bluuebunny/crossref_metadata_2025_split huggingface dataset:
A SPECIALIZED HERNIA SURGEON, BENEFITS FOR PATIENTS
Authors: Latham L , Casali A , Soldini G , Antonini I , Intelisano A , Musolino C , Callipari R , Scalambra S M 
Published: May 2024

Abstract

Introduction
Hernia surgery has become more and more complex over the last 30 years due to new surgical approaches, new techniques and innovation of the standardized techniques.
Therefore surgical teams need well trained surgeons dedicated to the abdominal wall hernias repairs. Nowadays it’s not acceptable to perform a hernia repair offering only one traditional technique.
Patients need to be evaluated by an open-minded surgeon that has more than one weapon in his cartridge.
Our team is a newborn team, we started our collaboration in this hospital only 9 months ago putting together different surgeons from different realities and with different know-hows.
Two of the new surgeons have wide experience in laparoscopic hernia treatments.
We started with a modern approach to the abdominal wall surgery either for ventral or inguinal hernias with the possibility to guarantee the patients traditional and laparoscopic approaches.

Materials and Methods
As concerns the inguinal hernia surgery, from the 15th of January till now we performed 100 inguinal hernia laparoscopic repairs, 55 for bilateral inguinal hernia and 45 for monolateral hernia, 64 TAPP technique, 2 with fixation of the mesh and 62 without fixation, and 36 TEP technique 9 with mesh fixation and 27 without fixation.
In the TAPP population in 2 cases a laparoscopic cholecistectomy has been performed before the hernia repair.

Results
The median operating time was 45 minutes for monolateral hernia with TEP technique vs. 49 minutes with TAPP, 53 minutes for bilateral hernia with TEP technique vs. 67 minutes with TAPP. The intra-operative complications were 1 mild bleeding, 1 lesion of the bladder treated with direct suture and positioning of the urinary catheter.
Post-operative complications were 1 seroma and 1 rectus hematoma treated laparoscopically.
No hernia recurrence and only 1 case of moderate postoperative pain was detected after 6 months of follow-up.

Discussion
In conclusion hernia surgeons are mandatory for a modern approach to the abdominal wall hernia surgery in order to guarantee a wide spectrum of techniques for each single patient and to achieve good results with low rate of hernia recurrence and good postoperative quality of life.
THE IMPORTANCE OF HORIZONTAL MESH OVERLAP IN OPEN RETROMUSCULAR MIDLINE INCISIONAL HERNIA REPAIR: NATIONWIDE ANALYSIS WITH LONG-TERM FOLLOW-UP
Authors: Marckmann M , Henriksen N A , Jensen K K 
Published: May 2024

Abstract

Aim
Recurrence after open incisional hernia repair remains an issue with long-term rates ranging from 11 to 29%. In open hernia repair it is preferred to place the mesh in the sublay position rather than underlay, however, it is unclear what the optimal mesh overlap is. We sought to determine the importance of this matter.

Material and Methods
This study was based on a nationwide hernia register allowing for a 100% follow-up from 2007 to 2022. Eligibility criteria were elective incisional hernia surgery, vertical incision, retromuscular mesh placement, and linea alba reconstruction. The 5-year cumulative incidence of reoperation for hernia recurrence was determined. Potential confounders were included in multivariate regression analyses.

Results
A total of 1539 patients were included. Mean (sd) age was 61.2 (12.4) years and 46.2% were females. The mean horizontal defect size was 8.4 (4.2) cm. Seventy-two (4.7%) patients underwent operative reintervention within 90 days postoperatively, and 112 (7.3%) developed recurrence during a median follow-up of 3.8 (IQR 1.8–6.1) years. Cox regression analysis showed that a mesh width of 10–15 cm significantly decreased the risk of recurrence development compared to both narrower and wider sizes (HR 0.38, CI 0.16–0.90, P = 0.029). Interestingly, in adjusted analysis the fascial defect width was not associated with risk of recurrence.

Conclusions
For patients undergoing elective open midline retromuscular incisional hernia repair, the size of mesh overlap is important as a golden mean reduces the risk of subsequent hernia recurrence and is more appropriate than both “too little” and “as much as possible”.
COMPLEX INCISIONAL HERNIA AND STOMA REVERSAL: SYNCHRONOUS OR TWO-STAGE APPROACH
Authors: Marques-Antunes J , Correia P , Osório C , Magalhães J , Guimarães M , Nora M , Pereira A 
Published: May 2024

Abstract

Background
Parastomal hernia (PH) is a common complication post stoma creation, often coexisting with incisional hernias. Stoma closure is the primary treatment for PH, with options including simultaneous repair (stoma closure and abdominal wall reconstruction – AWR) or a deferred two-stage approach. The optimal approach remains undetermined. The study aimed to assess outcomes following AWR and stoma closure in both simultaneous and deferred approaches, focusing on complications and hernia recurrence.

Method
Four cases were presented, with two undergoing one-stage treatment and the others with a deferred approach.

Results
In the one-stage approach, patients aged 58 and 78 with a history of Hartman's operation developed Type IV PH. Both received botulinum toxin type A (BTA), and one had progressive pneumoperitoneum. The deferred approach involved patients aged 45 and 46. One, with a colostomy post-traumatic severe pancreatitis, developed an incisional midline complex hernia. The other had an ileostomy post-intestinal occlusion for endometriosis. Both received BTA, and AWR was deferred due to intraoperative technical difficulties. Negative pressure therapy with mesh-mediated traction served as a bridging technique for one patient. Both were reoperated after 6 days, with one using intraoperative dynamic fascial traction. No short-term complications or recurrence were observed.

Conclusion
The decision to simultaneously treat the abdominal wall with stoma closure should consider the patient's functional capacity. Surgeons should prioritize patient selection, preoperative preparation, and maintain a low threshold to defer AWR, thereby avoiding complications associated with extensive operations.
SURGICAL TREATMENT OF COMPLEX ABDOMINAL WALL HERNIA IN OBESE PATIENTS
Authors: Marques-Antunes J , Correia P , Osorio C , Magalhães J , Guimarães M , Nora M , Pereira A 
Published: May 2024

Abstract

Background
Obesity is considered a factor contributing to the complexity of abdominal wall hernias due to an increased risk of surgical wound complications, intra-abdominal pressure and recurrence. The risks associated with obesity significantly escalate when the body mass index (BMI) is greater than 30 kg/m2. The optimal approach for managing these patients remains unclear. Our objective is to assess outcomes in the surgical treatment of complex abdominal wall hernias in obese patients.

Method
Retrospective analysis of 13 patients who underwent surgery for complex abdominal wall hernias after participating in a pre-operative program for both surgical and non-surgical weight loss. Patients with a BMI &gt;35 were included.

Results
The average initial BMI was 40 kg/m2 (39–47), and the preoperative BMI was 30 kg/m2 (21–36). Among the patients, six underwent bariatric surgery for the first time (four vertical gastrectomies, one Roux Y Gastric Bypass, and one SADI-S). For those included in the non-surgical weight loss protocol, all were supervised by a nutritionist and endocrinologist, and three of them underwent intragastric balloon placement. The complication rate was 23%, with two cases of wound dehiscence without infection and one case of hemorrhage requiring percutaneous embolization.

Conclusions
Primary surgical treatment of obesity is favored when indicated. Non-surgical weight loss program (including diet, medications, or intragastric balloon) with synchronous bariatric surgery should be reserved for patients unable to undergo primary surgery or those requiring rapid correction of abdominal wall defects. The pre-operative preparation process is gradual, and currently, numerous individuals are in the preparatory phase.
ENHANCED-VIEW TOTALLY EXTRAPERITONEAL RIVES STOPPA (eTEP-RS) TECHNIQUE VERSUS LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA) FOR VENTRAL HERNIA REPAIR: A COMPARATIVE ANALYSIS
Authors: Marrero Marrero P , Fernández Hernández L , Mon Martín F , González de Vera O , Lorenzo Rocha N , Delgado Plasencia L J 
Published: May 2024

Abstract

Background
The purpose of this study is to compare the postoperative outcomes of the enhanced-view totally extraperitoneal Rives Stoppa (eTEP-RS) technique to the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) for primary (PVH) and incisional (IVH) ventral hernia repair, in terms of the quality of life (QoL), postoperative complications and hernia recurrence rate at the six month follow-up.

Method
A comparative retrospective review of a prospectively maintained database of all patients undergoing eTEP-RS and LIRA from December 2022 to June 2023. Data retrieved included demographics, clinical and operative variables. Computed tomography scan was performed before and 6 months after surgery. QoL was assessed using the EuraHS-QoL scale prior to-and following eTEP-RS and LIRA. Pain was evaluated using the visual analogue scale.

Results
Ten and seventeen consecutive patients underwent eTEP-RS and LIRA, respectively. No significant differences were found in baseline characteristics between the two groups. PVH was the most common pathology (n = 19; 70,3%). Pre-operative and post-operative EuraHS-QoL questionnaire scores were available for the 100% of the patients and showed at the six postoperative month no significant differences in either pain (0.70 eTEP-RS vs. 1.41 LIRA; p = 0.556) or restrictions (0.50 eTEP-RS vs. 1.35 LIRA; p = 0.477) or cosmetics appearance (1.60 vs. 2.82; p = 0.588). Postoperatively, six (60%, Clavien-Dindo I) and five early complications (29,4%, Clavien-Dindo I) occurred in the eTEP-RS and in the LIRA group, respectively (p = 0.278). No hernia recurrence was found.

Conclusion
No significant differences were found between eTEP-RS and LIRA at the six month follow-up. So far, this is the first published study where QoL is evaluated and compared in patients undergoing these two techniques.
INCISIONAL HERNIA SURGERY: WHEN YOU NEED BACKUP
Authors: Melo Pinto D , Costa Farias L , Quintela Silva C , Saraiva P , Correia J 
Published: May 2024

Abstract

Background
Synchronous surgery to cure complex abdominal wall hernia and stoma reversal is associated with more morbidity, especially in cases in which a posterior component separation technique is performed.

Method
We present a case of a 64 years old man with BMI 27.8 kg/m2 with history of perfurated acuted diverticulitis with a previous Hartmann procedure.

Results
He presents with an incisional hernia M2M5W3 VHWG 3 with a median width of 15 cm. We performed a multi-step preparation for this surgery with botulinic toxin application four weeks before surgery. Intraoperatie we performed a stomal reversion surgery (terminoterminal anastomosis) and correction by Rives-Stoppa-Wantz technique with myofascial flap of rectus muscle. We used a myofascial traction system, which was tightened every 2 minutes. With this system we were able to reduce the defect from 15 to 3 cm and close the abdominal wall without the need for posterior component separation technique. Patient was discharged by the 5th day.

Conclusion
Myofascial relaxation and traction appears to contribute to a tension-free closure of the abdominal wall leading to slower morbidity rates.
CORRELATION BETWEEN CARBONELL’S RATIO AND EXPERT OPINION IN COMPLEX ABDOMINAL WALL HERNIAS
Authors: Mesquita Guimarães C , Melo Pinto D , Saraiva P , Correia J 
Published: May 2024

Abstract

Background
Complex abdominal wall hernias are still challenging. These patients require an extensive preoperative preparation, and, sometimes, the use of adjuvant techniques. Although some ratios (like Carbonell) are objectively estimate the surgical technique and the need of adjuvants preoperatively, Surgeon’s judgement is crucial for decision-making.

Method
This study aimed to evaluate a group of patients submitted to complex abdominal wall hernias correction after botulinum toxin administration (BTA) between 2012–2022, in order to evaluate a correlation between the choice of surgeon and Carbonell ratio.

Results
During this period, 38 patients were submitted to surgery (after BTA). BTA decision was used based on domain loss, wall rigidity and the size of the defect. Retrospectively, we applied the Carbonell ratio, and divided them in 3 groups. The first group (ratio &lt;1) was composed by 23 patients, 19 did a bilateral component separation (BCS), 3 did a Rives-Stoppa with unilateral component separation (RS+UCS) and 1 patient did a Rives-Stoppa (RS). The second group (ratio 1–2), was composed by 13 patients, 6 did a BCS, 2 did a RS + UCS and 5 patients did a RS. The third group (ratio &gt;2) had only 2 patients, 1 did BCS and the other RS. The recurrence rate was evaluated at two years both by clinical examination and image. We observed recurrence in 3 patients, 2 of them after BCS.

Conclusion
Based on this analysis, we can affirm that the use of objective measures might help the surgeons decide the best surgical approach and patient selection for adjuvant techniques.
OUTCOMES OF THE ABDOMINAL WALL RECONSTRUCTION IN A DISTRICT GENERAL HOSPITAL
Authors: Mohamedahmed A Y , Ramasamy S , Agrawal D , Muras Z , Marzook H 
Published: May 2024

Abstract

Background
The aim of this study was to explore the outcomes of abdominal wall reconstruction surgery by assessing postoperative complications and recurrence.

Methods
This is a retrospective case series. All patients who underwent abdominal wall reconstruction between 2018 and 2023 were included and followed up for complications and recurrence till January 2024. Patient demographics, operative parameters and postoperative complications were extracted in an Excel sheet, and data analysis was performed with SPSS 27 software.

Results
Forty-two patients were included in this study with a median age of 61.5 (34–83) and 1.2: 1 female: male gender distribution. Moreover, 41% of the included patients had a BMI &gt;35, and 47.6% were smokers. The type of hernia was incisional in 50% and recurrent hernia in 31%, and the defect size was &gt;10 centimetres in 48% of the included cohort. The type of operation was as follows: Rives-Stoppa (50%), TAR (24%), and combined procedure (26%). additionally, only 18% had their operation laparoscopically, and the position of mesh was retro-rectus in 88% of the cases. Post-operative complications were SSI (11.9%), seroma (28.6%), haematoma (7.1%), re-operation (9.5%), entero-cutaneous fistula (2.4%), and Hernia recurrence (4.7%) at a median follow-up of 42.5 months. Length of hospital stay was &lt;5 days in 48% of patients.

Conclusion
The Component separation technique is an excellent approach to repairing complex incisional hernia with excellent results (&lt;5% recurrence rate). Abdominal reconstruction is feasible in district general hospital settings.
EVALUATION OF QUALITY OF LIFE AND RECURRENCE RATE AFTER LAPAROSCOPIC VENTRAL HERNIA REPAIR: A COMPARATIVE STUDY OF IPOM VS IPOM PLUS
Authors: Pepe F , Giaccone M , Gambali E , Rosati S , Sandrucci S 
Published: May 2024

Abstract

Background
Intraperitoneal Onlay Mesh (IPOM) and IPOM plus are well-established techniques for the repair ventral hernias. IPOM plus could reduce recurrence but evidence regarding the post-operative Quality of Life (QoL) is still missing. This retrospective observational study aims to evaluate the difference in terms of recurrence rate, complication rate and postoperative QoL outcomes in patients who underwent IPOM or IPOM plus repair.

Materials and Methods
110 patients who underwent laparoscopic ventral hernia repair from 2011 to 2023 have been included in this analysis. All procedures were conducted following the standard IPOM procedure using polypropylene composite meshes (1) fixated with resorbable takers. In cases where IPOM Plus was performed, the defect was closed using transparietal sutures. Baseline characteristics and data for all patients were gathered from hospital medical records. QoL was evaluated using the EuraHS-QoL questionnaire. The primary endpoints of the study were the recurrence rate and the post-operative QoL in two subgroups: IPOM (na = 37) and IPOM Plus (nb = 80)

Results
The two groups didn’t show significant differences in baseline and hernia characteristics. With a comparable follow-up time, recurrence was significantly higher in the IPOM group (na = 10,8% vs. nb = 0% p &lt;0.001) without any difference regarding the complications rate. Both techniques show comparable improvements in the post-operative QoL.

Conclusion
Our clinical experience showed that both IPOM or IPOM plus techniques utilizing polypropylene composite meshes are safe and effective approaches for the treatment of primary and incisional hernias. We recommend prioritizing IPOM Plus over IPOM alone due to the lower recurrence rate and comparable QoL outcomes.
(ClearMesh-Composite, Dipromed srl)
IS THERE A PLACE FOR INTRAPERITONEAL ONLAY MESH(IPOM) FOR INGUINAL HERNIA? A SINGLE-CENTRE EXPERIENCE
Authors: Pepe F , Gambali E , Giaccone M 
Published: May 2024

Abstract

Background
IPOM is a well-established technique for the laparoscopic treatment of ventral hernias, for which it can also be considered the treatment of choice in selected patients. Its usage for the laparoscopic treatment of inguinal hernia has already been described. The main concern about this technique is the high risk of neurovascular damage since mesh fixation has always been achieved with resorbable tackers. Recently, some new glue-based fixation devices have been introduced that could almost nullify this risk. This study aims to evaluate the feasibility of IPOM techniques for inguinal hernia treatment using only glue-based fixation devices.

Materials and Methods
Sixteen patients (13 with bilateral inguinal hernias) who underwent IPOM inguinal hernia repair from 2021 to 2023 were included. All patient data were collected from the hospital's medical records. Follow-up appointments were scheduled for clinical visits every 3 months during the first year, and every 6 months thereafter to evaluate long-term outcomes.

Results
The mean follow-up time was 13.2 ± 6.8 months. The mean operative time was 22.5 ± 6.8 minutes and all the patients were discharged a one-night stay. Only one case of unilateral recurrence was reported. Complications occurred in 2 patients (Grade I according to the Clavien-Dindo scale). No cases of intraoperative bleeding or chronic pain were reported.

Conclusion
Our experience shows that the IPOM technique with glue-based fixation devices is a safe, feasible and easy-to-master method for the treatment of inguinal hernias. Due to its main characteristic such as the short execution time, it could be considered as an option for selected patients, particularly in cases of synchronous interventions. Further trials are needed to evaluate the clinical outcomes.
RECURRENCE RATE AND QUALITY OF LIFE IN OPEN INGUINAL HERNIA REPAIR: A COMPARATIVE STUDY OF LICHTENSTEIN VS TRABUCCO REPAIR
Authors: Pepe F , Giaccone M , Gambali E , Palazzo V , Rosati S , Sandrucci S 
Published: May 2024

Abstract

Background
The aim of this retrospective observational study with prospective follow-up is to evaluate the clinical outcomes and patients' Quality of Life (QoL) after either a Lichtenstein or a Trabucco inguinal hernia repair.

Materials and Methods
532 patients who underwent inguinal hernia repair from 2016 to 2022 were included in this analysis. All the patients' baseline characteristics and data were collected from the hospital medical records. A phone interview was conducted to investigate long-term outcomes and patients’ QoL (EuraHS-QoL questionnaire) was performed between December 2022 and January 2024. The primary endpoint was the evaluation of patients’ recurrence rate and QoL in two technique groups: Lichtenstein (nA = 391) or Trabucco (nB = 141).

Results
The two groups didn’t show significant differences in main baseline characteristics. With a comparable median follow-up, no differences in complication rate (nA = 10.2% vs. nb= 11.3% p = 0.78) and recurrence rate (nA = 7.9% vs. nb = 4.96% p = 0.08)were detected among the two groups. Patients’ QoL improvement compared to the baseline was statistically significant in both groups. On the other hand, the weight of the mesh appears to have no impact on clinical outcomes (such as recurrence and complications), but it could worsen QoL when a heavier mesh is employed.

Conclusion
This analysis did not reveal any significant differences in outcomes between the two primary inguinal hernia repair techniques. Based on our experience, the choice of surgical techniques could be made depending on the preferences of the surgeons. It is crucial to select the weight of the mesh carefully.
THE INCIDENCE OF ADDITIONAL HERNIA DEFECTS IN A DIASTATIC LINEA ALBA, NOT REPORTED ON PRE-OPERATIVE CT IMAGING
Authors: Sharma A , Simpson G 
Published: May 2024

Abstract

Aim
Patients with ventral primary or incisional hernias with significant recti diastasis are frequently refered to abdominal wall reconstruction (AWR) services. We audited the rate of incidental intra-operative ventral defects related to diastatic linea alba.

Method
A retrospective analysis of a prospectively maintained database was carried out from March 2023 to January 2024. All patients who underwent AWR using a minimally invasive approach (MIS) were included. Data on the following variables were collected: sex, age (years), BMI (kg/m2), length of hospital stay (LOS, days), operative time (hours), and ventral defects.

Results
27 patients underwent MIS AWR (22 robotic; 8 laparoscopic). Male to female ratio was 16:11. Median age was 58 years (IQR 48–66) and BMI 36 kg/m2 (IQR 32–37). All patients underwent eTEP retro-rectus Rives-Stoppa + diastasis plication using macroporous polypropylene non-absorbable synthetic mesh. Median operating time was 3.3 hours (IQR 3.1–3.5) and LOS was 2 days (IQR 1–2). 1 (3%) patient had laparoscopic converted to open procedure due to bowel involvement.
13 (48%) of patients had extra defects associated with diastatic linea alba which were not visualized in pre-operative cross-sectional imagining.

Conclusion
When compared to a local repair, the MIS AWR approach in patients with ventral hernias and significant diastasis is justified when considering the high likelihood of synchronous linea alba defects and therefore a risk for future recurrence. These extra defects are rarely detected on pre-operative cross-sectional images. In addition, the plication of diastasis during AWR allows surgeons to recreate a more functional linea alba.