bluuebunny/crossref_metadata_2025_split huggingface dataset:
A NEW ETIOLOGY SEMILUNAR LINE DIASTASIS AND POSSIBLE RELATION TO RECTUS DIASTASIS
Authors: Dudai M , Ganiem M 
Published: May 2024

Abstract
The guidelines for Rectus Diastasis (RD) of the European Hernia Association published in 2019, created the clinical basis for the diagnosis and treatment. There is no reference in the guidelines or in the medical literature to the situation of Semilunar Line Diastasis (SLD). We want to bring our experience with this new phenomenon and raise the discussion.
We have seen that after SCOLA for repair of Hernias with RD, some swelling of the lower abdomen can remain. A review of the CT scans showed that preoperatively the patients also had SLD on both sides, which widened postoperatively. From an examination of 8 cases that we located; we can see several things in common: 1. SLD is always accompanied by RD, but smaller 2. SLD is always bilateral 3. SLD is not symmetrical and is wider on one side 4. There is asymmetry of the lower abdomen probably due to SLD separations in different sizes 5. Patients always have CORE INSTABILITY, and probably it is aggravated by the addition of the SLD. From a systematic examination of the CT images of patients with RD, it was found that a small part also has BSLD.
There are no data in the medical literature regarding diagnosis or treatment of SLD. We present our report on SLD phenomenon and raise the need to check the situation with its implications on RD, CORE INSTABILITY and the possible need for surgical repair together with RD.
INCIDENCE OF HERNIA DEVELOPMENT IN A SURGICAL SCAR (POIH), IN THE PRESENCE OF UNTREATED RECTUS MUSCLE DIASTASIS TREATED BY SCOLA REPAIR
Authors: Dudai M , Ganiem M 
Published: May 2024

Abstract
In the last decade, many works have been published demonstrating the recurrence of Umbilical or Epigastric Hernia that are repaired without a combined repair of an existing Rectus Diastasis (RD). Guidelines recently published including the European Hernia Society recommend combined repair and use of the Mesh. These are mostly small Hernias, but we would like to report on the development of Post Operative Incisional Hernias (POIH) sometimes big in the midline, following even small incision of Laparoscopic and Robotic procedures, in the presence of undiagnosed and uncorrected RD. We will bring our experience to the repair of these POIH and RD by Subcutaneous Onlay Laparoendoscopic Approach-SCOLA with the Release of the Anterior Rectus Fascia (RFR).
Since 2016, we perform a combined repair of Hernias together with an existing RD using a SCOLA with RFR. All patients are discharged home the day after surgery. We analyzed 123 patients, 34 of whom had POIH combined with RD, while 17 of them had the POIH in a Laparoscopic or Robotic scar. Hernia width was 2–10 cm. The repaired Hernia recurred in only 2 of them, 10 of them developed a Seroma that was treated by aspiration.
Any surgical operation performed on the ventral abdominal line should ensure the presence of RD. Also, ventral penetration in Laparoscopic or Robotic approach in the presence of undiagnosed and uncorrected RD, will lead to the development of POIH. Even big POIH combined with present for RD, are successfully repaired with low trauma by SCOLA approach with RFR.
EMERGENCY TAPP FOR STRANGULATED HERNIA. SAFE OPTION OR ROAD TO DISASTER? CASE REPORT
Authors: Đurica N , Stojanović M , Stojanović N , Ardeljan D P 
Published: May 2024

Abstract

Background
Laparoscopic approach to strangulated hernia is controversial and there are only few papers on this topic. We present a case of emergency TAPP and complications that occurred during and after surgery.

Case presentation
A 68-year-old female came to the emergency department with complaints of right inguinal bulging, abdominal pain and vomiting. Abdominal ultrasound and X-ray confirmed small bowel strangulation.
Manual reduction was unsuccessful, so we proceeded to emergency laparoscopic surgery which showed femoral hernia with strangulation of small bowel and omental adhesions in the right iliac fossa. After adhesiolysis, reduction of herniated small bowel was achieved. Bowel was congested but peristalsis was present. We continued to repair hernia by TAPP approach. After completion, bowel was inspected and it was concluded that there were no signs of ischemia.
4 hours after the surgery patient became hypotensive and tachycardic. Abdominal CT scan showed hematoma with active bleeding.
We proceeded to emergency laparotomy and saw hematoma spreading from liver to the right inguinal region. Hemostasis was achieved by suturing the bleeding vessel on omentum. Because of the suspected bowel ischemia we decided to do resection. During procedure attempts of placing central venous catheter failed. After the surgery chest X-ray showed complete right sided pneumothorax, which was drained.
Patient was discharged with full recovery. There were no signs of mesh infection or recurrence.

Conclusion
Emergency TAPP for strangulated hernia should be done by an experienced surgeon. In the postoperative course one should expect complications which are uncommon in elective setting.
LAPAROSCOPIC INGUINAL HERNIA REPAIR IN A LOCAL HOSPITAL. 2 YEARS’ EXPERIENCE AND CHALLENGES
Authors: Đurica N , Stojanović M , Stojanović N , Morišan B 
Published: May 2024

Abstract

Although 3 decades have passed since the first laparoscopic inguinal hernioplasty, only small number of patients in Serbia is currently operated by laparoscopic approach. Around 260 hernia repairs per year is done in our hospital, and only 10% is operated by laparoscopic approach.

Aim
The purpose of this study is to present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our hospital and highlight the challenges we faced.

Material and Methods
It is a retrospective observational study including all patients who underwent a laparoscopic hernia repair (TAPP and TEP) in our hospital between January 2022 and July 2023.

Results
From a total of 49 patients, 46 (94%) were male and 3 (6%) were female. Mean age was 56,8 ± 11,9 years.
There were 24 patients with right sided hernia, 16 with left sided hernia and 9 with bilateral hernia.
45 patients (91,8%) had primary hernia and 4 patients (8,2%) had recurrent hernia.
44 patients were operated using TAPP technique and 5 using TEP.
ASA 2 was the most frequent score (69,4%).
All patients received flat polypropylene mesh and absorbable tackers were used for fixation. The mean time of postoperative hospital stay was 2,02 days ± 0,38.
Seroma was observed in 7 patients, and urinary retention in 2 patients. There was one recurrence (2,04%) and 2 patients acquired incisional hernia on the umbilical port site.

Conclusions
Laparoscopic hernioplasty can be performed safely and effectively, without increasing the rate of intraoperative or postoperative complications, with short operative times and successful results.
QUALITY OF LIFE IN PATIENTS, WHO UNDERWENT INGUINAL HERNIOPLASTY
Authors: Fedorkiv M , Pylypiuk B , Galipchak I , Omelchuk N , Filipenko A , Khrunyk A 
Published: May 2024

Abstract

Background
20 million people with inguinal hernias are operated annually throughout the world. Severe chronic pain after hernia repair effects social life, daily activity and overall quality of life (QL). In medicine, QL is assessed by the level of well-being and satisfaction with those aspects of life that are affected by the disease and its treatment. The Short Form-36 is (SF-36) a validated indicator of overall health status.

Method
this study was to evaluate QL by SF-36 questionnaire in patients, who underwent inguinal hernioplasty (open surgery – Lichtenstein tension-free mesh inguinal hernia repair or laparoscopic surgery – transabdominal preperitoneal (TAPP)). Results: State the main findings, including important numerical values.

Results
The majority had unilateral hernias 89.0% and the most common surgical technique was Lichtenstein’s repair (82.4%). The postoperative QL was significantly better after surgery. Comparing two groups of patients after surgery, only the pain domain of the questionnaire was worse in patients operated by Lichtenstein repair: 46.5%/39.8% experienced mild pain, 38.6%/42.0% experience moderate pain and only 14.9%/18.2% experienced severe pain.

Conclusion
Results showed that 213 (86.9%) patients felt that their QL was satisfactory after the hernia repair, with most of them being from the age group of 19–39 years (93.2%).
TAPP (TRANSABDOMINAL PREPERITONEAL) APPROACH IN A RARE CASE OF SPIGELIAN HERNIA INCARCERATED WITH OVARY
Authors: Florea I , Chiru B , Dutu C 
Published: May 2024

Abstract

Aim
Spigelian hernia, a very rare form of anterior parietal defect (incidence reaching maximum 0.12–2% of abdominal wall hernias), occurs at the semilunar line or Spigelian line. In most cases, it is a small hernia defect, measuring &lt;2 cm in diameter. With ambiguous symptoms and often no clinical findings, this hernia is diagnosed usually in the complication stages (the incarceration rate reaches up to 27%). This is why no “watchful waiting” approach is recommended and it should be operated upon even if the patient is asymptomatic.

Material and Methods
A 32-year-old female patient with incarcerated Spigelian hernia, presented to our clinic with pain in the left iliac fossa. The clinical examination revealed a small, irreducible swelling at the level of the left semilunar line. CT (computed tomography) examination described a 5 mm parietal defect – compatible with a left infraumbilical Spigelian hernia, in which the left adnexa was incarcerated.

Results
A laparoscopic TAPP approach was chosen, practicing the reduction of the herniated content (left adnexa of normal macroscopic appearance) and the placement of an 11/8 cm synthetic mesh at the preperitoneal level. After surgery, the patient was discharged safety on the second postoperative day, with favorable evolution, quick post-operative recovery, no surgical site infection, no postoperative complications and a good aesthetic outcome.

Conclusion
In conclusion, we want to highlight the importance of knowing rare pathologies such as Spigelian hernia and their high complication rate, as well as the benefits of minimally invasive treatment.
CASE PRESENTATION: INTERNAL HERNIATION CAUSES DOUBLE OBSTRUCTION, SMALL BOWEL AND URINARY TRACT
Authors: Fotiadis P , Gemousakaki E , Permekerlis A , Tepelidis C , Papalos C , Fentas A , Mallioris A , Kouridakis P 
Published: May 2024

Abstract

Aim
The presentation of a rare case of small bowel obstruction accompanied by obstruction of the urinary tract, due to an internal hernia caused by the ureter, as a secondary complication of ureteroplasty.

Material and Methods
A 58-year-old female, who underwent hysterectomy-right ureter injury-ureteroplasty ten years ago, presented to the Emergency Department with acute abdominal and right lumbar region pain accompanied by nausea. Clinical examination showed tenderness in the lower abdomen, positive Giordano's sign on the right, and metallic bowel sounds. A Computer Tomography scan revealed right- sided hydronephrosis with perinephric stranding, and absence of excretion in the right urinary tract. In the pelvic cavity, dilated loops of the small intestine were observed, and at the same level, a point of luminal narrowing of the right distal ureter.

Results
The patient underwent an investigative laparoscopy-laparotomy-resection of a segment of the ileum and oblique anastomosis-reimplantation of the right ureter, and placement of a ureteral catheter. The postoperative course was uneventful, and the patient was discharged 8 days postoperatively, with the ureteral catheter removed 30 days later.

Conclusions
The literature contains very few cases of internal herniation beneath the ureter, with retro-ureteral small bowel incarceration and simultaneous urinary tract obstruction. These cases typically involve patients who have undergone either gynecological surgeries or kidney transplant procedures. Surgical history should be strongly considered in the diagnostic approach, in order to recognize even rarer causes of small bowel obstruction.
REPAIR OF RECURRENT INGUINAL HERNIA AFTER ENDOSCOPIC TEP HERNIOPLASTY THROUGH TAPP APPROACH
Authors: Friedova P , Acosta Rodríguez A , Rodríguez Valenzuela N , Sánchez González J , Pérez Saborido B 
Published: May 2024

Abstract

Objective
To demonstrate the feasibility of repairing recurrent inguinal hernias following endoscopic TEP hernioplasty using a laparoscopic TAPP approach.

Materials and Methods
A 71-year-old male patient with no significant personal history underwent bilateral TEP hernioplasty in 2021. He presented with a right inguinal hernia on consultation. Abdominopelvic CT was requested, confirming a recurrent indirect right inguinal hernia. A TAPP approach was chosen, revealing a recurrent indirect inguinal hernia due to medial displacement of the mesh, classified as L3r according to the EHS classification. Repair was performed through the TAPP approach without removal of the previous mesh, with traumatic fixation of the new mesh to the pubis.

Results
Postoperative period was uneventful, with discharge 24 hours after surgery. The first follow-up at 10 days post-intervention showed that the patient only required continuous analgesia in the first 24 hours. Three months after surgery, the patient reported no pain, physical examination showed no recurrence (complications), and excellent aesthetic results.

Conclusions
Minimally invasive repair of inguinal hernias is not only advisable for primary hernias but should also be the treatment of choice for recurrent hernias through laparo-endoscopic approaches. Although repair may be more challenging due to fibrosis from previous surgery, in expert hands, it can be performed with the utmost safety for the patient.
THE IMPACT OF THE CREATION OF AN ABDOMINAL WALL UNIT
Authors: Gaspar B , Ribas S , Oliveira F 
Published: May 2024

Abstract

Background
Abdominal wall units in surgery departments are becoming more and more necessary due to the increasing complexity of hernias and the ongoing development of new surgical techniques and resources. This study aims to understand the impact of an abdominal wall unit in a medium-sized hospital's surgery department.

Method
A retrospective study was conducted involving all patients who underwent elective hernia repair between October 2021 and March 2023 and the outcomes were compared before and after the creation of the abdominal wall unit (July 2022).

Results
700 patients were included with median age of 59 and median BMI of 27.5 kg/m2. Of these, 388 underwent surgery from July 2022.
Was identified a reduction in complications after unit creation, from 7.7% to 7.2% (p = 0.811) and a decrease in recurrence from 3.8% to 2.1% (p = 0.159), diagnosed 8 months after surgery, on average. With the creation of the unit, an increase in the usage of minimally invasive techniques was observed, from 10.6% to 13.9% (p = 0.271). For example, the use of TAPP technique for inguinal and femoral hernias increased from 9% to 14,5%. New techniques and adjuvant procedures have also been introduced, such as LIRA technique, Fasciotens abdominal device and botulinum toxin A application.

Conclusion
Our study supports the existing literature, confirming the positive impact of an organized abdominal wall unit. We highlight the reduction in post-operative complications and recurrence after the unit creation and the introduction of new and innovative surgical techniques in the treatment of abdominal wall hernias.
COMPARATIVE ANALYSIS OF ANATOMICAL SHAPED AND STANDARD FLAT MESH IN TRANSABDOMINAL PREPERITONEAL (TAPP) INGUINAL HERNIA REPAIR: EARLY OUTCOMES
Authors: Gianluca B , Sartori A , Bagolini F , Simone T , Sanna A 
Published: May 2024

Abstract

Background
Mechanical fixation in transabdominal preperitoneal inguinal hernia mesh repair (TAPP) is associated with pain syndrome and mesh migration may occur without flat protheses fixation. An anatomical shaped mesh (4DTM Cousin Biotech) using no fixation would improve the pain syndrome.

Method
A retrospective case study, that included 100 patients and 200 TAPP performed from 2019 to 2023. This study was conducted to compare laparoscopic inguinal hernia repair with (group A) or without mesh fixation (group B) regarding outcomes using two different mesh technologies: well-established flat macroporous partially absorbable mesh and the anatomical shaped partially absorbable lightweight mesh (4DTM Cousin Biotech).

Results
Recurrence rates, postoperative outcomes, and complication rate and type were analyzed to provide insights into the performance of each mesh in TAPP. There was statistically significant difference in postoperative early pain, assessed via VAS score, 3 days after surgery (group A versus group B; 3,4 ± 1.46 vs. 4 ± 1.6, P &lt;0.001) and a week after surgery (group A versus group B; 1.5 ± 0.9 vs. 2.5 ± 0.6, P &lt;0.001). Operative time, on average, was longer in group B (92 ± 12. vs. 79 ± 20 min, P &lt;0.001).

Conclusion
The study results revealed that laparoscopic TAPP inguinal hernia repair with anatomical shaped mesh without fixation is safe and feasible with no increase in recurrence rate. In addition, it offers an improvement of operation time than TAPP mesh fixation. However, further study with a longer follow-up will be needed to confirm the results.
HERNIA REPAIR SURGERY IN INTERNATIONAL COOPERATION PROGRAMMES IN AFRICA
Authors: González-Valverde F M , Rodríguez-Lucas J M , Medina-Manuel E , Hernández Agüero Q , Torregrosa Pérez N M , Jimenez-Moreno I M , Hurtado Vázquez A M , Del Valle-Ruiz S R , Rodríguez González J M 
Published: May 2024

Abstract

Introduction
Hernia pathology is particularly prevalent in underdeveloped countries. The population is often forced to perform physically demanding work in order to survive. In many cases, hernia repair can be a vital part of survival.

Materials and Methods
Retrospective study of a consecutive series of patients who underwent inguinal hernia repair between 2005 and 2023 in Cameroon, Mali, Algeria, Kenya and Senegal as part of an international cooperation programme of the Spanish NGO "Cirugía Solidaria".

Results
1634 patients were operated on, with a total of 1823 surgical procedures. The mean age was 52.21 years. A total of 83.2% were male. More than 90% of the patients had comorbidities. 23% of patients had had the hernia for more than 10 years and 25.2% of patients were unable to work. Of the hernias repaired, 9.8% were recurrent and 13.2% were bilateral.
The rate of use of local anaesthesia with sedation was 16.36%. Antibiotic prophylaxis was 100%, but DVT prophylaxis was never used. The use of mesh was 82.8% and the number of procedures performed by residents was 20.42%. There was no mortality. The haematoma rate was 4.66% and the wound infection rate was 1.16%. The hernia recurrence rate was 3.3%, although only 20.97% were followed up. The mean length of stay was 18.8 hours.

Conclusions
Hernia surgery in underdeveloped countries with scarce instrumentation and suboptimal operating conditions can be performed with quality standards similar to those in developed countries.
OBTURATOR HERNIAS
Authors: González Valverde F M , Rodríguez-Lucas J M , Medina-Manuel E , Navarro-Duarte J C , Jimenez-Moreno I M , Sandoval Marin J , Moreno García C , Hurtado Vázquez A M , Del Valle-Ruiz S R 
Published: May 2024

Abstract

Introduction
Obturator hernias are an extremely rare cause of bowel obstruction. This type of hernia accounts for 0.5% to 1.4% of all hernias. In addition to the rarity of this type of hernia, there is no standard approach to its management.

Case Presentation
The case of an 88-year-old woman with a 24-hour history of intestinal obstruction is presented. A CT scan showed a strangulated obturator hernia of the right ileum. Laparotomy confirmed the presence of a right obturator hernia with ileal strangulation. A segmental enterectomy with primary anastomosis and reduction of the hernia sac with mesh was performed to close the obturator foramen.

Discussion
Due to the non-specific symptoms, the diagnosis of this type of hernia is usually challenging and its treatment is only surgical. It often occurs in older, multiparous and emaciated women. Risk factors include weight loss, chronic lung disease and ascites, which increases abdominal pressure. A rare presenting sign is a palpable mass or the Howship-Romberg sign (pain radiating from the inner thigh and knee). Computed tomography has a higher sensitivity and accuracy than other radiological investigations for assessing the presence of an obturator hernia.

Conclusion
Obturator hernia is a rare type of hernia due to its often unclear diagnosis; a rapid suspicion based on non-specific symptoms is crucial for diagnosis. Surgical management is the only possible treatment for this pathology and depends on early diagnosis.
WHEN THE GOING GETS TOUGH THE EXPANDERS START PLAYING
Authors: Grimaldi S , Morini L , Alampi B D , Nicastro V , Marin J N , Ferrari G 
Published: May 2024

Abstract

Background
Complex incisional hernias pose challenges for abdominal wall surgeons, often requiring invasive procedures like Transversus abdominis release (TAR). However, these approaches may not always be sufficient or may be overly invasive for patients. Tissue expanders provide a viable solution. This report presents a clinical case demonstrating the feasibility and safety of an abdominal wall expansion system, enabling the Rives technique in patients with large incisional hernias previously recommended for TAR.

Method
We treated a 77-year-old woman with ASA 3, BMI 33.69, affected by type II diabetes mellitus, arterial hypertension, hypothyroidism, dyslipidemia, chronic anemia, and multiple previous laparotomies. The patient presented to our department for recurrent and symptomatic incisional hernia (EHS classification M 2-3-4 W13L12) with a CeDAR score of 53% without TAR and 69% with TAR, and an RDR score of 1.35.
Once the retromuscular space was prepared, we positioned 6 stitches on each side, placed 2 cm from the medial margin. U-shaped stitches were used to encompass both the anterior and posterior fascia and were spaced 2 cm apart. The threads intersected the midline and were fixed to the device, which allowed for progressively increasing traction from 14 kg to 18 kg. We achieved an elongation of 8 cm toward the midline, enabling a downgrade of the procedure from TAR to Rives. A 30 × 45 cm polyvinylidenefluoride mesh was used in a sublay position.

Results
The patient was discharged on the fourth post-operative day without complications. Negative one-year follow-up.

Conclusion
When the going gets tough we should consider tissue expanders which can not only help us when we are unable to repair a complex hernia, but also offer the patient a less invasive surgery to reduce morbidity in high-risk patients.