. Postoperative events occurred in 62% of cases. Postoperative mortality was 3%. 81 patients were available for long-term follow up, the median length of which was 64 months (range 0–214 months). Clinical recurrence was present in 25 (28%) patients and in all cases it presented in the first 2 years. Twenty-one patients had died of unrelated causes during follow up. Two patients required further intervention for unrelated causes and no adverse mesh related events were recorded in the long-term.

Conclusions
CADM biologic implants for AWR are safe and early results appear to be maintained overtime without long-term adverse events. CADM seems to perform well in particularly challenging situations like emergencies which appears to be becoming its main clinical application.
EVALUATION OF POSTOPERATIVE COMPLICATIONS AND REOPERATIONS IN PATIENTS UNDERGOING OPEN UMBILICAL HERNIA REPAIR
Authors: Rothman J V , Henriksen N A 
Published: May 2024

Abstract

Background
Umbilical hernia repair is a common surgical procedure. Open repair is recommended for small to medium size hernias, and use of mesh reduces recurrence. The primary aim was to evaluate the risk of postoperative complications and reoperations after emergency and elective open umbilical hernia repair, and secondly to evaluate whether complications and reoperations were associated to type of repair.

Methods
A single center retrospective cohort study of patients undergoing open umbilical hernia repair from October 2022 to September 2023. Data was extracted from the patient charts.

Results
A total of 151 had an umbilical hernia repair, 103 (68%) elective surgeries and 48 (32%) emergency surgeries. For the elective repairs, 37 (36%) got a suture- and 66 (64%) a mesh repair. There was no difference in complications, 5.4% versus 7.6%, p = 0.675. A higher percentage of emergency surgeries had the mesh placed in the onlay position 45.8% (22/48) compared to elective surgeries 30.1% (31/103), which more often received a preperitoneal mesh 34% (35/103). The overall complication rate tended to be higher for emergency repair compared with elective surgery, 6.8% and 14.6%, p = 0.124, with a tendency towards more complications with the use of mesh 12.1% (12/99) compared with suture repair 3.8% (2/52), p = 0.096. The most frequent complications were wound related (seroma, hematoma, wound infection). There were three (3%) reoperations in the elective group due to infection, and correspondingly two (4%) in the emergency group.

Conclusion
There is no difference in postoperative complication regarding suture or mesh repair of umbilical hernias.