bluuebunny/crossref_metadata_2025_split huggingface dataset:
RETRORECTAL ABSCESS AFTER ABDOMINAL BLUNT TRAUMA
Authors: Martínez-López M , Verdaguer-Tremolosa M , Rodrígues-Gonçalves V , Martínez-López P , López-Cano M 
Published: May 2024

Abstract

Aim
To discuss an extended retrorectal abscess secondary to blunt abdominal trauma as a cause of abdominal wall (AW) infection and impairment.

Methods
We describe a case of blunt abdominal trauma with late diagnosis of jejunal perforation with an abscess that extensively dissected the retrorectus space.

Results
A 65 years-old female patient suffered multiple trauma after traffic collision. Ten days after admission, she presented fever and right abdominal swelling and induration. CT scan showed pneumoperitoneum and an extensive collection affecting the right retrorectal space until the ribs with preperitoneum.
Urgent laparotomy was performed and found a jejunal perforation with fecal peritonitis and extraperitoneal extension with dissection of the whole right retromuscular space.
Intestinal resection with anastomosis was performed. Exhaustive lavage of the cavity and retromuscular space with debridement of the necrotic posterior rectal lamina was required and a retrorectal drainage was placed. Primary closure of the aponeurosis was achieved with small bites technique and absorbable monofilament. Due to the weakness of the abdominal wall, an absorbable biosynthetic mesh impregnated with gentamicine was placed onlay. Negative pressure therapy was applied on the wound. Patient received antibiotics and CTs showed favourable evolution. No infectious complications or incisional hernia have been reported after more than 10 months of follow-up.

Conclusion
Literature does not report cases of blunt trauma causing extensive AW infection. Whilst rare, it should be considered in traumatic patients. Our experience shows they can be managed with surgical drainage and in case of fascial loss and AW weakness, absorbable meshes could be considered.
PARTIAL CYSTECTOMY DUE TO MESH MIGRATION FOLLOWING LAPAROSCOPIC INGUINAL HERNIOPLASTY. CASE REPORT
Authors: Martin-Ramos M , Bravo-Salva A , Fumadó Ciutat L , Pereira-Rodriguez J A 
Published: May 2024

Abstract

Aim
This case report aims to document and analyze a rare complication of mesh migration following laparoscopic inguinal hernioplasty.

Methods
We present the case of a 77-year-old male with a history of recurrent bilateral inguinal hernioplasty, the most recent procedure performed 17 years ago via laparoscopy. The patient presented with years of suprapubic pain, prompting investigation through abdominopelvic CT, revealing a metallic density image in the painful region and right inguinal hernia recurrence. Cystoscopy was performed observing mesh erosion into the urinary bladder. Surgical intervention was indicated.

Results
Open partial cystectomy, small bowel resection and anastomosis and recurrence herniorraphy was performed. The intraoperative findings confirmed the migration of the mesh into the bladder and its adherence to the intestine. Postoperative complication was intestinal ileus. Patient's symptoms were attributed to this rare complication, highlighting the importance of thorough evaluation in cases of persistent urinary symptoms or chronic pelvic pain post-hernioplasty.

Conclusions
Mesh migration following hernioplasty is an infrequent but significant complication. Persistent urinary symptoms or chronic pelvic pain should prompt suspicion of this pathology. The multidisciplinary approach is crucial for the effective management of such cases, emphasizing the need for thorough clinical evaluation and surgical intervention when necessary. This case underscores the importance of ongoing vigilance in post-hernioplasty patients, particularly those with atypical symptoms, to ensure timely diagnosis and appropriate intervention.
COMPARISON OF ANTERIOR COMPONENT SEPARATION (ACS) VERSUS POSTERIOR COMPONENT SEPARATION WITH TRANSVERSUS ABDOMINIS MUSCLE RELEASE (PCSTAR) FOR HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Mohamedahmed A Y , Talaat Issa M , Ramasamy S , Zaman S 
Published: May 2024

Abstract

Background
Component Separation (CST) typically involves the dissection of one or more fascial planes to generate myofascial advancement flaps to assist with fascial closure in incisional hernia repair. The aim of this systematic review and meta-analysis is to compare outcomes between anterior component separation (ACS) versus posterior component separation (PCS) with transversus abdominus release (TAR) for incisional and ventral hernias.

Methods
A systematic search of electronic data sources was conducted, and all studies comparing ACS versus PCSTAR for ventral hernia repair were included. The evaluated parameters were evaluated for overall wound-related complications, surgical site infection (SSI), hematoma, seroma formation, operative time, length of hospital stays (LOS), and recurrence rate. Revman 5.4 software was used for analysis, and the odds ratio (OR) and mean difference were calculated.

Results
Six observational studies reported that 2076 patients with ventral hernias in total were divided between the ACS group (n = 1436) and PCSTAR (n = 640). PCSTAR group showed a significantly lower rate of overall wound complications [OR 2.21, P = 0.03] and SSI [OR 1.86, P = 0.0007] compared to ACS. (Figure1) The two groups showed comparable outcomes regarding operative time [MD -3.01, P = 0.90], Haematoma [OR 0.80, P = 0.26], seroma [OR 1.28, P = 0.45], Hernia recurrence [OR 2.82, P = 0.24] and LOS [MD 0.56, P = 0.29]. Included studies showed moderate to low risk of bias.

Conclusion
Both techniques of component separation have comparable postoperative complications, operative time and LOS. PCSTAR is superior in terms of wound-related complications and SSI. Well-designed randomized controlled trials are needed to investigate this comparison.Figure 1:Forest plot of overall wound-related complications between ACS versus PCSTAR.
THE LONG-TERM OUTCOME OF SURGICAL TREATMENT IN PATIENTS WITH CHRONIC POSTOPERATIVE INGUINAL PAIN
Authors: Narita M , Yamaoka R , Hata H 
Published: May 2024

Abstract

Background
Surgical treatment for patients with chronic postoperative inguinal pain (CPIP) remains very challenging since there has been no consensus which procedure would be appropriate. The aim of the present study is to verify the effectiveness of surgical procedures for patients with CPIP by the patient-reported outcome measures.

Methods
Between February 2017 and May 2023, 50 patients who underwent surgery for CPIP in our institution were evaluated. A questionnaire survey was performed by post or at the outpatient clinic between January 2023 and December 2023. Surgical procedure was decided individually considering sort of pain and a previous surgical procedure. Outcome measures were complications, satisfaction (excellent/good/moderate/poor), and hernia recurrence rate.

Results
Among the study period, 50 patients underwent 53 surgeries for CPIP. Median age was 60 years old. There were 41 males and 9 females. Median duration from the primary hernia repair to surgery for CPIP was 28.8 months. A previous surgical procedure was Lichtenstein (n = 4), Bilayer (n = 5), mesh and plug repair (n = 11) Kugel repair (n = 2), TIPP (n = 10), laparoscopic repair (n = 16), and tissue repair (n = 2). Surgery for CPIP was performed via laparoscopy (n = 22), open anterior (n = 6), and both approaches (n = 25). Postoperative severe complications occurred in 3 patients (reoperation, abscess, and postoperative hemorrhage). A questionnaire was returned by 48 of 50 patients (96%). An 88% excellent/good long-term result was achieved (median 24.6 months). Two hernia recurrence was observed (4%).

Conclusions
An 88% of Patients suffering from CPIP that was refractory to alternative pain treatment benefited from surgery for CPIP.
VERY LONG-TERM QUALITY OF LIFE AFTER FOLLOWING MADRID'S MODIFICATION OF TAR FOR COMPLETE BILATERAL ABDOMINAL WALL SECTION AFTER A HIGH-ENERGY TRAUMA. HOW CAN WE FIX IT?
Authors: Nieto Martos R , Blázquez Hernando L , Divina Juez Sáez L , Manuel Molina Villar J , Martos Meléndez S , Andrés Andrade Yagual A , María Fernández Cebrián J 
Published: May 2024

Abstract

Introduction
We present the case of a young male transferred to our center after a high-speed car accident with multiple abdominal contusions. An urgent Angio CT scan revealed a grade 2 aortic laceration, colonic perforation with an expansive hematoma in the mesentery, and a complete bilateral section of the entire abdominal musculature.

Material and Methods
Initially, an aorto-aortic bypass treated the laceration, and a right hemicolectomy with manual anastomosis addressed the colonic perforation. Due to a complete bilateral abdominal wall section with significant active bleeding, packing was done, followed by transfer to the Intensive Care Unit.
48 hours later, a surgical review was performed. A complete left rectus abdominis and anterior aponeurosis section with an intact posterior rectus layer led to a retro-muscular space dissection (Rives Technique). On the right, there was a transverse section of the right rectus muscle, both oblique muscles, and disruption of the anterior aponeurosis and posterior layer, with integrity only of the peritoneum. A transversus abdominal release was done to place a mesh covering the defect. A slow-resorption biosynthetic mesh covered the space created with right TAR and left Rives, with a non-absorbable polypropylene mesh on top.

Conclusions
Abdominal wall injuries affect approximately one in ten patients presenting to the emergency department following nonpenetrating trauma. These injuries are frequently missed during clinical examination due to the focus on more severe associated injuries. Failure to promptly diagnose these injuries can lead to delayed complications such as giant abdominal wall hernias.
Complete muscle section on the right side of the abdominal wall
Right TAR
MESH placement

Before & After the abdominal wall reconstruction
50 × 50CM MESH IN THE TREATMENT OF COMPLEX ABDOMINAL HERNIAS: OUR HOSPITAL EXPERIENCE
Authors: Oliveira A , Barbosa E , Fonseca T , Barbosa E 
Published: May 2024

Abstract

Background
Repair for giant and/or complex hernias is a challenge that often needs complex abdominal wall reconstruction techniques and big size meshes to achieve a functional reconstruction with low recurrence. The outcomes of using one big size mesh instead of two meshes is poorly described in the literature and therefore the aim of this retrospective study.

Methods
Retrospective analysis of all patients with complex hernia treated at our hospital between May 2021 and December 2023 in which a polypropylene 50 × 50 cm mesh was used.

Results
There were a total of 32 patients. The median age, BMI and Cedar’s calculation were 67 years, 29,1 kg/m2 and 32%. 28% of the cases were recurrences. The hernias were mostly (81%) on the middle line, there were 2 lateral hernias and 4 cases with both. The average CT imaging measurement of the transverse defect and hernia volume was 11,6 cm and 875 cc3. In 22 cases Botulinum Toxin was used preoperatively and in 5 cases progressive pneumoperitoneum was added. 22 patients needed a bilateral TAR but in 9 patients an unilateral TAR was sufficient for adequate abdominal reconstruction. There was only 1 major complication that needed re-intervention (hemorrhage), 2 seromas and 1 wound infection. No recurrences were observed with a median follow-up of 11,2 months.

Conclusion
There is limited information regarding big size meshes in the treatment of incisional hernias. At our hospital, their use has a low percentage of complications and no recurrences. However, prospective multicenter studies are required for further validation and a longer follow-up.
ABDOMINAL WALL RECONSTRUCTION AFTER ILIAC CREST FREE GRAFT
Authors: Olona C , Rodrigo M , Díaz A , Rodríguez J , Caro A , Jorba R 
Published: May 2024

Abstract

Background
The iliac crest free graft with internal oblique muscle (IOM) is used for the reconstruction of composite head and neck defects. This graft can cause a muscular defect in the abdominal wall that requires complex reconstruction.
We present the case of a 43-year-old male patient who underwent left mandibulectomy with left iliac crest flap (LICF).

Methods
Pacient diagnosed with squamous cell carcinoma of bucal mucosa. He received adjuvant chemotherapy, and had a mandibular recurrence, so a left mandibulectomy was decided, and in collaboration with abdominal wall surgeon, a LICF was extracted.
The iliac crest free flap was harvested simultaneously with the resection and recipient site preparation with 2 teams of maxilofacial and abdominal wall surgeons. Internal oblique muscle and an island of subcutaneous tissue and skin were included.
A reconstruction by plans is necessary for the donor site. The TAM is sutured to the iliac muscle. The 10 × 5 cm defect created in the oblique muscles was reconstructed by approximating its margins and placing an onlay 15 × 15 cm PVDF prosthesis.
In the following days, bleeding at the level of the ileolumbar artery was observed and selective embolization was performed. The patient was discharged 50 days after without any other abdominal complication.

Conclusion
The closure of the abdominal wall defect is a challenging step and could be meticulously performed jointly maxillofacial and abdominal wall surgeons. The use of a synthetic mesh might help to the correct closure of abdominal wall.
HERNIA REPAIR WITH LOSS OF DOMAIN AT HOME ASSOCIATED WITH UROSTOMY PARASTOMAL HERNIA WITH SUBCUTANEOUS EXPANDER PLACEMENT
Authors: Plazas D , Gutierrez C , Serrano A , Carreño-Sáez O , Pous-Serrano S , García-Moreno M A , Bueno-Lledó J 
Published: May 2024

Abstract

Objectives
To showcase our experience in the surgical treatment of a complex parastomal hernia case. As a secondary objective, we aim to emphasize the importance of managing these cases in Reference Units and employing a multidisciplinary approach to ensure an optimal surgical outcome.

Materials and Methods
We present a 71-year-old patient diagnosed with a complex hernia secondary to radical cystectomy. The patient was evaluated using Valsalva-computed tomography (CT).
The hernia was classified as L2 M2 M3 M4 W3 according to the EHS classification, with a diameter of 16 × 17 cm and a Tanaka index of 45%. Significant cutaneous atrophy at the midline was noted, anticipating the need for a cutaneous flap for coverage.
Five months before the reparative surgery, a subcutaneous pocket was created for the placement of a subcutaneous expander with progressive inflation. Botulinum toxin infiltration was performed 5 weeks prior, and progressive pneumoperitoneum was created 10 days before the intervention. A follow-up CT scan was conducted 1 day before the procedure.

Results
An eventroplasty was performed using the Anterior Component Separation Type I technique with a 30 × 30 cm polypropylene mesh with silver ions, preceded by urostomy transposition. Finally, a cutaneous flap was designed for coverage. The patient progressed without complications.

Conclusions
Optimizing the surgical treatment outcome for complex hernias requires management by high-volume Reference Units and a multidisciplinary approach.
IMPLANTATION OF A BRIDGING MESH CAN BE AN IMPORTANT EXTENSION OF SOLE TRANSVERSUS ABDOMINAL RELEASE IN OPEN VENTRAL HERNIA REPAIR
Authors: Riediger H , Gröger C , Kundel L , Adam U , Köckerling F 
Published: May 2024

Abstract

Background
Transversus abdominis release (TAR) permits placement of large meshes (TAR-Mesh) between the posterior (PL) and anterior layer (AL). Additional bridging mesh (BM) can be necessary for the PL and less frequent for the AL. (retrospective review of clinical data)

Methods
In 2023, we performed open TAR in 22 patients without BM (n = 15) and with BM (n = 7). Surgical steps: laparotomy, leaving the hernia sac (HS) in place (!), ventral adhesiolysis, Retrorectus access, TAR dissection, PL reconstruction and optional bridging with long-term absorbable BM, placement of TAR-Mesh, linea alba reconstruction with optional skin/HS resection or AL bridging.

Results
The median defect width was 15 cm (without BM) and 24 cm (with BM). Without bridging, the TAR-Mesh had a median size of 1200 cm2. With posterior bridging (median bridging mesh size at PL: 600 cm2), the median size of the TAR-Mesh was increased approximately by this (1750 cm2). The duration of surgery was 139 and 222 min and the hospital stay 6 and 10 days, respectively. The morbidity (8/22, 36%, Clavien-Dindo 1 and 2: 6/8) was without bridging 3/15 and with bridging 5/7; p = 0.02.

Conclusion
Using the TAR technique with additional bridging, even large hernias can be safely repaired without further preoperative preparation of the hernia defect. Additional posterior bridging provides for reliable separation of the posterior plane from the intestines. Hence, the hernia sac is always available for anterior reconstruction of the linea alba. The bridging technique can be applied when tension free closure is not possible.
THE EFFECT OF ROBOTICS IN THE PERIOPERATIVE OUTCOMES OF HERNIA REPAIR IN MORBIDLY OBESE PATIENTS
Authors: Ruotsalainen A , Husu H , Harju J , Vironen J 
Published: May 2024

Abstract

Aim
To show that robotic hernia surgery in morbidly obese patients is feasible. Surgery is often denied in the fear of complications associated with obesity. Consequently, obese patients are over-represented in those requiring emergent repair.

Methods
From a prospective database, all patients with body mass index (BMI) ≥40 kg/m2 operated during 1.3.2022–25.1.2024 were analyzed. Robotic repair is our standard procedure for ventral hernias since 1.3.2022. Open surgery is still common in emergency cases.

Results
62 patients with BMI ≥40 (median 44.7, range 40–67) were operated for primary (n = 44, robotic 23) or incisional (n = 18, robotic 8) hernia. 32/62 (52%) were emergency/urgent operations (robotic 10, open 22).
There was no difference between robotic and open repairs in average defect width (4 cm primary, 9 cm incisional) or defect area (16,8 vs. 16,0 cm2 primary, 120 vs. 105 cm2 incisional). In primary hernias larger meshes were used in robotic procedures (291 vs. 197 cm2). In incisional hernias there was no difference (489 vs. 509 cm2).
Median operation time for primary hernias was 114 vs. 99 minutes and hospital stay 1 vs.2 days after robotic vs. open procedure. In incisional hernia operation time was 205 vs. 184 minutes and hospital stay 2 vs. 3 days.
After robotics complications (n = 9, 29%) were mild, mainly seromas. After open procedures (n = 10, 32%) complications were more severe leading to return to hospital (wound infections, mesh removal).

Conclusion
Robotic surgery should be offered to morbidly obese patients. More severe complications and prolonged hospital stay were seen after open procedures.
ABDOMINAL WALL PSEUDOHERNIA AFTER SHOCK WAVE LITHOTRIPSY: A RARE CAUSE OF ABDOMINAL WALL BULGING
Authors: Santana Valenciano Á , del Carmen Ortega Ferrete A , Zaborras Buill J , López Monclús J , Porrero Guerrero B , Valle de Lersundi A R , Muñoz Rodriguez J , Molina Villar J M , Garcia de León L R , Fernández Cebrian J M , Garcia Ureña M Á , Blazquez Hernando L 
Published: May 2024

Abstract

Introduction
Abdominal wall pseudohernia (AWP) is a marked protrusion of the abdominal wall due to neuropathy or denervation. It is a well-known complication of abdominal surgery, herpes zoster infection, diabetes and iatrogenic trauma. Here we present the first case of AWP after shock wave lithotripsy (SWL).

Case report
A 59 years old male presented with symptomatic left flank bulging. He had undergone SWL in 2003 due to a left kidney stone. He had no previous history of abdominal surgery or blunt abdominal trauma. He presented with pain and weightlifting impairment. CT-scan showed muscular atrophy on the left side of the abdominal wall, but no hernia defect (Figure 1).
A lateral incision on the bulging area was performed. Muscular atrophy and fatty infiltration were observed. The preperitoneal space was dissected from the retrodiaphragmatic space down to Retzius space, laterally to quadratus lumborum and psoas muscle and medially until linea alba. For reconstruction double preperitoneal mesh technique was used: a biosynthetic resorbable mesh of polyglycolide:trimethylene carbonate copolymer (PGA:TMC) (20 × 30 cm) and a polypropylene mesh (45 × 40 cm). He was discharged after 5 days, without complications. Pathology exam showed myofibers’ atrophy and mature adipose tissue with isolated skeletal muscle. He presented no pain and no clinical relapse after 6 months follow-up.

Discussion and Conclusion
There are cases of AWP reported after percutaneous nephrolithotomy, videoassisted thoracoscopy or spine surgery, but no case of AWP after SWL was ever reported. CT-scan shows muscular atrophy without hernia defect. Given AWP’s low incidence the optimal approach is controversial, leaving surgery mainly for symptomatic cases.
INITIAL EXPERIENCE WITH AN INTRAOPERATIVE FASCIAL STRETCHING DEVICE TO REPAIR COMPLEX INCISIONAL HERNIAS
Authors: Santidrián Zurbano M , Fernández Baeza M , Domínguez Bastante M , Mansilla Roselló A 
Published: May 2024

Abstract

Aim
Midline closure is a target of incisional hernia (IH) repair and poses a surgical challenge, especially in W3 IH. Therefore, measures such as surgical prehabilitation (Botulinum Toxin -BT- or progressive pneumoperitoneum -PN-) have been adopted.
We present our initial results with a fascial traction (FT) device for treating large IH.

Material and Methods
Single-centre, observational, retrospective study (April 2022–December 2023), including patients treated with FT (transverse defect greater or equal to 15 cm).
Epidemiological characteristics, comorbidity, prehabilitation, type of IH, bridging, surgical time, hospital stay, morbidity, mortality and recurrence were studied.

Results
Patients characteristics (N = 5) Male/Female 3/2 Age 57(43-63) Diabetes mellitus 2(40%) Arterial hypertension 4(80%) Body mass index 34,4 (30,7–41,5) CeDAR 32,6% (17-47)
IH classification (EHS): 3 M2-3-4-5 (60%), 1 M2-3-4 (20%), 1 bilateral L1 (20%), all W3 (15–27 cm). 2 cases R0 (40%), 2 R1 (40%), 1 R2 (20%). All received preoperatively TB and 4 PP, mean insufflated volume 8150 cc (4000–14400).Surgery related parameters (N = 5)TechniqueRives-StoppaBilateral TAR3(60%)2(40%)MeshesPVDF2(40%)Biosynthetic +PPL3(60%)Primary fascial closure4(80%)Bridging(size)1(15 × 5 cm)Surgical time(minutes)278(210–330)IFSD use30 minutesHospital stay(days)12,8 (6–29)Related postoperative painLow2Medium2High1ComplicationsWound-related (N = 4,80%)Infection3 (60%)Seroma2 (40%)Haematoma2 (20%)General (N = 0)Mortality0Recurrences0

Conclusions
FTD are useful to treat IH, but a rational use must be made through proper preselection of candidates (W3 defects wider than 15 cm), due to economic cost, increased surgical time and the possible complications they entail.