bluuebunny/crossref_metadata_2025_split huggingface dataset:
WHAT WOULD YOU DO DIFFERENTLY? COMPLEX MANAGEMENT OF RECURRENT INCISIONAL AND PARA-STOMAL HERNIAS: A CASE STUDY OF A 52-YEAR-OLD PATIENT WITH COMPLICATIONS AND SURGICAL CHALLENGES
Authors: Alabbasi I E A , Sanders D 
Published: May 2024

Abstract

Case Presentation
A 52-year-old man with recurrent incisional hernia and para-stomal hernia presented to another hospital over the weekend due to abdominal pain, repeated vomiting, and a non-functional stoma. Enlargement of the scrotal region was noted, reflecting a pattern of similar admissions in the past. He was transferred to our unit for potential early surgery, having previously sought care for abdominal wall reconstructions at our center, including a scheduled preoperative Botox treatment.
The patient's medical history involved a 2017 emergency laparotomy for perforated diverticular disease resulting in a Hartmann procedure, and subsequent repairs for incisional and right groin hernias in 2019. The latter surgery led to wound dehiscence, prompting emergency intervention with small bowel resection and mesh removal. In 2023, the patient underwent removal of an infected right groin mesh, leaving behind a draining sinus. Hernia-related risks included ex-smoking, a reduction in BMI from 39 to 34, and diabetes.

Management and Outcomes
The patient's admission bloodwork showed slightly elevated inflammatory markers. A CT scan revealed a complex hernia scenario with distended small bowel and pockets of free fluid, suggesting at-risk bowel. The intraoperative procedure involved scar removal, adhesiolysis, and hernia repair, with complications such as dusky bowel appearance and fluid accumulation in the scrotum. The surgical approach included bilateral retro rectus with TAR, lateralization of the stoma, and mesh placement.

Discussion
In the post-operative period, the patient experienced challenges, including five days of intubation without muscle relaxation, abdominal pressure monitoring, and renal function decline requiring hemofiltration. Stoma function resumed on the third post-operative day, and the patient transitioned from total parenteral nutrition (TPN) to a mix of TPN and enteral feeding.
eTEP PAULI IN A TYPE IV PARASTOMAL HERNIA
Authors: Bellido-Luque J , Alpizar-Rivas O , Scammon Duran A , Sanchez Matamoros M I , Nogales Muñoz A , Morales-Conde S 
Published: May 2024

Abstract

Video abstract
A 63-year-old male with a history of abdominoperineal resection due to rectal adenocarcinoma presenting discomfort in a reducible 6 cm parastomal hernia (PSH) & M3W1 incisional hernia (Type IV PSH).
We propose a full endoscopic minimally invasive extraperitoneal modified Sugarbaker approach (e-TEP Pauli). A 2 cm incision on the right subcostal region is made, opening the anterior rectal sheath, medializing the right rectus muscle. A dissection balloon was introduced to release the retromuscular space on the right side. Two more trocars were inserted in the right hypocondrium and right iliac fossa (10 mm, 5 mm respectively).
The medial aspect of the right posterior rectus sheath (PRS) was incised, and the preperitoneal dissection was performed superficial to the Falciform ligament, doing the crossover above the umbilicus. The hernia was reduced, connecting both right and left retrorectus spaces.
A modified posterior components separation (TAR) is performed, sectioning the aponeurosis of the transverse muscle (TM), accessing the preperitoneal space laterally without sectioning the TM. The colonic stump is released and reintroduced. The anterior defect is closed maintaining adequate passage of the colonic stump, and is fixated with sutures to the lateral abdominal wall. The peritoneal orifice is sectioned to lateralize the stump. The peritoneum and PRS are closed around the colonic stump.
A PVDF-mesh covering both retrorectus and preperitoneal spaces is placed. A drainage is place and removed 24 h after. He was discharged 24 h after. In the CT 6 months after surgery, no abdominal wall defect was observed and pain and esthetic results where satisfactory.
e-TEP TAR IN A L4W3 RIGHT POST NEPHRECTOMY HERNIA
Authors: Bellido-Luque J , Alpizar-Rivas O , Scammon Duran A , Sanchez Matamoros M I , Nogales Muñoz A , Morales-Conde S 
Published: May 2024

Abstract

Video abstract
A 58-year-old woman with a history of right nephrectomy and open appendectomy, with a past medical history of chronic abdominal pain and bulging at the level of the nephrectomy scar. A partially reducible 9 cm lateral hernia L3W3 (EHS) was diagnosed.
The patient underwent an extended totally extraperitoneal hernia repair on the right side. A 2 cm incision on the epigastrium was made medially to the rectus muscle in order to enter the right homolateral retrorectus space. A dissection balloon was introduced to release this space. A 10 mm and 5 mm were inserted in the right hypocondrium and right iliac fossa respectively.
A posterior component separation (TAR) was performed, caudal to cranial. We sectioned the aponeurosis of the transverse muscle (TM), accessing the defect and the preperitoneal space laterally. After the hernia content was introduced to the abdominal cavity, the defect was closed. Finally, a wide pore polypropylene mesh was placed, covering the right retrorectus space with the preperitoneal Bogros/Retzius spaces. Atraumatic fixation with cyanoacrylate was used. An aspiration drainage was placed and removed 24 h after surgery. The patient was discharged the day after, and no complications were reported. In the CT scan 6 months after surgery, the correction of the defect was confirmed and pain and esthetic results were satisfactory.
LAPAROSCOPIC TREATMENT OF RIGHT INGUINAL HERNIA RE-RECURRENCE
Authors: Belkebir R , Gherardi D , Hauters P , Malvaux P 
Published: May 2024

Abstract

We report the case of an 81-year-old man presenting with a right inguinal hernia re-recurrence. He had undergone a laparoscopic transabdominal preperitoneal hernioplasty in 2001. The recurrence occurred in 2021, and therefore, he had to be treated with an open approach.
Past medical history included arterial hypertension, COPD, coronary artery stenting for ischemic heart disease, stage II chronic renal failure. Previous surgeries consisted of bilateral iliac arteries, percutaneous angioplasty and stenting with a right femoral arterial access, laminectomy of L3–L5, and laparoscopic cholecystectomy.

Surgical procedure
Laparoscopy confirmed a right hernia re-recurrence. Herniated ileal loop was completely reduced. Peritoneal incision was performed with a lateral-to-medial approach. The mesh was dissected away from the pre-peritoneal fat. The shrunk mesh was pulled downwards to allow the identification of the epigastric vessels, which were then dissected according to a cranial-to-caudal approach. The large hernia sac was completely reduced thus exposing the re-recurrence orifice. Dissection was carried out towards the Bogros’ space. Epigastric vessels were detached from the mesh thus allowing to expose the medial part of the myopectineal orifice. Cooper’s ligament and pubic symphysis were therefore identified. The epigastric and spermatic vessels were freed from the mesh only after the critical view of the myopectineal orifice (MPO) was achieved. The mesh was completely mobilized from the peritoneum and removed. A “landing zone” was obtained, a 15 × 10 cm self-fixating mesh positioned around the re-recurrence orifice. Peritoneum closure was performed by means of a 3–0 running barbed suture from medial to lateral.
LAPAROSCOPIC TAPP REPAIR OF SPIGELIAN AND BILATERAL INGUINAL HERNIA
Authors: Chamzin A , Theodoropoulos C , Galyfos G , Triantafyllou A , Michalopoulos N V , Toutouzas K G , Theodorou D 
Published: May 2024

Abstract

Introduction
A Spigelian hernia is the protrusion of preperitoneal fat, peritoneal sac, or organ(s) through a congenital or acquired defect in the Spigelian aponeurosis as defined in the last EHS guidelines for hernias in rare locations. Due to limited data no recommendation on the preferred approach could be made. We will report a case with a spigelian and bilateral inguinal hernia to show our preferred method of repair.

Case presentation
A 65-year-old male presented with a symptomatic palpable mass in the left lateral abdominal wall and bilateral inguinal hernia. We diagnosed by abdominal CT a Spigelian hernia along with bilateral direct inguinal hernias. A laparoscopic transabdominal approach was decided to manage all three hernias.

Results
Laparoscopic transabdominal approach confirmed the clinical and radiological diagnosis. The bilateral inguinal hernias were MW3-P and were repaired with invagination of the transversalis fascia into Cooper’s ligament and placement of XL 3D polypropylene mesh that was fixed in 3 points with absorbable tuckers. The Spigelian hernia was repaired by TAPP, closure of the 4 cm orifice with V-loc 1–0 and placement of a 12 × 16 cm self-gripping mesh to avoid postoperative pain due to fixation.

Conclusion
The use of laparoscopy facilitates low wound complication rate, complete intra-abdominal visualisation, repair of multiple hernia sites and probably less postoperative pain if no intrusive fixating devices are utilised. On the contrary open repair needs a wide operative field to introduce the mesh resulting in more postoperative pain, possibly increased wound complication rate and lacks the chance of simultaneous repair of concomitant inguinal hernias through the same approach.
PARASTOMAL HERNIA REPAIR
Authors: Clavell A , Herrero C , Torres A , Gené C 
Published: May 2024

Abstract

Background
Parastomal hernias are frequent. The optimal surgical strategy for treating symptomatic parastomal hernias (PSH) subsequent to ileal conduit urinary diversion remains an unresolved challenge, characterized by limited data and persistently high recurrence rates across diverse repair methodologies.

Methods
A 73-year-old male patient with a history of radical cystectomy and ileal conduit urinary diversion due to bladder cancer presented with a symptomatic parastomal hernia. The repair technique was performed through the stoma site involving a right retromuscular dissection. A keyhole technique with a biosynthetic PTFE mesh was used in the retromuscular and preperitoneal plane.

Results
The post-operative period was uneventful, and no recurrence occurred during the first 6-months of follow-up.

Conclusions
This case highlights the importance of tailored surgical approaches for addressing parastomal hernias, a repair through the stoma site is feasible and safe.
ROBOTIC ASSISTED TOTALLY EXTRAPERITONEAL INCISIONAL HERNIA REPAIR WITH POSTERIOR COMPONENT SEPARATION AFTER ORTHOTOPIC LIVER TRANSPLANTATION
Authors: Costa T 
Published: May 2024

Abstract

Aim
Incisional hernia is a common complication following liver transplantation. Open repair remains the standard of care, due to the fear of adhesions and complications. Recently, some groups published a series of minimally invasive approaches. However, most of them were laparoscopic approaches with intraperitoneal mesh placement with potential complications. The robotic-assisted extended extraperitoneal approach (r-eTep) could be a feasible and safe way to treat the hernia.

Methods
We present a case of a 64-year-old male patient submitted to an orthotopic liver transplantation. One year after the procedure he developed a large incisional hernia in the midline and right upper quadrant. The hernia classification was M1-3, L 2, W 3 (15 × 20 cm). After clinical optimization, the patient was taken to the OR for a r-eTep repair of his hernia.

Results
We begin the procedure by the left quadrant of the abdomen, creating a extraperitoneal space. Three trocars of the robot are placed. The extraperitoneal space is then dissected showing the midline hernia and part of the lateral. A posterior component separation with transversus abdominis release (TAR) is done. After the complete dissection, the abdominal wall is closed and the mesh is placed.
The procedure lasted 170 minutes. There were no complications. Length of stay was 2 days. There is no recurrence in a period of 2 years.

Conclusion
R-etep with TAR is feasible and safe in patients with incisional hernia after liver transplantation. This video shows our standardization in a patient with good post-operative results.
A NEW TECHNIQUE THAT FACILITATES SURGERY IN e-TEP REPAIR
Authors: Ertem M , Babur T 
Published: May 2024

Abstract
With our current knowledge, the e-TEP technique is considered the best anatomical plan to place the synthetic mesh in ventral hernia repair, as it is placed in the retromuscular area (Rives-Stopa Repair). In this technique, closing the existing diastasis recti in midline hernias reduces the recurrence rate. If the midline gap in the diastasis recti is over six cm, it may be technically difficult to close it. Approximating the midline with two or three transfascial sutures during the surgery makes it easier to close this line with a continued suture. In addition, it reduces the load on the midline.
In this video presentation, we present the technique we applied. We technically use two self-locking absorbable sutures. We also close the entire distance from the symphysis pubis to the Xiphoid process in the midline. We end by joining the continued sutures, one starting from the pubis and the other from the Xiphoid, in the midline. We preferably place transfascial sutures just below and above the umbilicus. Thus, we ensure that the anatomical hollow structure of the umbilicus is preserved.
DynaMesh CICAT.
LiquiBand FIX8.
V-Loc.
LAPAROSCOPIC eTEP RIVES-STOPPA FOR THE TREATMENT OF PFANNENSTIEL INCISIONAL HERNIA ASSOCIATED WITH BILATERAL INGUINAL HERNIA AND DIASTASIS RECTI
Authors: Friedova P , Acosta Rodríguez A , Rodríguez Valenzuela N , Sánchez González J , Pérez Saborido B 
Published: May 2024

Abstract

Objectives
Demonstrate the benefit of the extraperitoneal endoscopic approach for the treatment of Pfannenstiel incisional hernia (IH) associated with bilateral inguinal hernia and diastasis recti.

Materials and Methods
Descriptive video of the endoscopic eTEP technique for the treatment of Pfannenstiel IH (M1W5) associated with bilateral inguinal hernia (L1, L2) using two light 3D mesh placed in inguinal space without fixation and PLP mesh with silver ions placed in supra and infraumbilical space without fixation.

Results
The postoperative period was without complications, discharge 48 hours after surgery. The patient only required continuous analgesia for the first 72 hours. Control consultation after 3 months of surgery in which the patient is painless on physical examination, absence of recurrence and excellent aesthetic results.

Conclusions
The incidence of the Pfannenstiel IH is the lowest of all IHs. However, it is quite common that patients who underwent surgery with low transverse abdominal incision can develop inguinal hernias over the years. We believe that endoscopic preperitoneal eTEP Rives-Stoppa is a feasible and reproducible technique to do a complex abdominal wall reconstruction in patients diagnosed with IH associated with diastasis recti. This minimally invasive technique offers the possibility of repairing a weak linea alba and prevent the future ventral hernias with excellent aesthetic results.
SAGA OF A DECADE! BILATERAL GROIN MESH EXPLANTATION WITH COLOCUTANEOUS FISTULA
Authors: Gandhi J , Chaudhari S 
Published: May 2024

Abstract

Background
Mesh-related complications following previous laparoscopic hernia repair, especially transabdominal preperitoneal (TAPP) surgery, can present significant challenges. This case report highlights the utilization of the Mesh Explantation Classification in a 60-year-old male with a colocutaneous fistula a decade after index surgery & emphasises the use of mesh explantation classification for standardisation & case reporting (Published in Hernia Surgery).

Objective
Describe the laparoscopic mesh explantation and stapled disconnection of a colocutaneous fistula in a patient with mesh-related complications post-TAPP surgery 10 years back and emphasize the mitigation strategies and technical nuances.

Methods
A 60-year-old male, previously subjected to TAPP surgery, presented with a colocutaneous fistula with faecal discharge secondary to mesh-related complications. Pre-operative colonoscopy, marking the site of the fistula and use of fluoroscopy for identification of any metal tacks were performed. The Laparoscopic mesh explantation and the disconnection of the colocutaneous fistula using an intestinal stapler and intraoperative sigmoidoscopy performed to avoid any luminal narrowing. Two pieces of polyester mesh, with metal tackers were successfully explanted without any collateral vascular injury.

Results
The patient experienced resolution of symptoms postoperatively, and there were no signs of recurrent fistula during follow-up; the explanted mesh showed features of atypical mycobacterium on the microbiology, and hence, the patient was put on one year of treatment for atypical mycobacterium, he tolerated the treatment well and recovered.

Conclusion
This case emphasises the importance of a team approach at Index surgery in every case of Mesh Explantation to get the best surgical outcomes. Mesh explantation standardisation classification helps in proper documentation by the surgeon and guides future additional treatment if required. Further research and collective documentation using standardized classifications are essential to refine and validate the approach for mesh explantation in hernia surgery.
LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA) IN A POST-PERITONECTOMY AND HIPEC PATIENT. HOW FAR CAN WE GO?
Authors: Gaspar Reis S , Navarro-Morales L , Licardie E , Moreno-Suero F , Gómez Menchero J , Morales-Conde S 
Published: May 2024

Abstract

Background
Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) was first described in 2018. Since then, its application has grown, particularly in challenging scenarios, such as cases following Cytoreductive Surgery with Peritonectomy and Hyperthermic Intraperitoneal Chemotherapy (CRS + HIPEC). This video aims to demonstrate the application of Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique in a complex midline ventral hernia case.

Patient and Methods
Video presentation demonstrating the step-by-step execution of LIRA technique. The video showcases the feasibility, safety, and potential advantages of this method in improving surgical outcomes.

Results
We present the case of a 66-year-old female patient with a history of multiple surgeries for ovarian cancer. In 2016, she underwent CRS + HIPEC. In 2017, she was reoperated through bilateral subcostal laparotomy due to tumor recurrence in the celiac trunk.
Because of several supra and infraumbilical hernial defects, she underwent minimally invasive abdominal wall reconstruction using LIRA technique. During the postoperative period, the patient developed a septic condition and on the tenth postoperative day a exploratory laparotomy was performed, but no signs of infection were found.

Conclusion
This case not only highlights the advancements achieved in minimally invasive techniques but also demonstrates that LIRA enables tension-free midline restoration, providing a promising alternative to conventional component separation or endoscopic procedures.
LAPAROSCOPIC TOTAL EXTRAPERITONEAL FASCIOTOMY FOR FOURNIER GANGRENE EXTENDING TO RETROPERITONEUM: A CASE REPORT
Authors: Hsieh C H , Hsu C H 
Published: May 2024

Abstract

Background
This case report aims to contribute to the limited literature about the feasibility and effectiveness of laparoscopic total extraperitoneal (TEP) fasciotomy in the management of extensive Fournier gangrene to the retroperitoneal space.

Material and method
We present a case of a 60-year-old man with newly diagnosed type 2diabetes and diabetic ketoacidosis. He presented with left scrotal and inguinal swelling for days. A computer tomography scan revealed extensive Fournier gangrene involving the left scrotum, left inguinal canal, left retroperitoneum, left psoas muscle and left anterior inner abdominal wall. Immediate incision and drainage at the left scrotum were performed for infection control. However, due to widespread necrotizing fasciitis in the left retroperitoneal space, fasciotomy was necessary to control infectious disease.

Result
Four-port laparoscopic TEP fasciotomy was performed to facilitate extensive drainage and debridement of necrotic tissues in the left retroperitoneal space. Klebsiella pneumonia infection was identified through aerobic culture. The patient was discharged on postoperative day 14 with one rubber drain placed in the left retroperitoneal cavity.

Conclusion
Laparoscopic TEP fasciotomy proves to be a feasible and effective option for managing extensive necrotizing fasciitis at the retroperitoneum. The procedure offers advantages such as enhanced visualization, complete drainage and debridement through small incisions, reduced postoperative pain, and a shorter hospital stay.
PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM AND ANTERIOR COMPONENT SEPERATION WITH PERITONEAL FLAP HERNIOPLASTY FOR RECURRENT INCISIONAL HERNIA AFTER TRANSVERSUS ABDOMINIS RELEASE WITH POSTERIOR COMPONENT SEPERATION
Authors: Jha A K , Kumar M , Priyadarshi R , Badani A 
Published: May 2024

Abstract
A 42-year-old gentleman presented with recurrent incisional hernia (M1-M4W3R1). He underwent transversus abdominis release with posterior component separation (TAR with PCS) one year ago. In the immediate postoperative period after TAR with PCS, he developed abdominal compartment syndrome (ACS). Due to ACS, the surgical team opened his midline skin sutures and anterior rectus sheath, and applied negative pressure wound therapy. Eventually, the wound healed by secondary intention. On examination, there was a wide irregular scarring at the previous wound site, along with a hernial defect of approximately 20 × 20 cm in size. He underwent a CECT abdomen, which revealed a 20 × 20 cm defect along with a loss of domain. We initially instituted the botulinum-A injection into his lateral group of abdominal wall muscles. However, we could not achieve the desired results after botulinum injection. Therefore, we switched to preoperative progressive pneumoperitoneum to increase the abdominal cavity volume. Afterwards, we scheduled him for anterior component separation (ACS). In addition to ACS, we had to preserve the peritoneal sac to facilitate midline closure. We then placed an onlay polypropylene mesh and closed the skin. During a 6-month follow-up, the patient is doing well.
rTAPP FOR THE SIMULTANEOUS TREATMENT OF RECURRENT BILATERAL SPIGELIAN AND INGUINAL HERNIAS
Authors: Olona C , Díaz A , Rodrigo M , Vadillo J , Ilari A , Jorba R 
Published: May 2024

Abstract

Aim
Spigelian hernias are a rare variant of primary ventral hernias. Minimally invasive surgery has allowed new treatment techniques.
The objective of this video is to demonstrate the advantages of robotic TAPP for the single-stage treatment of this type of hernia in a complex case of recurrence and bilaterality associated with inguinal hernia.

Methods
A 70-year-old patient with a history of bilateral Lichtenstein inguinal hernioplasty and right Spiegel subaponeurotic hernioplasty presented with bilateral abdominal pain and left inguinal mass.
CT: Bilateral spigelian and left inguinal hernia.

Technique
The DaVinci Xi system is docked with 3 trocars located in the epigastrium and both hypochondria. Dissection of the preperitoneal plane of the right flank is performed with reduction of the recurrent Spiegel hernia, closure of the defect with VLock suture and placement of preperitoneal polypropylene mesh. The peritoneal section is closed with VLock running suture.
On the right side, the same technique is performed, progressing distally until the dissection and reduction of the inguinal hernia, treating the two hernias together with a single mesh placed preperitoneally.

Conclusion
The robotic TAPP approach allows for single-stage resolution of various abdominal wall hernias. The correct visualization of the hernia contents, the minimum approach and repair without tension allows the rapid recovery of the patient.