bluuebunny/crossref_metadata_2025_split huggingface dataset:
PRIMARY FASCIAL CLOSURE IN LAPAROSCOPIC VENTRAL HERNIA REPAIR. THE PROSECO-TRIAL A RANDOMISED DOUBLE-BLINDED MULTICENTRE TRIAL
Authors: Lindmark M , Tall J , Darkhahi B , Österberg J , Strigård K , Thorell A , Gunnarsson U 
Published: May 2024

Abstract

Background and Objective
Laparoscopic ventral hernia repair was introduced in the 1990s as a bridging repair where the mesh overlaps the hernia aperture with no attempt at closure. In recent years, interest in closing the defect has grown, and several fascial defect closure methods have been reported. Trials evaluating the effectiveness of fascial closure, however, have failed to come to a conclusion. This was a double-blinded randomised controlled multicentre trial to see if fascial closure prior to mesh placement decreases hernia site complication rate.

Methods
Adults with a midline hernia aperture measuring 2–8 cm were randomised to either primary fascial closure prior to mesh placement or the classic bridging procedure. Clinical assessment and Ventral Hernia Pain Questionnaires (VHPQ) were answered at three and twelve months after surgery. CT scan was performed after 12 months. To reach a power of 80% and 95% significance level, 180 patients were required in this randomised study.

Results
A total of 192 patients were operated: 97 with primary fascial closure (PFC) and 95 with the classic technique. Of the 192 patients, 79% had completed the one-year follow-up and 92% the three-month follow-up. No differences in hernia site complications between groups were seen at three (p = 0.38) and twelve months (p = 0.73).

Discussion
Primary fascial closure does not reduce hernia site complications after laparoscopic ventral hernia repair at twelve months. There is a significantly increased risk of recurrence and psuedohernia at twelve months if the defect is not closed.
GROIN LUMPS DURING PREGNANCY: EXPLORING THE KNOWLEDGE GAP AMONG SURGEONS AND OBSTETRICIANS REGARDING ROUND LIGAMENT VARICOSITIES
Authors: Malaibari Z , Alrahil R , Alrahil R , Alghabban A , Alshamrani S , Alshehri S , Alzubaidi S , Aldemyati R 
Published: May 2024

Abstract

Background
This cross-sectional pilot study aimed to evaluate awareness and management strategies for Round Ligament Varicosities (RLV) during pregnancy among obstetricians and surgeons in the Kingdom of Saudi Arabia.

Methods
An online questionnaire was distributed through convenience sampling to surgeons and obstetricians across the Kingdom of Saudi Arabia. It assessed demographics, clinical knowledge, experience in diagnosing and managing groin lumps during pregnancy, and engagement in continuing medical education.

Results
Of the 39 participants, 56.41% (n = 22) were obstetricians, and 43.59% (n = 17) were surgeons, with the majority having 5–10 years of practice (35.90%, n = 14). Groin hernia was reported as the most frequent diagnosis for groin lumps during pregnancy (43.59%, n = 17), while only 7.69% (n = 3) identified RLV, indicating a significant gap in recognizing RLV. Furthermore, 35.90% (n = 14) recognized RLV as a differential diagnosis, but only 25.64% (n = 10) were aware of its management.

Conclusion
RLV, which is more common than hernias during pregnancy, is often misdiagnosed due to its similar presentation. Accurate differentiation, often achieved through ultrasound, is crucial as management strategies significantly differ. This study underscores the need for enhanced awareness and training among obstetricians and surgeons to accurately diagnose and manage RLV. The observed knowledge gaps highlight the critical role of continuous medical education in improving patient care. These findings will guide a larger study to assess practices across the Kingdom and develop national recommendations for the management of RLV and groin hernias during pregnancy.
MINIMALLY INVASIVE SURGERY FOR INGUINAL HERNIA: FROM IMPLEMENTATION IN A SERVICE TO RESIDENTS' FORMATION
Authors: Marques-Antunes J , Rodrigues E , Magalhães J , Guimarães M , Nora M , Pereira A 
Published: May 2024

Abstract

Background
Inguinal hernia surgery is one of the most commonly performed procedures by surgeons and is a crucial part of a surgeon's training process. Implementing minimally invasive hernia surgery in the training of surgical residents can be a challenging process. Our aim is to retrospective review and analyze the evolution and results of minimally invasive surgery for inguinal hernia performed by both residents and more experienced surgeons.

Method
Retrospective analysis of patients operated using the TAPP and TEP techniques for inguinal hernias. Descriptive analysis of the evolution over the years and a comparison of outcomes.

Results
An average of 655 inguinal hernias were operated on per year. The percentage of minimally invasive surgeries grew from 0.9% in 2018 to 25% in 2022. The rate of any morbidity was 8.9%, with a slight predominance in the first two years, and the overall recurrence rate was 2.1%. A total of 12 surgeons and 14 residents performed TEP and/or TAPP at least once. 10.7% of the minimally invasive hernia surgeries were performed by residents, 14.2% were performed by both residents and more experienced surgeons. There were no statistically significant differences between the groups in terms of morbidity or recurrence, although the average surgery time was longer in the resident group (p &lt; 0.05).

Conclusions
It is important for residents to collaborate closely with experienced surgeons, seek feedback, and gradually gain proficiency in performing these procedures. With correct patient selection, residents can achieve good outcomes.
MESH REMOVAL DUE TO FOREIGN BODY REACTION AND MESH INFECTION IN GROIN HERNIA SURGERY: A LONG-TERM NATIONWIDE POPULATION-BASED REGISTER STUDY
Authors: Melkemichel M , Nordenson M , De la Croix H , Nordin P 
Published: May 2024

Abstract

Background
Groin hernia repairs (GHRs) with mesh is today gold standard procedure in western countries. Yet, foreign body reaction and mesh infection are feared complications. This study aimed to investigate the incidence and risk factors for mesh removal due to foreign body reaction and mesh infection following GHR.

Method
This is an observational nationwide populations-based register-study with the use of prospectively collected data from the Swedish Hernia Register (SHR). All patients ≥15 years old with a GHR registered in SHR between 1992 and 2022 were eligible. Primary outcome was the incidence of re-surgery for mesh removal. Secondary outcome was risk factors for re-surgery with mesh removal.

Results
Out of 364 012 GHRs during this 30-years long study-period, 216 (0.059%) had a re-surgery with mesh removal. Mesh removals were more frequently performed in men (85.2%). Median age was 56 years old. 91.2% had earlier been performed electively and 73.1% with a previous open anterior mesh repair. In the adjusted multivariate Cox regression analysis for the risk of re-surgery with mesh removal, significantly increased hazard ratios were estimated for women (2.62, CI 1.61–4.27), emergency GHR (3.88, CI 2.20–6.85), postoperative complications (3.45, CI 2.34–5.08), high ASA class (2.12, CI 1.16–3.88) and age below median (1.59, CI 1.09–2.32).

Conclusion
The groin tissue tolerance for implanted mesh following GHR is considered high where re-surgery for mesh removal due to foreign body reaction and mesh infection is rare. Women, younger patients, comorbidity, emergency repairs and presence of postoperative complications were associated risk factors for such re-surgery.
CAN SURGEONS ACCURATELY IDENTIFY MESH TYPE WHEN INTERPRETING COMPUTED TOMOGRAPHY SCANS AFTER VENTRAL HERNIA REPAIR?
Authors: Messer N , Melland M S , Miller B T , Krpata D M , Beffa L R A , Tu C , Petro C C , Maskal S M , Ellis R C , Rosen M J , Prabhu A S 
Published: May 2024

Abstract

Background
Recurrent ventral hernia repair can be a challenging procedure. Given the challenges of acquiring complete and accurate prior operative reports, surgeons often rely on CT scans to obtain information and plan for re-operation. Still, the contribution of CT scans and the ability of surgeons to interpret them is controversial. Here, we assessed the accuracy of expert abdominal wall reconstruction (AWR) surgeons in identifying the type of prior mesh using CT imaging.

Methods
Twenty-two highly experienced AWR surgeons were asked to evaluate 21 CT scans of patients who had undergone open AWR with bilateral transversus abdominis release utilizing mesh. The surgeons were required to identify the mesh type from a multiple-choice selection. Additionally, negative controls (patients without a history of prior laparotomy) and positive controls (patients with laparotomy but no ventral hernia repair) were incorporated.

Results
The accuracy rate in correctly identifying mesh type was 46%, with heavy-weight synthetic mesh (HWSM) being identified only 35.4% of the time, Strattice mesh and medium-weight synthetic mesh (MWSM) were identified at 46.3%, and 51.8% respectively. The interrater reliability analysis found a moderate level of agreement 0.428, and the Repeatability measure was poor – 0.053 (95% CI 0–0.119); this indicates that surgeons cannot reliably replicate the identification process.

Conclusions
Surgeons’ ability to accurately identify the type of previous mesh using CT scans is poor. This study underscores the importance of documenting the type of mesh used in the operative report and the need for standardized operative notes to improve the accuracy and consistency of documentation.
LAPAROSCOPIC PARASTOMAL HERNIA REPAIR WITH A FUNNEL INTRAPERITONEAL MESH DEVICE
Authors: Pietsch A P 
Published: May 2024

Abstract

Aim
Parastomal hernias (PSH) are an underestimated and sometimes undertreated complication after permanent stoma formation. Surgical treatment can be challenging and the optimal treatment options are not determined yet. Laparoscopic parastomal hernia repair using 3D funnel intraperitoneal mesh appears to be a promising approach.

Material and Methods
11 patients (7 females, age 71.7 ± 15.4, range 42–86 y.) could be included in this analysis. Elective surgery due to parastomal hernia had been performed in 5 patients following formation of an ileum conduit and in the remaining patients following formation of a colostomy. In addition, concomitant incisional hernia could be treated in 4 patients. All PSH repairs used a laparoscopic approach.

Results
Mean operations duration was 100 ± 27.6 min. All procedures could be completed laparoscopically. No major postoperative complications requiring redo surgery have been observed. Recurrence rate was 9.1 % (1/11) after a mean follow-up time of 17.7 ± 9.4 (range 6–30) month.

Conclusions
The laparoscopic approach to PSH repair with 3D funnel mesh in IPOM technique is safe and efficient, provides probably advantageous results compared to other techniques and allows the simultaneous repair of additional incisional hernias, with a low rate of recurrence and no major complications. Since the follow up peroid is still not really long, the recurrence rate and other stoma related complications have to be evaluated in the long term and studied more comprehensively.
LAP-T® (LAPAROSCOPIC ABDOMINOPLASTY POZZI TECHNIQUE) IN WOMEN WITH POST-PARTUM RECTUS MUSCLE DIASTASIS AND HERNIA. 1.305 PATIENTS TREATED, MONITORING AND FOLLOW-UP ON 53 WOMEN WITH SUBSEQUENT PREGNANCY. SINGLE SURGEON SETTING
Authors: Pozzi G 
Published: May 2024

Abstract

Background
Aim of this retrospective review on 1.305 female patients undergoing LAP-T® Repair for Diastasis Recti (DR) and Abdominal Wall Hernia (AWH) developed after pregnancy, is evaluating the safety and efficacy of LAP-T® technique, in terms of intra and post operative complications. Secondary aim, proving the feasibility of subsequent pregnancies in 53 women who received the LAP-T® Repair, evaluating complications and recurrence during the pregnancy and after delivery.

Methods
1,305 cases from January 2007 to January 2022, minimum follow-up 24 months. Elected patients, BMI &lt; 30, 3 &lt; IRD &gt; 13 cm. According to LAP-T® Technique rectus muscles are re-approximated from xiphoid to pubis using tailored double row, laparoscopic, running Musculo-fascial suture and intra-peritoneal mesh when needed. After receiving the LAP-T repair, 53 women came back pregnant. Follow-up with clinical examination and ultrasound during pregnancy a 4, 6 and 8 months, and 3, 6 and 12 months after delivery.

Results
In all 1.305 cases, full abdominal physiologic functioning and anatomy were successfully restored. No intra operative bleeding, no seroma formation, nor mesh infection or chronic pain reported. All 53 women coming back pregnant carried out subsequent pregnancy after LAP-T repair with no complications related to repair, no parietal pain recorded. No midline pathologic relapse, DR or AWH recurrence observed.

Conclusions
LAP-T® allowed for DR and AWH sound reconstruction, with restitutio ad integrum of anatomy and physiologic functioning of AW, reduced trauma, fast recovery and no intra or post operative complications. LAP-T® proved to be compatible with carrying out further pregnancies without complications or recurrence.
SURGICAL TECHNIQUE AND CHRONIC POSTOPERATIVE INGUINAL PAIN IN PATIENTS UNDERGOING OPEN INGUINAL HERNIOPLASTY IN PORTUGAL – A PROSPECTIVE MULTICENTRIC COHORT STUDY
Authors: Santos I , Peyroteo M , Simões J F F , Camila Cláudia , Sampaio Alves M , Azevedo J , Cunha M , Alagoa João A , Guilherme Nobre J , Picciochi M , Sampaio Soares A , Vieira B 
Published: May 2024

Abstract

Background
Evidence about the advantage of Lichtenstein’s repair, the guidelines’ recommended technique, is scarce regarding postoperative chronic inguinal pain (CPIP). The primary aim of this study was to compare CPIP in patients undergoing Lichtenstein versus Other techniques.

Methods
Prospective multicentric cohort study including consecutive adults undergoing elective inguinal hernia repair in Portuguese hospitals (October–December 2019). Laparoscopic and mesh-free hernia repairs were excluded.
The primary outcome was postoperative pain at three months, defined as a score of ≥3/10 in the EuraHS-QoL score pain domain. The secondary outcome was 30-day postoperative complications.

Results
869 patients were included from 33 hospitals. The majority were men (90.4%) and had unilateral hernias (88.6%).
Overall, 53.6% (466/869) underwent Lichtenstein’s repair and 46.4% (403/869) other Techniques, of which 83.9% (338/403) Plug and Patch.
The overall rate of CPIP was 16.6% and 12.2% of patients had surgical complications. The unadjusted risk was similar for CPIP (OR 0.76, p = 0.166, CI 0.51–1.12) and postoperative complications (OR 1.06, p = 0.801, CI 0.69–1.60) between Lichtenstein and other techniques. After adjustment, the risk was also similar for CPIP (OR 0.83, p = 0.455, CI 0.51–1.34) and postoperative complications (OR 1.14, p = 0.584, CI 0.71–1.84).

Conclusion
The Lichtenstein technique was not associated with lower CPIP and showed comparable surgical complications.
Further investigation assessing long term outcomes is necessary to fully assess the benefits of the Lichtenstein technique regarding CPIP.
PROPHYLACTIC MESH DOES NOT PREVENT PARASTOMAL HERNIA AT LONG-TERM: META-ANALYSIS AND TRIAL SEQUENTIAL ANALYSIS
Authors: Verdaguer-Tremolosa M , García-Alamino J M , Rodrigues-Gonçalves V , Martínez-López M P , López-Cano M 
Published: May 2024

Abstract

Introduction
Previous randomized clinical trials (RCT) and systematic reviews evaluating parastomal hernia (PH) after a prophylactic mesh placement during end colostomy formation have reported contradictory results. This review attempted to determine the efficacy of this strategy in long-term follow-up according to the latest available data.

Methods
Medline, EMBASE, Cochrane Library, Web of Science and Google Scholar were searched. RCTs were included if they compared mesh with no mesh during initial end colostomy creation in adults to prevent PH with a follow-up longer than 2 years. To evaluate PH incidence, PH repair rate and mortality a meta-analysis was performed. Subgroup analysis included surgical approach and mesh position. A trial sequential analysis (TSA) was performed.

Results
Eight RCTs involving 537 patients were included. The incidence of PH at long term was not reduced when a prophylactic mesh was placed (RR = 0.68 [95% CI:0.46–1.02]; I2 = 81%, P = 0.06). The PH repair rate was low but no difference was found between the groups (RR = 0.90 [95% CI: 0.51–1.56]; I2=0%; P = 0.70). No difference was detected between groups when mortality was assessed (RR = 1.03 [95% CI: 0.77–1.39]; I2 = 21%; P = 0.83). Subgroup analyses did not show differences according to the surgical approach or mesh position used. With regard to TSA, an optimal information size was not achieved.

Conclusion
Prophylactic mesh placement during end colostomy formation does not prevent PH in the long term. The PH repair rate and mortality rate did not vary between groups. Heterogeneity among the included RCTs might restrict the accuracy of the results.
ROBOT-ASSISTED EXTRAPERITONEAL VENTRAL HERNIA REPAIR—EXPERIENCE FROM THE FIRST 160 CONSECUTIVE OPERATIONS WITH LATERAL eTEP AND eTAR TECHNIQUES
Authors: Vogel R , Heinzelmann F , Büchler P , Mück B 
Published: May 2024

Abstract

Background
As in various other surgical domains, robotically assisted procedures have become integral in the management of ventral hernias in recent years. The employment of robotic technology enables the integration of minimally invasive techniques with retromuscular mesh placement. Beyond the conventional transabdominal approach, these surgical interventions can alternatively be executed in a total extraperitoneal fashion. The objective of this study is to demonstrate that robotic total extraperitoneal management of abdominal wall hernias is safe and efficient.

Method
A retrospective analysis encompassing all patients who underwent robotic surgery for ventral hernia repair utilizing the extraperitoneal eTEP technique with a lateral approach was conducted. The study period spanned from December 2019 to December 2023.

Results
Over the study period, a total of 160 patients underwent surgical intervention utilizing the lateral robotic eTEP technique. Among these cases, 43 patients required a lateral extension of retro-rectal dissection through extraperitoneal transversus abdominis release (eTAR) due to either the hernia size or lateral hernia localization. In every instance, an uncoated synthetic mesh was positioned in the retromuscular location, accompanied by complete fascial closure. The median hernia defect area was 25 cm² (2.25–375 cm²). The median mesh size was 540 cm² (225–1350 cm²). The median mesh defect ratio (MDR) was 21 (2.3–150). Two conversions (1.72%) were necessary. One intraoperative and seven postoperative complications were encountered (5%) out of which two required reoperations (1.72%).

Conclusion
The robotic extraperitoneal eTEP technique enables a retromuscular mesh placement in a minimally invasive approach. With the possibility of combination with a transversus abdominis release, even complex findings can be treated using this technique.
REDUCED INCISIONAL HERNIA INCIDENCE AFTER COLORECTAL CANCER SURGERY- THE REIN4CETO1 RANDOMIZED CONTROLLED TRIAL
Authors: Wenzelberg C L 
Published: May 2024

Abstract

Aim
Incisional hernia (IH) is a common long-term complication after surgery for colorectal cancer (CRC). Using a prophylactic mesh reduces the incidence, but many surgeons hesitate mostly due to the fear of surgical site infections. The aim of this study was to investigate if the reinforced tension line (RTL) suture technique reduces the IH incidence after elective CRC surgery.

Materials and Methods
In this randomized controlled clinical trial, patients planned for CRC surgery through a midline incision at two Swedish hospitals, October 2017 until May 2021, were eligible for inclusion. Patients &gt;18 years were randomized to two different fascia closure techniques: 4:1 small-bite technique with polydioxanone suture (the PDS-group) or RTL+ the 4:1 small-bite technique with polypropylene sutures (the RTL-group). The CT-diagnosed IH incidence was compared 1 year postoperatively.

Results
Total 248 patients were eligible, of which 160 (86M, 74F, mean BMI 25.6) were randomized at operation and 134 patients remained for analysis at 1 year; 71 in the PDS group and 63 in the RTL-group. IH was found in 19 patients: 15 (21.1%) in the PDS-group and 4 (6.4%) in the RTL-group (p ≤ 0.014, OR 3.95, 95% CI 1.24–12.6). No difference was found in base-line characteristics, surgical site occurrences or overall complications according to the Clavien-Dindo classification. Neoadjuvant radiotherapy was more frequent (p = 0.030), more patients received stomas (p = 0.020) and fascia closure time was longer in the RTL-group (p &lt; 0.001).

Conclusions
We found fewer CT-diagnosed IH one year after fascia closure with the RTL technique in electively operated CRC patients.
THE IMPACT OF BOTULINUM TOXIN A APPLICATION ON REDUCING THE NECESSITY FOR "COMPONENT SEPARATION TECHNIQUES" IN GIANT ABDOMINAL HERNIAS: A DUAL-CENTER, POLISH-UKRAINIAN, RETROSPECTIVE COHORT STUDY
Authors: Zamkowski M , Lerchuk O , Porytsky A , Ushnevych Z , Khomyak V , Śmietański M 
Published: May 2024

Abstract

Introduction
Abdominal hernias are a common post-laparotomy complication, with a significant number of cases evolving into giant hernias, challenging the effectiveness of traditional surgical approaches. Component separation techniques (CST), while popular, come with several drawbacks, including irreversible anatomical alterations and increased perioperative trauma. The preoperative use of Botulinum Toxin A (BTA) has emerged as a promising alternative, potentially reducing the necessity for CST by temporarily paralyzing and elongating the lateral abdominal muscles, thus facilitating hernial defect closure.

Materials and Methods
This cohort study compared two groups of patients undergoing elective surgery for giant abdominal hernias (W3 according to the European Hernia Society classification) between 2022 and 2023 at two reference centers located in Gdansk (Poland) and Lviv (Ukraine). The NON-BOTOX group (n = 50) underwent traditional surgery, while the BOTOX group received preoperative BTA injections (n = 50). The primary outcome measured was the necessity of performing CST for anterior abdominal wall closure. Complications such as surgical site infections (SSI), seroma, and hematoma were also evaluated.

Results
Preliminary findings suggest that the preoperative application of BTA significantly reduces the need for CST in patients with giant abdominal hernias with a notable decrease in CST necessity by 38%. The groups were comparable in demographics and hernia specifics, allowing a fair comparison of surgical outcomes and complication rates.

Conclusions
Preoperative BTA application appears to be an effective strategy to decrease the reliance on CST in the treatment of giant abdominal hernias, potentially leading to simpler surgical procedures, reduced anatomical disruption, and a decrease in perioperative complications. However, during the study, two individuals reported respiratory efficiency issues following BTA administration. This observation has inspired the authors to continue their research and verify whether BTA administration benefits all patient groups equally. Further investigations are crucial to ensure the safety and efficacy of BTA use in preoperative preparation for patients with complex abdominal hernias.