bluuebunny/crossref_metadata_2025_split huggingface dataset:
CONTRALATERAL (eTEP) INGUINAL HERNIA REPAIR IN A PREVIOUS LEFT eTEP INGUINAL HERNIA SURGERY: TECHNIQUE & MITIGATION STRATEGY
Authors: Gandhi J , Chaudhari S 
Published: May 2024

Abstract

Background
Endoscopic Totally Extraperitoneal (eTEP) inguinal hernia repair has gained popularity as a minimally invasive technique with favorable outcomes. However, encountering a contralateral hernia in a patient with a history of eTEP inguinal hernia repair presents a unique surgical challenge.

Objective
This case report aims to describe the successful management of a contralateral inguinal hernia in a patient with a previous left-sided eTEP inguinal hernia repair, highlighting the technical nuances and outcomes of the contralateral eTEP approach.

Methods
An elderly gentleman presented with a symptomatic right inguinal hernia 1.5 years after having undergone a left eTEP inguinal hernia repair. After a comprehensive preoperative evaluation, including imaging studies, the decision was made to perform a contralateral eTEP inguinal hernia repair.

Results
The contralateral (Right) eTEP inguinal hernia repair was successfully performed from the left side approach technique. The surgical technique involved meticulous dissection, identification of anatomical landmarks, and placement of an anatomical mesh. Intraoperative and postoperative complications were carefully monitored. The patient experienced a smooth recovery and was discharged on postoperative day 1.

Conclusion
Contralateral inguinal hernia repair following a previous eTEP procedure can be safely and effectively performed using the eTEP approach. This case underscores the adaptability and versatility of the eTEP technique in addressing recurrent or contralateral hernias. Further studies and larger case series are warranted to validate the generalizability of this approach and assess long-term outcomes.
ROBOTIC RETROMUSCULAR ABDOMINAL WALL REPAIR USING AN INVERTED TEP (iTEP) APPROACH: RESULTS OF THE FIRST 100 PATIENTS
Authors: Geers J , Abasbassi M , Venken R , Olivier F 
Published: May 2024

Abstract

Background
In 2022, our technique of robotic retromuscular abdominal wall repair (RAWR) for ventral hernias, using an inverted totally extraperitoneal repair (iTEP)-approach, was first described. Up until this day, this technique is used in the robotic treatment of all ventral hernias with rectus diastasis. The aim of the study is to analyse surgical outcomes and to report the results of the first 100 patients.

Method
A retrospective analysis of a prospectively maintained database was performed, including all consecutive patients who underwent a robotic RAWR using the iTEP-approach. Patients’ characteristics, intra- and postoperative parameters were studied. Follow-up time was calculated from the date of surgery up until study closure in January 2024.

Results
Between December 2019 and January 2024, 100 patients (female/male 39/61, median age 62 years, range 20–90) were treated using the iTEP-approach. In 58 patients (58%), the indication was an incisional hernia. Median operating time was 135 minutes (range 65–300). The median length of stay was 1 day (range 1–4). No intraoperative complications were observed. One patient (1%) required reoperation for a small bowel internal herniation due to a rupture of the posterior rectus sheath. In two patients (2%), conversion to a laparotomy was necessary due to extensive adhesions. There were no recurrences or mortality with a median follow-up of 14 months (range 0–49).

Conclusion
For defects in the upper abdominal region, a robotic RAWR with an iTEP-approach appears to be safe and feasible. Long-term follow-up is still needed to evaluate late recurrence rate.
LAPAROSCOPIC TRANSABDOMINAL LUMBAR HERNIOPLASTY: MAIN TECHNICAL STEPS AND MESH FIXATION WITH CYANOACRYLATE
Authors: Hoyuela C , Rovira M , Caballero D , Navarro J , Pierres M , Cubel M , Astete S , Muñoz C 
Published: May 2024

Abstract

Background
Mesh atraumatic fixation for hernia repair avoids tissue damage, reducing the risk of bleeding and acute postoperative pain. The objective of this video is to describe the main steps of the laparoscopic transabdominal repair of a primary lumbar hernia, focusing on the mesh fixation with cyanoacrylate.

Method
A 66-year-old woman (BMI 34 kg/m2) presenting with a 7 cm. lipomatous right lumbar tumor, which causes mild discomfort and occasionally changes in size with movement. CT and MRI confirmed upper lumbar hernia of 7 × 6 cm (Grynfelt hernia).

Surgical technique
Patient in supine decubitus with marked left lateralization. The procedure was performed using three trocars. The parietal peritoneum is opened, identifying a 3 cm. hernia defect containing perirenal fat. After widening the space, a 15 × 10 cm. PVDF mesh (Endolap 3D® Dynamesh), is placed in an extraperitoneal fashion and fixed with a double crown of cyanoacrylate drops (Glubran®). Once the proper hemostasis was verified, reperitonization was completed and the 12 mm trocar was sutured to minimize the risk for herniation. Any drain was used.

Results
Operating time: 70 minutes (performed on an outpatient basis) Postoperative period was uneventful. Maximum postoperative pain VAS: 2/10. The patient remains asymptomatic, with no bulging or recurrence on CT scan after 12-months follow-up. The patient satisfaction was high (score: 10/10).

Conclusion
Lumbar hernia can be treated successfully and efficiently by minimally invasive approach. Mesh fixation with cyanoacrylate is safe and reduces the risk of hemorrhage and acute postoperative pain, facilitating outpatient procedures.
PERINEAL HERNIA: A PERINEAL GENU PECTORAL APPROACH WITH FLAP AND NON-ABSORBABLE MESH REPAIR TECHNIQUE
Authors: Khalil H , Berthelot J , Codjia T 
Published: May 2024

Abstract

Background
A perineal hernia is a protrusion of an organ or an intra-peritoneal tissue through a defect of the pelvic floor, which occurs after extended perineal surgeries. The incidence of perineal hernia is poorly documented. To date, there is no gold-standard technique. Numerous surgical approaches are described: abdominal (laparotomy or laparoscopy), perineal and combined approach, using flap, mesh or both for perineal hernia repair. We hereby describe a perineal approach with flap and non-absorbable mesh repair technique.

Method
The patient is lying in genu pectoral position. A gluteal Y-like incision is performed with subcutaneous dissection of the hernia sac with anterior bladder dissection and dorsal dissection to the coccyx, which allows a reduction of the hernia contents. Then a dissection of subcutaneous flaps from the gluteus maximus muscle (GMM) is performed. Peritoneal closure is performed with exclusion of the perineal cavity. Detachment of the lower third of the GMM from the sacrum and release of the pedicled gluteus flap is made. The mesh covering the perineal defect extensively is fixed with a 2 cm overlap to the pubis, then to the coccyx, and laterally the mesh on the sacral-tuberosity ligament, the ischium, the coccygeal muscle and the ischio-pub branch. Gluteal flaps are fixed to the coccyx and pubis for mesh adequate coverage. A preventive negative pressure wound therapy is placed over the skin closure. The patient shows no evidence of recurrence after 2 years follow-up.
ROBOTIC TOTAL EXTRAPERITONEAL (rTEP) INGUINAL HERNIA REPAIR: A PRAGMATIC APPROACH
Authors: Kumbhar U 
Published: May 2024

Abstract

Background
There has been an evolution in inguinal hernia surgery from open, laparoscopic to the current robotic approach. A recently published meta-analysis supports robotic surgery as a safe, effective, and viable alternative for Inguinal hernia repair. Like laparoscopic hernia repair, robotic surgery has trans-abdominal preperitoneal (rTAPP) and total extraperitoneal (rTEP) approaches. However, most of the studies are confined to the rTAPP approach, and there is minimal published data on the rTEP approach.

Rationale
A total extraperitoneal approach has various advantages, like non-violation of the peritoneal cavity, less chances of paralytic ileus, and lower seroma formation and infection. However, multiple difficulties exist in performing rTEP inguinal hernia repair, creating the preperitoneal space, ergonomics, and the site of robotic port placement. Thus, most robotic surgeons perform rTAPP inguinal hernia repair.

Novelty
An extensive literature search found no resources for the rTEP surgical technique. Hence, we developed a method of rTEP inguinal hernia repair based on the experience of the laparoscopic TEP repair collaborated with the robotic surgery principles.
Here, I present a video demonstrating the steps of rTEP inguinal hernia repair in a 47-year-old female patient with a left-sided direct inguinal hernia.
MINIMALLY INVASIVE APPROACH TO STRANGULATED VENTRAL HERNIA AND USE OF ICG FLUORESCENCE ANGIOGRAPHY IN EMERGENCY SURGERY
Authors: Licardie E , Moreno-Suero F , Navarro-Morales L , Bellido-Luque J , Morales-Conde S 
Published: May 2024

Abstract

Aims
One of the main mid- and long-term complications after abdominal surgery is the occurrence of an eventration. The minimally invasive approach (MIS) to midline hernias currently one of the least used techniques in the emergency department. One of the great advantages of the laparoscopic approach to a strangulated ventral hernia (VH) is to be able to adequately assess the viability of the intestinal loops. The use of ICG can help to objectively assess adequate intestinal blood supply.

Methods
A 72-year-old woman with previous umbilical hernia operation, BMI: 44. Came to the ER with abdominal pain related to umbilical prolapse. CT-showed a diastasis of the rectum and a VH of approximately 4 cm containing a distal ileum loop with signs of distress in the hernial sac and the loops with liquid at that level.

Results
We observe a VH with dilated bowel loops and distressing fluid inside which is reduced with atraumatic maneuvers and graspers. A midline V-H is identified with a 4 × 5 cm defect (M3W1). Direct closure of the defect was performed with a non-absorbable barbed suture. Adhesiolysis and then a PVDF mesh is placed and fixed with absorbable tacker and cyanoacrylate glue. Affected intestinal loop is identified and fluorescence angiography with ICG is performed to confirm the adequate viability of the intestinal loops.

Conclusions
We believe that MIS to abdominal wall complications in the emergency setting is feasible and provides the advantages of laparoscopy in addition to being able to explore the abdominal cavity with support of ICG.
ROBOTIC TAPP FOR VENTRAL HERNIA REPAIR
Authors: Lodha M , Sharma N , Karthik N , Abhijeet  
Published: May 2024

Abstract

Background
TAPP repair of ventral hernia is increasingly being practised because of the natural barrier provided by the peritonium, which prevents adhesion formation between bowel and mesh.

Method
We present a video of a robotic TAPP ventral hernia repair. After painting and drapping the part, pneumoperitoneum was created by the help of the varress needle at site of the palmer’s point, then robotic scope was introduced, diagnostic laparoscopy was done, omentum reduced from hernial site, with the help of the other two port, scissor dissection of the peritoneal flap was made all around approximately 7–10 centimeter so as to acomodate a 15 × 15 cm. size prolene mesh, on raising peritoneal flap we identified they were multiple defect, defects were closed and a prolene mesh was fixed with help of suture under the posterior rectus sheeth, later flap was sutured with the help of the suture. Port were closed.

Result
Postoperative patient did well and went home after first postoperative day.

Conclusion
Robotic TAPP is a very good technique for new learner who are not very good with suturing, robot give advantage for suturing and raising the flap for TAPP procedure.
MANAGEMENT OF A CENTRAL RECURRENCE AFTER A POSTERIOR COMPONENT SEPARATION REPAIR IN A GIANT SUBCOSTAL HERNIA
Authors: Lopez-Monclus J , García de León L R , Munoz-Rodriguez J M , Grillo Marin C , Rodriguez Fernandez M , Gil Cidoncha L , Martin Rodrigo P , Blazquez Hernando L A , Valle de Lersundi A R , Medina Pedrique M , Garcia-Urena M A 
Published: May 2024

Abstract

Aim
Central recurrences after posterior component separation due to mesh failure are exceptional. We present our approach to solve this complex situation.

Material and Methods
59 years old male patient with previous diabetes type II and arterial hypertension. He underwent an open cholecystectomy due to a septic shock secondary to a perforated acute cholecystitis. Wound infection in the po period. After one year follow-up he developed a giant subcostal hernia with a 15 × 20 cm defect. We repaired this incisional hernia with a Madrid posterior component separation with a double mesh technique. After 18 months follow up the patient developed a central recurrence, so a new surgery was proposed. A new preperitoneal retromuscular dissection was performed, creating a new preperitoneal pouch to locate a new absorbable + permanent 25 × 30 meshes. The disrupted previous mesh was partially removed and closed above the new meshes.

Results
No immediate postoperative complications. Discharged in the third postoperative day without any complications. No recurrence after 18-month follow-up.

Conclusion
Central recurrences following the failure of a Madrid posterior component separation repairs can be managed with the re-dissection of the preperitoneal retromuscular space.
SUPRAPUBIC HERNIA AFTER PELVIC TRAUMA – TAPP AS DAY SURGERY
Authors: Martins F , Pinto C , Magalhães C 
Published: May 2024

Abstract
The authors present a video of a surgical treatment, of a Suprapubic Hernia, after a Pelvic Trauma.
It was a male patient, 52 years, ASA II, that 10 years ago had a Pelvic Trauma, with fracture of the Pelvis.
He was evaluated because of left groin pain and non-reductible suprapubic swelling.
The patient was submitted to a TAPP approach and discharged the same day, with no complications.
LAPAROSCOPIC REPAIR OF MORGAGNI HERNIA
Authors: Morejón Ruiz S , De Luca M , Avilés Oliveros A , Medina Pedrique M , Casanova A , Cruz A , García-Ureña M A 
Published: May 2024

Abstract

Aim
Morgagni hernia, a congenital defect of the diaphragm typically found retrosternally on the right side, though occasionally bilateral, is rare in adulthood and old age, often presenting with subtle abdominal symptoms. Advancements in laparoscopic techniques have facilitated minimally invasive repairs, reducing morbidity and expediting recovery.

Materials and Methods
We describe a 69-year-old patient without significant medical history, diagnosed incidentally with Morgagni hernia during evaluation for recurrent retrosternal pain. Abdominal computed tomography confirmed the diagnosis, leading to laparoscopic repair with synthetic material reinforcement.

Results
The patient underwent laparoscopic surgery without intraoperative complications and experienced uneventful postoperative recovery, resulting in discharge within days. Follow-up revealed no hernia recurrence or significant complications.

Conclusions
In elderly patients with Morgagni hernia and subtle thoracic or abdominal symptoms, laparoscopic repair provides a safe and effective treatment option. Our case underscores the successful application of minimally invasive techniques, emphasizing the importance of patient selection and expertise in advanced laparoscopy for favorable outcomes and swift recovery.
EXPLORING THE DOWN TO UP RIVES eTEP TECHNIQUE: MANAGING RECURRENT MIDLINE INCISIONAL HERNIA WITH PRIOR PREPERITONEAL MESH PLACEMENT
Authors: Munoz-Rodriguez J M , Lopez-Monclus J , Román García de León L , Blazquez Hernando L A , Robin Valle de Lersundi A , Medina Pedrique M , Gil Cidoncha L , Martin Rodrigo P , Rodriguez Fernandez M , Garcia-Urena M A 
Published: May 2024

Abstract

Background
To demonstrate the efficacy of the "down to up" Rives eTEP technique in the surgical management of recurrent midline incisional hernias with a history of prior preperitoneal mesh placement.

Methods
A 76-year-old woman with a midline incisional hernia, previously repaired using preperitoneal mesh three years ago, presented with a recurrent hernia, classified as M2-3 W2 by the European Hernia Society and confirmed by computed tomography. An endoscopic abdominal wall repair with defect closure was performed.
Beginning with the insertion of the Hasson trocar into the right retrorectal space, the procedure involved meticulous dissection of the suprapubic preperitoneal space and sequential placement of three suprapubic trocars. Comprehensive dissection encompassed both retrorectal spaces and the midline preperitoneal space, including sectioning of the medial edge of the posterior rectus sheath, facilitating unification of all dissected spaces. The pre-existing mesh remained integrated into the posterior sheath. Post-dissection, the posterior and the anterior sheath were closed with a barbed suture. Finally, a 30 × 15 cm polypropylene mesh was positioned in the preperitoneal space without fixation.

Results
The patient experienced an uneventful postoperative recovery, leading to discharge without complications on the first postoperative day. An 18-month follow-up revealed no hernia recurrence.

Conclusions
This intervention successfully demonstrates the application of the "down to up" Rives eTEP technique for recurrent midline incisional hernias with prior preperitoneal mesh placement. As an alternative to open surgery, this approach offers advantages, including low infection rates, reduced postoperative pain, and shorter hospital stays.
RIVES eTEP PROCEDURE FOLLOWING LAPAROSCOPIC REDUCTION FOR CHRONIC INCARCERATED INCISIONAL HERNIA MANAGEMENT
Authors: Munoz-Rodriguez J M , Jiménez Cubedo E , Román García de León L , Lucena de la Poza J L , Gil Cidoncha L , Fernández Rodríguez M , Robin Valle de Lersundi A , Medina Pedrique M , Garcia-Urena M A , Blazquez Hernando L A , Lopez-Monclus J 
Published: May 2024

Abstract

Background
We aim to showcase the effectiveness of the Rives eTEP technique in surgically managing chronically incarcerated midline incisional hernias following laparoscopic reduction of herniated contents.

Methods
A 69-year-old woman, with predisposing factors for surgical wound infection and hernia recurrence (obesity, smoking, diabetes mellitus), presented with a midline incisional hernia, previously managed conservatively with manual reduction during multiple emergency room visits. Preoperative optimization was conducted for a hernia classified as M2-3 W2 by the European Hernia Society. On the scheduled surgery day, the patient presented with a hernia incarcerated for several days. Exploratory laparoscopy was performed to reduce hernia contents (omentum), followed by trocar reorientation to access the retromuscular plane for endoscopic abdominal wall repair with defect closure. After laparoscopic intraperitoneal reduction, trocar insertion in retrorectal space cause a tear in the posterior rectus sheath and create a pneumoperitoneum. This prompted a shift in dissection initiation to the right retrorectal space, achieving extensive dissection before performing the crossover to the left side to counteract pneumoperitoneum effects. Closure of both posterior and anterior layer was accomplished using barbed sutures, followed by placement of a 30 × 18 cm polypropylene mesh in the retromuscular space without fixation.

Results
The patient experienced an uncomplicated postoperative recovery, with discharge on the second postoperative day. A 12-month follow-up revealed no hernia recurrence.

Conclusions
Exploratory laparoscopy for hernia reduction enables avoidance of inadvertent intestinal injuries and allows for adaptation to the retromuscular plane via eTEP. Extensive retrorectal space dissection is advisable to prevent undesired pneumoperitoneum consequences.
CONTINUOUS FASCIAL TRACTION SYSTEM*: PREVENTING FASCIA RETRACTION OF AN OPEN ABDOMEN
Authors: Peck C , Sánchez D , Gajda J , Martínez Alegre J , Vaquero M A , Ferrero E , García-Sancho L , Rodríguez C , O’Reilly M , Mellado I , Núñez S , Picardo A 
Published: May 2024

Abstract
We report a 45-year-old male patient on whom a laparoscopic gastric bypass was performed without intraoperative complications. On day one post-surgery (PS), the patient showed mild abdominal distension and poor pain control. On day two of PS, the patient presented with acute abdominal distension requiring an urgent surgical revision. The findings of this surgery were small bowel ischemia with neither leakage from anastomosis, nor visible perforations. The patient was transported for a CT scan with an open abdomen showing permeable vessels. The intervention the following day found areas with poor blood flow; a 2 mm leakage on the gastro-jejunal anastomosis was repaired with 3 simple stitches. Because an abdomen primary closure approach wasn’t possible, a continuous fascial traction system* was used. Twelve traction points were placed on the anterior rectus sheath. The traction system allowed for the maintenance of an open abdomen for subsequent revision surgeries without reopening the abdomen wall and also for the prevention of fascial retraction. For control of the open abdomen, the patient was admitted to ICU, and up to four additional revision surgeries were performed resulting in increased blood flow of the small bowel. On day fourteenth PS, the abdomen was successfully primarily closed without the need for component separation techniques. After a 64-day hospital stay, the patient was discharged. At year one follow up, the patient had fully recovered with a 50 kg weight loss and a completely competent abdominal.
*Fasciotens abdomen®
SOMETIMES LESS IS GOOD TOO – LAPAROSCOPIC 2 PORT TOTALLY EXTRA-PERITONEAL (TEP) PROCEDURE FOR GROIN HERNIA REPAIR
Authors: Radhakrishnan S , Baste N 
Published: May 2024

Abstract

(Laparoscopic 2 port TEP procedure for Groin Hernia.)
58 yrs old, male presented with swelling in the left inguinal region since 2 yrs.
No medical comorbidities.
On Clinical Examination – Completely reducible Left Direct Inguinal Hernia.
Ultrasonography Abdomen & Pelvis - S/O 1.2 cm defect in the left inguinal region.
Preoperative labs – Within Normal limits.
Plan – 2 port TEP hernia repair.

Procedure
Supine position under General Anesthesia.

Ports
Left sided Pre – Peritoneal space created.
Dissection done in space of Retzius.
Space of Bogros dissected.
Spermatic cord dissection done. Sac separated and parietalisation of cord structures done.
Sac reduced.
15 × 12 cm Polypropylene mesh inserted and placed to cover the myopectineal orifice of fruchaud.
Hemostasis confirmed.
Pneumo preperitoneum deflated.
Port sites closed and strapping done.
Minimal Blood loss.
No Suction used during procedure.
Post Operative period uneventful. No analgesics used post op.
Discharged on day 2 post op.