bluuebunny/crossref_metadata_2025_split huggingface dataset:
ROBOTIC-ASSISTED LATERAL VENTRAL HERNIA REPAIR—EXPERIENCE FROM THE FIRST 50 CONSECUTIVE OPERATIONS WITH PREPERITONEAL AND RETROMUSCULAR MESH PLACEMENT
Authors: Mück B , Vogel R , Heinzelmann F , Büchler P 
Published: May 2024

Abstract

Background
Due to the proximity to bony structures and the complex anatomy of the three-layered lateral abdominal wall, the surgical treatment of lateral ventral hernias is technically demanding. With this we demonstrate how lateral abdominal wall hernias can be treated using new robotic surgical techniques with extraperitoneal mesh placement.

Objectives
The purpose of this study is to demonstrate that robotic management of lateral abdominal wall hernias is safe and efficient.

Materials and Methods
A retrospective analysis of all robotically operated patients on lateral ventral hernia from June 2019 to December 2023 was performed.

Results
A total of 50 ventral hernias were operated robotically because of a lateral hernia in the study period. 90 per cent of the patients had an incisional hernia, 10 per cent had a primary spighelian hernia. 27 patients had only lateral findings, 23 patients had combined hernias with lateral and medial hernial defects. 18 patients were treated with a preperitoneal mesh (r-vTAPP). 31 patients were treated by TAR with a retromuscular mesh (24 extraperitonel approach r-eTAR/7 transperitonel approach r-TAR). One patient had to be converted intraoperatively from a planned preperitoneal mesh to an intraperitoneal mesh repair (r-IPOM).
The median hernia defect area was 71 cm² (3–375 cm²). The median mesh size was 600 cm² (150–1290 cm²). The median mesh defect ratio (MDR) was 10 (2,33–133,33). Three postoperative complications were encountered (6%) out of which two required reoperations (4%).

Conclusion
With the use of new robotic surgical techniques, even complex lateral hernias that previously caused difficulties in surgical care can be treated safely with promising results in the early postoperative course.

Keywords
lateral ventral hernia, robotic eTEP, retromuscular mesh placement, robotic ventral TAPP, robotic transversus abdominis releaseGesamtAnzahl50vTAPP1836%eTAR2448%TAR714%rIPOM12%Alter (Median)67,00(23–85)Männlich2754,00%Weiblich2346,00%ASA (Median)2(1–3)Größe m (Median)1,72(1,50–1,90)Gewicht kg (Median)82,5(54–125)BMI (Median)28(19–39)Zeit min (Median)214(53–525)Komplikationen36,00%Interventionen00,00%Reoperationen12,00%Aufenthalt3(1–16)Narbenhernien4590,00%primäre Hernien (Spieghel)510,00%simultane Leistenhernien2 Leistenhernien1 PatientenNetzgröße600(150–1225)Netzgröße gesamt600(150–1290)Bruchpforte71(3–375)MDR10(2,33–133,33)kombinier mediale-laterale Bruchpforte2346,00%laterale Bruchpforte2754,00%
CASE REPORT: OUR MISTAKES IN THE eMILOS TECHNIQUE LEADING TO THE NEED FOR REOPERATION
Authors: Musilova Z , Handl V 
Published: May 2024

Abstract
The Endoscopic MILOS (Mini- or Less-Open Sublay) technique has demonstrably fewer complications, favorable healing, a better cosmetic effect. Adherence to the precise procedure is necessary for a successful operation and patient satisfaction. This case report presents our mistakes that led to the reoperation and could have been avoided.
The patient underwent eMILOS hernioplasty in 2019 for an umbilical hernia with a symptomatic wide diastasis extending to the xiphoid. Mesh was implanted retromusculary with fixation to the xiphoid. The wound healed primarily, however, on the 13th postoperative day, patient felt a burst beneath the xiphoid without any complications. In 2023, the patient presented with year-lasting subxiphoidal pain. A palpable resistance was found in the abdominal wall in the epigastric region. A CT scan revealed a hyperdense infiltrate at the site of the mesh. During the reoperation, a retromuscular calcified hematoma (14 × 6 cm) was found wrapped in a folded mesh. The hematoma with a portion of the mesh was removed.
The likely cause of the formation of the calcified hematoma was a torn fixation suture of the mesh to the xiphoid. The resulting hematoma leaked into the folds of the mesh, did not absorb, and calcified. The mesh was likely extremely wide, leading to its wrinkling.
In conclusion, we would like to emphasize that fixation of the mesh is not necessary in eMILOS, and the accurate size of the implanted mesh is crucial. The patient could have avoided painful laparotomy, and the cosmetic effect would have been more favourable.
INITIAL EXPERIENCE ON EMERGING MULTIMODULAR ROBOTIC PLATFORM: CASE SERIES OF BILATERAL INGUINAL AND VENTRAL HERNIA REPAIR
Authors: Nicastro V , Marin J N , Morini L , Alampi B , Grimaldi S , Ferrari G 
Published: May 2024

Abstract

Background
Robot-assisted approach in abdominal wall hernia repair (AWHR) is constantly spreading, increasing minimally invasive procedures and sublay or extraperitoneal mesh placement. Few evidences about robotassisted approaches are available in literature, especially looking at new emerging robotic platforms. The aim of this study is to prospectively report our initial monocentric experience of robotic AWHR performed with a multimodular robotic platform.

Method
All consecutive patients, undergoing robotic AWHR with a multimodular robotic platform, between February 2023 and September 2023, were considered. Data of patients were retrieved from a prospectively collected database. Clinical and demographic characteristics, short and long term outcomes were analyzed.

Results
Thirty patients underwent robotic AWHR. Eighteen underwent bilateral inguinal hernia repair with transperitoneal approach (TAPP). Twelve patients underwent robotic transabdominal retromuscular umbilical prosthetic repair (TARUP) for umbilical hernia combined with symptomatic diastasis recti. Mean operating time was 174,28 min. Three intervention were concluded laparoscopically due to arms conflicts. No major intra- and post-operative surgical complications were observed. The mean post-operative hospital stay was 1.14 days. All patients received a follow-up at one week, 1, 3 and 6 months from surgery

Conclusion
The role of robotic surgery for AWHR is being defined. We can conclude that robotic AWHR for inguinal and ventral hernia is feasible and safe in term of surgical outcomes. In fact, sublay ventral hernia repair is encouraged by robotic approach, rather than intraperitoneal onlay mesh placement.
COMPLEX ABDOMINAL WALL HERNIAS: A MULTICENTER COHORT STUDY
Authors: Nieto Martos R , Blázquez Hernando L , Martos Meléndez S , Andrés Andrade Yagual A , López Monclús J , Robín Valle de Lersundi A , Muñoz Rodríguez J , Porrero Guerrero B , Román García de Leon L , Manuel Molina Villar J , María Fernández Cebrian J , Ángel García Ureña M 
Published: May 2024

Abstract

Introduction
The TAR description has revolutionized complex abdominal wall surgery, providing solutions to previously challenging issues. We acknowledge its associated morbidity, low recurrence rates, and short-term improvement in quality of life. However, its long-term impact on patients' quality of life remains unknown.

Material and Methods
prospective study of consecutive patients undergoing transverse abdominis release (TAR) for complex abdominal hernias between 2014 and 2017 in four different centers with a minimum of 5-year follow-up. Demographics, operative and postoperative variables were analyzed. Preoperative quality of life assessments (EuraHS QoL) was conducted, along with follow-ups at one and two years postoperatively. A fourth assessment was performed more than five years after the intervention, incorporating the use of the Carolina's Comfort Scale on this occasion.

Results
A total of 60 patients undergoing TAR were included. The mean follow-up was 82 months. Of them, 59,6% were men and 40,4% women. The mean age was 61 (52–69) years. The EuraHS QoL score significantly improved compared to the preoperative score in terms of pain, aesthetic perception and physical functioning (p &lt;0,0001). The Carolina’s Comfort Scale after 5 years showed a low incidence of mesh sensation, pain related to mesh and limitation for movements or physical exercise.

Conclusions
The TAR technique for complex abdominal wall hernias improves long-term quality of life after surgery with a low incidence of postoperative chronic pain and functional impairment.
RISK FACTORS FOR CHRONIC PAIN FOLLOWING LAPAROSCOPIC GROIN HERNIA REPAIR IN THE SWEDISH HERNIA REGISTRY: 2. MESH AND FIXATION COMBINATIONS
Authors: Novik B 
Published: May 2024

Abstract

Background
A recent Swedish Hernia Registry (SHR) study associated standard, aka “heavyweight”, polypropylene flat mesh (StdPPM) without fixation, and lightweight polypropylene or polyester based flat mesh (LWM) with fibrin glue, with the lowest reoperation risks (Novik, et al. J Am Coll Surg 2022).

Aim
The present prospective cohort study aimed at correlating mesh/fixation combinations with chronic postoperative inguinal pain (CPIP) risk.

Material and Methods
Virtually all patients ≥15 years, operated with TEP or TAPP in Sweden during September 2012—December 2018, were routinely sent a CPIP questionnaire at 1 year postoperatively. This study defined CPIP widely, as “non-ignorable pain in the operated groin anytime during the recent week”.
A. Mesh alternatives:
StdPPM
LWM
Anatomically (“3D”) shaped polypropylene mesh, standard or lightweight.
Non-characterized polyester mesh.
B. Fixation alternatives:
Non-fixation
Tacks
Fibrin glue
Progrip® self-gripping absorbable micro-hooks (only with LWM).
Thirteen mesh/fixation combinations were analyzed with multivariable logistic regression, rendering adjusted odds ratios with 95% confidence intervals.
Effect modifiers adjusted for were sex, age, ASA, body mass index, smoking, recurrent hernia, emergency repair, bilateral vs. unilateral, and anatomical type and defect size of hernia.

Results
Eighty surgical centers contributed 29,109 laparoscopic repairs (78% male). Patient mean age was 58 years. From 20,455 (70%) questionnaire responders, 5,786 (28%) qualified as having CPIP.
With non-fixated StdPPM as reference, some mesh/fixation combinations were associated with a significantly higher CPIP risk, while no alternative combinations correlated with a lower risk.

Conclusions
Of the mesh/fixation combinations associated with the lowest CPIP rates, non-fixated StdPPM is the least expensive, and can therefore be recommended.
STRANGULATED SPIGELIAN HERNIA: A RARE CASE REPORT AND DIAGNOSTIC DILEMMA
Authors: Pal A K , Kumar Agrawal M , Singh H , Karnik A , Kumar A 
Published: May 2024

Abstract

Background
Spigelian hernia, is a rare abdominal wall anomaly with an incidence of 0.1–2%, was initially documented by Josef Klinkosh in 1764. This hernia protrudes through the Spigelian aponeurosis, a continuation of the transversus abdominis muscle's aponeurosis situated between the rectus abdominis muscle's lateral border and the linea semilunaris. They primarily occur within the spigelian hernia belt, a region below the umbilicus delineated by the anterior superior iliac spines. These are often misdiagnosed as lateral incisional hernias (eg, port site hernia).There’s no clear sex predilection, and most patients are diagnosed in the fifth or sixth decade of life.

Case Presentation
A 56-year-old woman presented with acute onset and severe abdominal pain persisting for four days, accompanied by bilious vomiting. She had history of intermittent pain and swelling in left abdomen for more than 20 years and had undergone Hysterectomy with bilateral salpingo-oophorectomy 11 years earlier. Clinical examination revealed a palpable 5 × 5 cm lump in the left iliac fossa, with tenderness and mild erythema of overlying skin. Non-contrast abdominal CT confirmed a bowel loop protruding through an abdominal wall defect. Exploratory laparotomy revealed a gangrenous ileal segment of about 10 cm and segmental resection followed by anastomosis by single layer interrupted technique was done. The patient recovered well during a 5-day hospital stay and continued follow-up without complications.

Conclusion
This case report emphasizes the importance of diagnosing spigelian hernia with increased risk of strangulation in patients with prior abdominal surgery. A high index of suspicion is needed for early diagnosis resulting in better outcomes.
A NEWER METHOD OF SEROMA REDUCTION BY FENESTRATION OF PSEUDO-SAC DURING LAPAROSCOPIC REPAIR OF DIRECT INGUINAL HERNIA: A RANDOMISED, CONTROLLED PILOT STUDY
Authors: Parihar Y K 
Published: May 2024

Abstract

Background
Minimally invasive surgeries for inguinal hernia repair have been reduced post-operative morbidity. However, certain complications such as seroma formation are unavoidable. In this study, we introduce a newer technique of reducing seroma formation by fenestration of the pseudo-sac (thickened transversalis fascia) in patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia.

Patients and Methods
A randomised, controlled pilot study was conducted from January 2019 to December 2020 for the patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia. Study participants were randomised into interventional group and control groups. Demographics, operative duration and complications including post-operative pain and seroma on days 1, 10 and 30 were analysed between both the groups.

Results
A total of 20 cases with 30 hernias were included in the study. Demographic data were comparable between the two groups. The intervention group showed a statistically significant decrease in the incidence of seroma formation on the post-operative day 10 (13.3% vs. 46.6%, P = 0.046). The mean volume of seroma on day 10 was also less compared to the non-fenestration group (2.5 vs. 6.58 ml, P = 0.048). After the 30th day, no patient had a presence of seroma. There were no statistically significant differences in terms of mean operative duration, post-operative pain and other complications.

Conclusion
Fenestration of pseudo-sac in laparoscopic hernia repair for uncomplicated direct inguinal hernia is a simple and effective technique. It has reduced the incidence and volume of seroma formation without any increased risk of infection, acute or chronic pain and recurrence.
EXTRA-ABDOMINAL APPENDICITIS: A CASE REPORT FROM AN AMYAND HERNIA
Authors: Pera R , Frazão J , Fragoso M , Alves P , Mira P 
Published: May 2024

Abstract

Introduction
Hernioplasty is one of the most common procedures in general surgery. The post-operative period extends until 6 months of surgery, to detect early recurrence.
This aims to share the management of appendicitis in a recurrent hernia.

Methods
This is a case report based on a patient who presented as an Amyand hernia, complicated with appendicitis.

Results
This case is from a male patient aged 50 years, who was submitted to an elective right inguinal hernia repair 8 months before, without other relevant past medical history. He presented in the emergency room with right groin pain, nausea, vomiting and fever. Blood tests showed increased white blood cells (14,000/mm3) and increased C-reactive protein (11 mg/dL). In the ultrasound performed, there were signs of recurrence of the hernia, the appendix was noted to be part of the hernia contents and it had findings suggestive of appendicitis. The patient underwent emergency surgery. Intraoperatively, there was incarceration of the appendix and the cecum. Appendectomy was completed without further intestinal resection. The hernia defect was corrected with a mesh based technique. Postoperative period went without complications and the patient was discharged on day 2 postoperative with amoxicillin-clavulanate. Histology showed appendicitis.

Discussion
This case reports the rare event of appendicitis in the context of an Amyand hernia. This is important to raise awareness for this condition, which can mimic an incarcerated hernia. The management of the patient is relevant to be shared and discussed with hernia experts to improve management of future patients with the same condition.
SHEATHED GORING CAUSING AN OCCULT TRAUMATIC EVISCERATION
Authors: Plazas-Font P J , Gómez-Torres I , Menor-Duran P D , Martínez-Hernández A , Queralt-Escrig M , Alcobilla-Ferrara E , Laguna-Sastre J M 
Published: May 2024

Abstract

Background
Bull horn lesions entail one of the Spain’s most common cause of politraumatism. These, result mostly in musculocutaneous lesions, and they are more frequent in the lower limbs and perineum.
However, it exists a less usual entity that is the abdominal hernia due to closed trauma, which in the case of bullfighting corresponds to sheathed goring.
This kind of injury is caused by a blowout mechanism in areas of fascial weakness such as the ones close to the iliac crest or lateral to rectus muscles. Furthermore, they do not compromise the integrity of the overlying skin, and this is why they can go unnoticed.

Material and Methods
During the last 10 years, 958 patients were treated in our health area because of bull horn injuries. 6 of them presented abdominal herniation due to sheathed goring. All of them were men, with an average age of 33 years old.

Results
All the patients underwent emergency surgery. Given the condition of infection of the surgical wound and destructuring of the fascia, only 2 defects could be repaired by placing a retromuscular mesh in the Rives space. The other 4 cases were repaired by an edge refreshing following the Friedrich technique and fascial raffia.

Discussion/Conclusion
This kind of lesion can compromise the patients’ lives, especially due to the severity of the associated intraabdominal injuries.
Therefore, in the case of high-energy trauma such as sheathed goring, there should be a high diagnostic suspicion even though no external injuries are evident.
OUR SURGICAL TREATEMENT STRATEGY IN A CASE OF COMPLEX INCISIONAL HERNIA
Authors: Prodan A , Matei M , Beuran M , Turculet C , Cancea B 
Published: May 2024

Abstract

Background
We present the case of a 38-year-old man with a giant incisional hernia, related to multiple abdominal surgeries and Staphylococcus aureus infection, for more than 5 years. This pathology is more unusual and very challenging in terms of surgical management.

Material and Methods
The computer tomograf (CT) and measurements showed that we have a case of loss of domain. Physical examination revealed a giant, irreducible incisional hernia.
The purpose of the complex hernia was to eliminate Staphylococcus aureus infection, repair the incisional hernia defect, strengthen the abdominal wall, prevent recurrences and recover the functionality of the abdominal wall. We treated the incisional hernia using a combined approach consisting of: surgical mesh excision, antibiotic treatment, Botox injection after three months, pneumoperitoneum (PPP) one month after Botox injection and the transversus abdominis release procedure (TAR).
We performed separation of the posterior components obtaining a large retromuscular space. After reduction of the incisional hernia, the abdominal wall was reconstructed by placing a large 50/50 cm macroporous polypropylene mesh, in the retromuscular space created by the TAR.

Results
The patient was discharged on the eighth postoperative day. At three-month follow-up, the patient had no recurrence of hernia, chronic pain, or other complications. The patient also noticed a significant improvement in his quality of life.

Conclusion
This case represents a successful combined approach of surgery, Botox, and PPP to treat a complex incisional hernia in a 38-year-old man with good results.
NO RECURRENCE AFTER 16 YEARS PROSPECTIVE LONG-TERM FOLLOW-UP OF OPEN TEP/TIPP INGUINAL HERNIA REPAIR
Authors: Ribokas D 
Published: May 2024

Abstract

Aim
Evaluation of long-term follow-up results after open transinguinal preperitoneal (TIPP) technique with preformed lightweight mesh (PLM).

Material and Methods
This unicentric study included 102 patients treated with surgery for groin hernia by the same surgeon using the same technique, with PLM, June 2008–September 2009. All patients were postoperatively followed with clinical control 1 month later, and a survey follow-up 40–54 months after surgery, in January 2013.Those reporting any complaints were invited for outpatient review. Chronic pain, hernia recurrence and reoperation were documented.
Results until January 2024 were retrieved from the Swedish Hernia Register.

Results
102 hernia repairs; 46 with local anaesthesia with no intraoperative complications.
Clinical control after 1 month:
No infection of the mesh.
No clinical recurrence.
No re-operation required.
Questionnaire follow-up:
Mean follow-up time: 47 months.
95 patients (93%) followed-up.
Light, not permanent pain in 8.8% of patients who did not require the consumption of systematic painkillers and are not limited in their activities. No re-operations have so far been recorded in the Swedish Hernia Register with a median follow-up of 182 (range 176–187) months and 79 patients still alive.

Conclusions
No recorded recurrences after almost 16 years of follow-up are encouraging. This technique consisted of the placement of a patch in the preperitoneal space, which combines the benefits of the anterior approach (safe technique, short learning curve, local anaesthesia, low cost) and the preperitoneal placement of the mesh (less recurrence, less pain).
PLM = BARD®POLYSOFT®Hernia Patch
HYBRID APPROACH FOR MADRID POSTERIOR COMPONENT SEPARATION IN LARGE LATERAL HERNIAS: EARLY RESULTS OF A MULTICENTRIC STUDY
Authors: Román García de León L , Munoz-Rodriguez J M , Blazquez Hernando L A , Garcia-Urena  , Valle de Lersundi A R , Medina Pedrique M , Remirez Arriaga X , Gil Cidoncha L , Fernández Rodríguez M , Lopez-Monclus M A J 
Published: May 2024

Abstract

Aim
This study evaluates the results of the hybrid approach (extended totally extraperitoneal (e-TEP) and open) to perform Madrid-Posterior Component Separation (PCS) for the treatment of lateral hernias.

Material and Methods
A retrospective multicentric study was conduced involving patients with lateral hernias operated by hybrid approach between 2021 and 2023. The inclusion criteria were lateral hernias with associated midline defects and large defects involving the semilunar line. The technique performed was in all cases a Rives – Stoppa with PCS according to the Madrid modification.

Results
A total of 12 patients with lateral incisional hernia were analyzed. Three of them were L4 and the rest L3 (EHS Classification). The mean transverse size of the defect was 10,3 cm (range 6–14). Seven of them had a concomitant midline hernia, all of them were W1.
In 4 patients only the Rives-Stoppa (RS) dissection was performed by e-TEP approach and the PCS was done open, performing a Reverse-TAR. In the rest, the complete dissection including the PCS was done by e-TEP approach and the open part was used only to complete the posterolateral reconstruction. The mean operative time was 255 minutes (range 240–350).
No patient presented complications or recurrence with a median follow-up of 10,6 months (range 4–24).

Conclusions
The hybrid approach for performing Madrid-PCS in the treatment of medium-large lateral hernias is a feasible technique with both technical and patient advantages, allowing to maintain the benefits of minimally invasive but ensuring the principles of abdominal wall reconstruction.