bluuebunny/crossref_metadata_2025_split huggingface dataset:
TAPP FOR RECURRENT INGUINAL HERNIA IN OUR HOSPITAL
Authors: Ando M , Saito T , Ueda S , Shinohara K , Yasui K , Osawa T , Matsumura T , Fukami Y , Komatsu S , Kaneko K , Sano T 
Published: May 2024

Abstract

Background
Laparoscopic surgery for recurrent inguinal hernias is technically advanced but has the advantage of better understanding of the anatomy of the recurrent form and mechanically strong repair. Transabdominal preperitoneal repair (TAPP) is the first choice for inguinal hernia surgery and is also the first choice for recurrent inguinal hernias at our hospital. We review the results of TAPP for recurrent inguinal hernias at our hospital.

Methods
We reviewed 29 patients who underwent TAPP for recurrent inguinal hernia at our hospital from January 2015 to December 2023.

Results
The previous surgical procedures were mesh plug in 11 cases, tension repair in 8 cases, tension free repair with unknown technique in 3 cases, UHS in 3 cases, TAPP in 2 cases, Lichtenstein in 1 case, and Polysoft in 1 case. Nine patients underwent repair using the modified intraperitoneal onlay mesh (mIPOM) technique. The median operative time (range) was 109 minutes (73–217). 2 patients (6.9%; 1 with bowel obstruction, 1 with mesh infection) had postoperative complications. No apparent recurrence has been observed to date.

Conclusions
No recurrence was observed, but shortening the operation time and decreasing complications are future issues. IPOM is not recommended for first inguinal hernias, but the mIPOM may decrease complications in recurrent cases.
TRANSVERSUS ABDOMINIS MUSCLE RELEASE (TAR) IN GIANT INCISIONAL HERNIA
Authors: Baćo S , Mitrić M 
Published: May 2024

Abstract

Background
We present a case of giant ventral incisional hernia, where a favorable outcome was achieved with Transversus Abdominis Muscle Release technique (TAR), in a contaminated environment without perioperative complications and recurrence after 36 months, with the placement of inexpensive non-absorbable ‘Paha’ mesh.

Materials and Methods
A 70-year-old man, who had undergone two previous operations presented with a giant incisional hernia. The rectus defect in the umbilical region was 20 cm in the transverse direction wide and 20 cm in the vertical direction and a defect area of 400 cm2 with the bowel adherent to the skin. We were compelled to resect approximately 15 cm of the intestine tenui and constructed a T-T anastomosis, alert to the risk of the operating field contamination. Two non-absorbable, monofilament polypropylene mesh sized 30 × 30 cm were placed retro muscular.

Results
The problem of extending the dissection from the rectus abdominis muscle to the lateral compartment was resolved by Novitsky et al. Mesh is placed sublay and perforators to the rectus muscle are preserved. TAR could be an ideal hernia repair technique for complex defects because it weakens the lateral sides of the abdominal wall to augment the midline repair, thereby also increasing the lateral abdominal wall compliance and reducing the pressure on the midline.

Conclusion
Our case shows that even the most challenging abdominal wall hernias can be reconstructed with TAR. It is a safe, effective, and reliable technique with low perioperative morbidity (reduced risk of skin necrosis and surgical site infection).
OPEN VS. ROBOT-ASSISTED PREPERITONEAL INGUINAL HERNIA REPAIR. ARE THEY TRULY CLINICALLY DIFFERENT?
Authors: Bel R , Rodrigues-Gonçalves V , Verdaguer-Tremolosa M , Martínez-López P , Fernandes N , López-Cano M 
Published: May 2024

Abstract

Introduction
Inguinal hernia repair lacks a standard repair technique, with laparo-endoscopic and open preperitoneal methods showing similar outcomes. Despite higher costs, the popularity of robotic surgery is on the rise, driven by technological advantages. Controversies persist in comparing open repair techniques with the robotic approach, given contradictory results. The objective of this study was to compare postoperative outcomes, including complications, chronic pain, and recurrence, between open and robotic-assisted preperitoneal inguinal hernia repair.

Methods
This single-center retrospective study encompassed patients undergoing elective inguinal hernia repair in a specialized unit, employing both open preperitoneal and robotic-assisted laparoscopic approaches from September 2018 to May 2023. Comparative analysis of short- and long-term outcomes between these techniques was conducted. Additionally, multivariate logistic regression was employed to explore predictors of postoperative complications.

Results
A total of 308 patients met the inclusion criteria. 198 (64%) patients underwent surgery using an open preperitoneal approach and 110 (36%) using robot-assisted laparoscopy. Patients in the robot-assisted group were younger (P = 0.006) and had fewer comorbidities (P &lt;0.001). There were no differences between the groups in terms of postoperative complications (P = 0.133), chronic pain (P = 0.463) or recurrence (P = 0.192). Multivariate analysis identified ASA ≥III (OR, 1.763; 95%CI, 1.068–3.994; P = 0.027) and inguinoscrotal hernias (OR, 2.371, 95%CI, 1.407–3.944; P = 0.001) as risk factors of postoperative complications.

Conclusion
Both open preperitoneal and robotic-assisted laparoscopic approaches show similar outcomes for complications, chronic pain, and recurrence when performed by experienced surgeons. The open preperitoneal approach, with its quicker operative time, may be advantageous for high-comorbidity cases. Treatment choice should consider patient factors, surgeon experience, and healthcare resources.
BOTTOM-UP ROBOTIC E-TEP HERNIA REPAIR STANDARTIZATION: THE LANDING RUNWAY CONCEPT
Authors: Biscuola Garcia R , Nogueira Costa T , Armando Buzzo M , Pascotini Pereira N , Zugaib Abdalla R 
Published: May 2024

Abstract

Introduction
The e-TEP (extended totally extraperitoneal) technique has gained popularity due to its minimally invasive nature and reduced postoperative pain and infection rates compared to open hernia repair. This paper aims to describe standardization of bottom-up robotic e-TEP hernia repair. With trocars located in suprapubic area there is a different perspective, and landmarks and standardization can make learning curve easier and faster.

Methods
We use landmarks previously described by Ramana in 2020 and new ones for standardization of Bottom-up E-tep hernia repair, based on the concept of fatty trident described by Garcia-Ureña in 2022.

Results
Use of the following concepts and landmarks: inferior crossover to create sufficient space for trocar insertion below the arcuate line; lamppost sign, to prevent arcuate line injuries so as neuvascular bundles iatrogenic lesions; volcano sign, to complete dissection of lateral hernia margins; inverted Y concept to identify the iliac and epigastric vessels; frenulum sign, to identify the correct planes at xyphoid process area; runway concept, where we can identify the whole hernia defect, and visualize the hernia limits.

Conclusion
Standardizing this technique requires addressing challenges related to the learning curve, cost, accessibility, and technical limitations. The Bottom-up approach in midline hernias is feasible in M1 to M4 and some lateral hernias. Is a good alternative when abdominis rectus muscles are narrow, because in these cases the space to lateral approach. Also allows a more precise incision at medial posterior sheath of rectus abdominis muscle.
LAPAROSCOPIC APPROACH TO COMPLEX INGUINAL HERNIA: A FEASIBLE OPTION
Authors: Bravo-Salva A , Navarro-Barbancho A , Riba-Combatti L , Perez-Guitart M , Pereira-Rodríguez J A 
Published: May 2024

Abstract

Aim
The aim of our study is to demonstrate the safety of laparoscopic approach of complex inguinal hernia, defined as multirecurrent or with previous pelvic surgery according to the European Hernia Society (EHS).

Material and Methods
A retrospective cohort study was conducted, including all patients undergoing laparoscopic inguinal hernioplasty in our Abdominal Wall Surgery Unit from 2020 to 2022. Comparative analysis between two groups: the study group with complex inguinal hernia (multirecurrent and/or with previous pelvic surgery) and the control group was performed.

Results
132 cases were included in the study, with 28 (21.2%) having complex inguinal hernia. The mean follow-up was 12.7 +/- 7.44 months. 120 cases (90.9%) had comorbidities. Study groups were comparable, except for a higher number of smokers in the study group (14 (13.5%) vs. 9 (32.1%); p = 0.025). Hernia characteristics showed a higher percentage of bilateral hernias in the control group (68 (65%) vs. 12 (42.9%); p = 0.027) and a higher percentage of recurrent hernias in complex cases (33 (31.7%) vs. 16 (57.1%); p = 0.013). No differences were found in complications, both groups were comparable (8 (7.7%) vs. 2 (7.1%); p = 0.642). One case of recurrence was observed in the control group, one case of conversion and reintervention due to occlusion in the study group, and one readmission in each group. Finally, in long-term follow-up, there was one case of chronic pain in the study group and only one recurrence in the control group.

Conclusions
The laparoscopic approach to complex inguinal hernia appears feasible, with results like non-complex cases.
A NEW MODEL TO LEARN AND TEACH
Authors: Calabrò M , La Terra A , Latham L , Scalambra S M , Muratore A 
Published: May 2024

Abstract
E. Agnelli Hospital is a tertiary hospital routinely performing mini-invasive gastro-enteric surgery such as rectal or gastric resections. Surgical repair of abdominal wall herniae, usually open is one of the most common operation performed. Laparoscopic approach to abdominal wall herniae has become the gold-standard approach in many surgical department. In order to introduce this type of approach in our surgical department, a three-step training program was planned. Two surgeons have been assigned to learn mininvasive abdominal wall surgery and we start from laparoscopic inguinal hernia.
First, once we made the program and kept in contact we moved to Fate Bene Fratelli Hospital in Erba (Italy) to see the technique. We spent one day and we saw three interventions of bilateral inguinal hernia, they showed us the intervention and some tips and tricks.
Second, in the following week, Erba hospital surgeons come to our hospital to follow us during our interventions, we performed one bilateral inguinal hernia with intraperitoneal technique (TAPP) and another one with extraperitoneal technique (TEP).
Third, one week later, we operated in our hospital on two bilateral inguinal hernias remotely connected live with the teaching surgeon in Erba; thanks to our integrated operatory theatre system, they could have laparoscopic vision during all the interventions, and they could give suggestions at the same time to help us and to avoid mistakes. In this third date we performed a TAPP, as the first intervention, in a 66 yo male patient with a direct hernia on the left and direct and indirect hernia on the right. The second one was a TEP in a 72 yo male patient with a direct, indirect and femoral hernia on the left and indirect on the right. The defects were both repaired by the BD 3D mesh.
Patients were discharged the following day in good condition and without pain. We saw the patients 48 hours after the procedure to remove the compression bandage, 8 days later to remove the stitches, and one month later; they didn't have any complications.
Our experience has continued, we have performed 20 bilateral inguinal hernia repairs without major complications, three patients reported small haematomas at the trocar sites.
Surgeons have less and less time to learn and teach, so the remote device could help them grow in technically demanding procedures, allowing them to share knowledge where it is needed most, when someone needs it, without wasting time travelling to another city.
New project it will start to approach incisional hernia with total extraperitoneal technique, with this remote modality and laparoscopic component separation too.
The new experience was possible thanks to our hospital equipment, we have a multi-integrated operating theatre that allows us to share not only the laparoscopic camera image with external resources through a dedicated link on WEBEX, but also voice and sound from the theatre and most importantly with our colleagues at Erba Hospital.
TRANSABDOMINAL SUTURING OF INTERNAL INGUINAL ORIFICE DURING LAPAROSCOPIC TAPP REPAIR OF L3 HERNIAS: 6-MONTH FOLLOW-UP OF 15 PATIENTS
Authors: Chamzin A , Theodoropoulos C , Ioannou T , Triantafyllou A , Galyfos G , Michalopoulos N V , Toutouzas K G , Theodorou D 
Published: May 2024

Abstract

Aim
To present mid-term follow-up data on suturing of the internal inguinal orifice during transabdominal preperitoneal (TAPP) repair of large inguinal hernias.

Methods
This study involved a prospective documentation of surgical outcomes and quality of life in patients with large indirect inguinal hernias who underwent laparoscopic internal ring suturing during TAPP repair.

Results
Between November 2022 and March 2023, 15 patients underwent laparoscopic transabdominal repair of symptomatic L3 inguinal hernias, which included suturing of the internal inguinal ring and preperitoneal mesh placement. All patients were men, with a mean age of 42.4 years (range 23–74). The average size of the hernia defect was 3.8 ± 0.3 cm (range: 3.0–5.4 cm). The mean operative time was 56.8 ± 8.2 minutes (range: 36.2–85.7 minutes), and the time required for internal ring suturing averaged 8.2 ± 1.9 minutes (range: 5.2–11.6 minutes). Patients were assessed clinically for signs of hematoma, seroma, or recurrence on the 1st and 7th postoperative day, and at the 3rd and 6th postoperative month. Additionally, postoperative pain and comfort were assessed using the Visual Analogue Scale (VAS) for pain and the Carolinas Comfort Scale, respectively. All patients reported no postoperative pain and exhibited excellent comfort levels.

Conclusions
Transabdominal internal ring suturing during laparoscopic TAPP repair of L3 inguinal hernias appears to be safe, is not associated with chronic pain, and helps in reconstituting the floor of the inguinal canal for mesh placement. This technique potentially reduces mesh eventration and the consequent risk of recurrence.
INITIAL EXPERIENCE IN INTRODUCING RIVES STOPPA TECHNIQUE IN A WELL-ESTABLISHED ABDOMINAL WALL SURGERY UNIT
Authors: Comas J , Subirana H , Crusellas O 
Published: May 2024

Abstract

Aim
To analyze initial experience with Rives Stoppa Technique in a well-established Abdominal Wall Surgery Unit.

Material and Methods
We analyzed 45 consecutives Rives Stoppa procedures in our center since January 2020, when we introduced at our center, to August 2023.

Results
16 (35%) were male and 29 (65%) female. Median length of transverse defect was 6.17 cm (W2 of EHS classification). One patient required preoperative progressive pneumoperitoneum. In two patients right colectomy for colon cancer was associated. In one patient radical nephrectomy for renal cancer was associated. One case was performed in an Emergency setting.
8 patients presented postoperative adverse events in first 30 postoperative days (17%). Seven related to surgery: 2 hematoma (one subcutaneous that no required treatment, and one preperitoneal that required percutaneous drainage) and 6 seromae (3 non requiring treatment, and 3 requiring percutaneous drainage). One patient presented a transient ischemic stroke that required medical treatment. 75% of adverse events were Clavien Dindo I-II and 25% IIIa. No surgical site infection was observed.
At 6 months follow up (100% of patients), only one patient presented radiological asymptomatic seroma. No incisional hernia recurrence was observed. At one year follow up (54% of patients) no recurrence was observed. At two year follow up (26% of patients) 1 recurrence was observed.

Conclusion
In our center the introduction of Rives Stoppa technique was safe and effective with good results regarding recurrence and adverse events.
WHAT IS IMPORTANT TO KNOW ABOUT SPORTSMAN HERNIA AND ATHLETES PUBALGIA
Authors: Dudai M , Ganiem M 
Published: May 2024

Abstract
Sportsman Hernia (SH) and Athletes Pubalgia (AP) is a new complex pathology involving two different medical fields: Sport Injury and Inguinal Hernia (IH). SH is different from IH and must be diagnosed as such because the treatment and surgery are different.
SH is traumatic athletic damage to the groin wall leading to weakness of the area and pain. The injury expands as the athlete continues the athletic activity to the Pubic Bones, AP.
The diagnosis is based on a clinical history and physical examination when the US and MRI imaging aren't always diagnostic. SH has a typical Chronic pattern of groin pain in sports activities and continues to everyday activities. Pain over 3 months not responding to conservative treatment, is a surgery indication. Nowadays most patients are sports activities amateurs and not professionals. The surgery is by Bilateral TEP approach but is different from a standard IH surgery. The surgery is complete with a dedicated Athletics Muscle Rehabilitation Program (AMRP) that is 5–12 weeks long depending on the severity. Since 2016 we have operated on 468 athletes, 353 has also another hernia and the majority returned to sporting activity.
Treatment of SH requires surgeon with unique expertise in the diagnosis and surgery, but also having a follow-up system for performing the AMRP. A general surgeon should know how to differentiate SH from IH. The presence of chronic pain must light a red lamp, performing surgery like IH and not the specific SH procedure, the chronic pain will continue after the surgery!
TREATMENT OF W1 VENTRAL HERNIAS WITH PREFORMED MESH – SIMPLE SOLUTION FOR A “NOT” SO SIMPLE PROBLEM?
Authors: Gaspar B , Ribas S , Oliveira F 
Published: May 2024

Abstract

Background
In literature there is no agreement on the best method for surgical treatment of ventral hernias and thus, more and better studies are required. The aim of this study is to describe the results of W1 ventral hernias open repair with a preformed mesh.

Method
Was conducted an observational retrospective study of all adult patients who underwent elective W1 ventral hernia open repair with a preformed mesh between January 2022 and September 2023. The characteristics of the patient group, the size of the hernias and the results obtained based on complications and recurrence were analysed.

Results
26 patients were included with an average age of 52 and an average MBI of 28 kg/m2. The average of the hernia defect was 2.2 cm (with defects from 0.6 cm until 4.4 cm) and the average of overlap was 3,7 cm. In all of them, the defect was closed with suture. One case had the mesh placed intraperitoneally, while in all other cases the meshes were placed pre-peritoneal. 19.2% of complications were detected, one classified as Clavien-Dindo (CD) III-b and the others classified as CD I and II. There were no recurrences in this group of patients, with an average follow-up of 5 months.

Conclusion
In our study, preformed meshes showed to be effective. Despite the high number of complications detected in this group of patients compared to the 4.4–6.7% described in the literature, this was not reflected in an increase in recurrence, and can be related with a small sample.
AUTOIMMUNE/AUTOINFLAMMATORY SYNDROME INDUCED BY ADJUVANTS (ASIA SYNDROME) AFTER POLYPROPYLENE MESH IMPLANTATION – PROTOCOL OF A PILOT STUDY FOR DIAGNOSTICS AND TREATMENT
Authors: Gielen M J C A M , van Rest K L C , Bouvy N D , van Koeveringe G A , Kowalik C R , Roovers J P W R , Roumen R M H , Slot M C , Willems H P J , Zwaans W A R 
Published: May 2024

Abstract

Purpose
An increasingly vocal movement of patients with systemic complaints, supposedly linked to polypropylene mesh implants, is leading to growing numbers of patient-preferred non-mesh surgical repairs for inguinal hernia. However, current literature does not support any association between polypropylene implants and Autoimmune Syndrome Induced by Adjuvants (ASIA). This prospective pilot aims to examine autoimmunity in patients in whom ASIA is suspected, based on previously described criteria. We aim to demonstrate the effectiveness of Mesh Allergy Testing and to investigate the natural evolvement of ASIA symptoms and the effect of mesh removal on ASIA-complaints.

Methods
This multi-center, prospective pilot study will include patients with symptoms of the ASIA syndrome following Shoenfeld’s Criteria. Physical examination, immunologic blood tests, and Mesh Allergy Tests will be performed and assessed by an experienced immunologist/allergologist. Questionnaires on improvement of symptoms, psychological susceptibility, and connective tissue disease will be collected at predefined time points. When patients’ wish for mesh removal is persistent, despite repeated elaborate discussion on the risks, mesh implants will be removed surgically. All meshes will be assessed histopathologically. Follow-up is 12 months.

Discussion
Current evidence on a causal relation between polypropylene mesh and ASIA syndrome is lacking, as is a treatment algorithm. Objective diagnostic tests are absent, expensive and/or aspecific. In this study, Mesh Allergy Testing will be evaluated as a first screening test specific for polypropylene implants. This study will be performed to further clarify knowledge gaps on diagnosis and prognosis on ASIA with polypropylene adjuvants.
TEXTBOOK OUTCOME IN W3 INCISIONAL HERNIA REPAIR. NATIONAL MULTICENTER STUDY
Authors: Gomis Martin A , Zaragoza Zaragoza C , Parra Chiclano J , Rubio García J J , Duque Alvarez N X , Ramia Ángel J M 
Published: May 2024

Abstract

Background
Textbook Outcome (TO) is a quality tool based on multiple postoperative endpoints that classifies a surgical intervention as successful. To the best of our knowledge, there has not been previously reported TO in W3 incisional hernias interventions. This study aims to determinate TO in W3 incisional hernia repair using data from a national multicenter database and analyze the variables associated to achieve TO.

Method
Retrospective observational study of W3 incisional hernia repair from a Spanish multicenter database between January 2012 and December 2022. TO was defined as: hospital stay &lt;8 days, no Clavien-Dindo complications &gt;IIIa and no mortality or readmission in the 30 postoperative days. A comparative analysis was performed between TO group versus non-TO group.

Results
Of the 2763 patients included, 2100 (76%) obtained TO. Significant variables associated to the achievement of TO in both univariable and multivariable analysis were lower age, transverse hernia size, colostomy, lower ASA classification, elective surgery, clean surgery, minimal invasive access and need for mesh. Variables associated with failure to achieve TO were intraoperative complications (such as visceral injuries), component separation technique and intraperitoneal position of the mesh. Higher ASA classification was the most significant variable associated with failure to achieve TO (OR 7.439 p &lt;0.001).

Conclusion
The TO rate in our study was 76%. The variables identified with the success to achieve TO in W3 incisional hernia repair need to be further investigated in other studies to validate these preliminary results.