bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMPLEX THORACOABDOMINAL RECONSTRUCTION AFTER A THORACIC ONCOLOGICAL RESECTION
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
Surgical reconstruction of the thoracoabdominal region after resective oncological procedures is a surgical challenge. We present our approach to this situation.

Material and Methods
67-year-old patient with the diagnosis of a mixoid sarcoma in the lower left thoracic wall. Previous myocardial stroke (double by-pass), chronic obstructive pulmonary disease, arterial hypertension and obesity (BMI 32.6). An oncological resection including the left 8th, 9th, and 10th left ribs, diaphragm, and the lateral musculature of the abdominal wall is performed. A diaphragmatic PTFE bridged mesh augmentation is performed to maintain pulmonary capacity. The reconstruction is based in the overextended dissection of the preperitoneal retromuscular space and the subdiaphragmatic area, restoring the muscular continuity after reinforcing the dissected area with a reinforced 25 × 30 biological mesh and a 35 × 40 cm large pore polypropylene mesh. The resected area is covered with muscular flaps of the transversus abdominis, anterior serratus and latissimus dorsi muscles with full coverage of the meshes.

Results
No immediate postoperative complications. Discharged in the sixth postoperative day without any complications. No abdominal wall instability after 18-month follow-up. Oncological progression with lung metastasis.

Conclusion
Anatomical restauration of the thoracoabdominal junction after oncological resections is based in the overextended preperitoneal retromuscular dissection with the use of large pieces of meshes, covered with flaps of the surrounding muscles.
PHASIX™ MESH FOR GIANT PARAOESOPHAGEAL HERNIAS – THE FUTURE OF HIATUS HERNIA REPAIR?
Authors: Lorenzo A , Mahmood S , Goltsman D , Berney C 
Published: May 2024

Abstract

Background
Mesh reinforcement of the oesophageal hiatus decreases recurrence rates for giant paraoesophagal hernias. The use of permanent synthetic mesh is associated with significant risk of erosion which is not observed in absorbable biosynthetic mesh – with the trade-off long-term hernia recurrence. We aim to assess the safety and effectiveness of Phasix™ nonST mesh in the repair of giant paraoesophageal hernias.

Method
Patients presenting to Bankstown hospital in 2020–21 with giant paraoesophageal hernias were included. 7 × 10 cm Phasix™ nonST mesh, fashioned in a standardised configuration was inserted behind the oesophagus, secured with fibrin glue and monofilament sutures. A modified Dor technique was used. Primary endpoint was early endoscopic recurrence and secondary endpoints were length of hospital stay, morbidity, mortality and symptom recurrence.

Results
Thirty-two patients (mean age 68.1 years) with giant paraoesophageal hernias underwent laparoscopic Phasix™ nonST mesh repair with modified Dor fundoplication in 32 cases. Dyspnoea (63.6%), epigastric/chest pain (48.5%), and dysphagia (51.5%) were the most common symptoms. Reflux was negligible. There were 62.5% type III and 15.6% type IV hernias. Thirty-five (85%) patients had more than 50% herniation of the stomach. Median length of stay was 3 days and 97% were symptom free at 12 and 24 months. There was no major complication and no mortality. There was one endoscopic and radiological recurrence was found in one (3.1%) patient at 24 months.

Conclusion
Phasix™ non ST mesh reinforcement of the oesophageal hiatus with fibrin glue fixation shows promise in reducing recurrence rates for repair of giant paraoesophageal hernias.
LAPAROSCOPIC REPAIR OF A LEFT BOCHDALEK HERNIA IN AN ADULT
Authors: Maillo C , Sacadura Fonseca J , Oliveira G , Garcia T , Nobre I , Sousa S , Afonso V 
Published: May 2024

Abstract

Introduction
Congenital diaphragmatic hernias have an incidence of 1 in 2000 to 1 in 3000 births. Of them, about 70% are postero-lateral defects (Bochdalek hernias BH). Most of them are symptomatic in newborns with respiratory complaints. In adults, they can produce vague or nonspecific gastrointestinal complaints.
When a BH is diagnosed in adult patients, surgery is recommended when it is symptomatic or even asymptomatic, when the patient is fit for surgery.

Material and method
We present the case of a 53 African male with the incidental diagnosis of a BH in a thoracic CT scan with fat and splenic colon in the hernia.
A laparoscopic approach was performed. The hernia was dissected with the reduction of the viscera and the visualization of the diaphragm.
We performed a suture of the diaphragmatic edges, and a coated mesh was used to reinforce the diaphragm. The mesh was fixed with resorbable tuckers in the lower part and with barbed suture in the upper part.
The patient was discharged 24 hours after surgery.

Discussion
BH has risk of growing because of the negative pressure of the thorax. The risk of an incarceration of a viscera in the thorax can develop serious complications. Laparoscopic approach is a minimally invasive access that allows a good repair of diaphragmatic hernias with a fast recovery. For theses reasons we recommend laparoscopic repair of BH.
POSTOPERATIVE INTERSTITIAL HERNIA AFTER e-TEP CAUSING INTESTINAL OBSTRUCTION
Authors: Maillo C , Oliveira G , Nobre I , Cabrita S , Pires R 
Published: May 2024

Abstract

Introduction
Interstitial or intraparietal hernias are those placed between the two layers of the abdominal wall. They are rare and can be congenital or acquired. One of the presentations can be as bowel obstruction.

Material and Method
We present a case of a 71 caucasian male with primary ventral hernias and diastasis recti operated by laparoscopy performing a total extraperitoneal e-TEP with a retromuscular polipropilene mesh.
The 4th postoperative day he complained with nausea and vomiting.
CT scan demonstrated a bowel obstruction with a small bowell loop adherent to the abdominal wall, but no hernia was demonstrated. Conservative treatment was tried without result.
He was operated again 7 days after the first surgery by laparoscopy approach.
An interstitial hernia with intestinal obstruction was confirmed with 1,4 m of small bowel in the abdominal wall.
The hernia was reduced, and a suture was performed to close the defect.
We present the video of both surgeries, the e-TEP and the interstitial hernia repair.

Conclusion
Even when the repair is extraperitoneal, the tension created with the closure of the posterior fascia can lead to a small hole where a loop of small intestine can pass creating the interstitial hernia. This is a diagnostic we need to have in mind and, when a postoperative obstruction is not rapidly solved, we have to re-operate the patient.
LAPAROSCOPIC SUGARBAKER TECHNIQUE FOR PARAOSTOMAL HERNIAS. HOW WE DO IT
Authors: Medina M , De Luca M , Avilés A , Vaello V , Martinez C , Robin A , Blasquez L , García-Ureña M 
Published: May 2024

Abstract

Aim
To delineate the critical steps involved in Sugarbaker laparoscopic paraostomal hernia repair. By providing a detailed understanding of these steps, surgeons can improve their procedural proficiency, leading to enhanced patient outcomes and reduced postoperative complications.

Material and Methods
We compiled several videos to identify and highlight the critical steps to performing and adequate Sugarbaker laparoscopic repair for paraostomal hernias.

Results
The critical steps in Sugarbaker laparoscopic paraostomal hernia repair were identified and categorized into preoperative, intraoperative, and postoperative phases. These steps include patient selection, stoma site, trocar placement, dissection and reduction of herniated contents, mobilization of the colon, closure of the hernia defect, measurement according to anatomical landmarks for mesh preparation, placement of mesh reinforcement. Emphasis was placed on meticulous technique, anatomical landmarks, and avoidance of potential pitfalls.

Conclusions
Sugarbaker laparoscopic paraostomal hernia repair is a technically demanding procedure requiring adherence to critical steps for optimal outcomes. Surgeons should prioritize thorough preoperative planning, precise intraoperative technique, and vigilant postoperative care to minimize complications and achieve successful hernia repair. Further research and refinement of surgical techniques are warranted to continually improve the efficacy and safety of this approach.
SURGICAL REPAIR OF POSTOPERATIVE PERINEAL HERNIA
Authors: Morante A , Alonso S , Hernández P 
Published: May 2024

Abstract

Background
The incidence of perineal hernia (PH) after abdominoperineal (AP) excision (classic or extralevator) ranges from 1 to 26%. The available data regarding the treatment of PH after rectal surgery are heterogeneous. Open or laparoscopic approach has been described.

Material and Methods
A 89-year-old woman was diagnosed of PH after laparoscopic AP resection due to rectal cancer five years ago. She presented pain associated with a reducible soft mass, increased with Valsalva maneuver and skin problems in perineal scar. Surgical repair by open approach was deemed necessary.
She was positioned in jack-knife position. An elliptical incision was made. The hernia sac was of significant size and was in close contact with the perineal skin and vagina. The final defect measured 6 cm longitudinally by 5 cm transversely. Dissection of the hernia sac was performed until reaching the boundaries of the defect. The dissection was challenging in the region closest to the vagina due to firm adhesions. After sac closure, we continued the dissection to release the hernia sac at the pelvic rim, presacral, and lateral margins. The repair was performed using a prosthesis composed of ovine derived extracellular matrix and polypropylene measuring 10 × 15 cm*, fixed with continuous absorbable sutures, covering the mesh with approximation of the remain of levator muscles. Subcutaneous drain was placed.

Conclusions
We present one of the most used surgical techniques in incisional PH repair.
*Ovitex 1S
ROBOTICALLY ASSISTED REPAIR OF A BILATERAL PARASTOMAL HERNIA
Authors: Mück B , Vogel R , Heinzelmann F , Büchler P 
Published: May 2024

Abstract

Introduction
We report a case involving a 60-year-old patient who underwent a robotic bilateral parastomal hernia repair utilizing two intraperitoneal funnel meshes. The patient had a history of resection of a leiomyosarcoma situated in the pelvis, resulting in the creation of two artificial bowel orifices via midline laparotomy. These orifices included a descendostomy in the left lower abdomen and an ileum conduit in the right lower abdomen.
The CT scan showed a 4,5 × 8 cm MII, MIII, WII incisional hernia of the midline and 3,8 × 5,2 cm parastomal hernia at the site of the ileum conduit and a 3,9 × 4,1 parastomal hernia at the site of the descendostoma.

Methods
The robotic trocars were placed in the upper abdomen directly under the costal margin. After adhesiolysis and mobilization of the two bowel loops a 16 × 16 cm two intrapertioneal funnel meshes were placed around both stomas. In the lower abdomen, the midline was already covered by the two stoma meshes. In the upper abdomen, an additional 10 × 10 PVDF mesh was placed in order to cover the entire scar.

Results
The postoperative recovery was uneventful. Because laxative treatment was necessary discharge was delayed. One month after surgery the patient is free of complains and shows no signs of recurrence.

Conclusion
The management of bilateral parastomal hernias poses technical challenges and is not suitable for traditional procedures involving lateral trocar placement. In cases where cranial or caudal trocar positioning is feasible, the application of an intraperitoneal funnel mesh emerges as an effective approach for addressing bilateral parastomal hernias.
HYBRID APPROACH FOR MADRID-PCS IN LATERAL HERNIAS
Authors: Román García de León L , Munoz-Rodriguez J M , Blazquez Hernando L A , Garcia-Urena M A , Robin Valle de Lersundi A , Fidalgo Martínez C , Fernández Rodríguez M , Artés Caselles M , Lucena de la Poza J L , Lopez-Monclus J 
Published: May 2024

Abstract

Aim
To present a case of a hybrid approach (extended totally extraperitoneal (e-TEP) and open) to perform the Madrid Posterior Component Separation as a treatment for lateral hernias.

Material and Methods
This is a 61-year-old male with a history of left radical nephrectomy in 2010 and subsequently two repairs of the lumbar incisional hernia, one with a preperitoneal prosthesis and the other with a supraaponeurotic mesh.
He presents with a 12 cm incisional hernia in the lumbotomy incision, close to the left semilunar line (L3W3).
A Rives-Stoppa technique was performed with left posterior component separation according to the Madrid modification. The entire dissection was completed by minimally invasive extraperitoneal (e-TEP) approach and subsequently the open approach was used to perform a complete lateral abdominal wall reconstruction.

Results
The patient was discharged with no postoperative complications and very good pain control, with no complications or recurrence at subsequent follow-up.

Conclusions
The hybrid approach allows treatment of lateral hernias while maintaining the advantages of the minimally invasive approach, such as less postoperative pain and early recovery, associated with the complete reconstruction of the lateral abdominal wall of the open approach, making it an alternative for patients with large lateral hernias.
THE ADVANTAGES OF THE LAPAROSCOPIC APPROACH IN MULTI-RECURRENT INGUINAL HERNIA
Authors: Ruiz Marzo R , Rico-Arrastia A , Otegi-Altolaguirre I , González-Tolaretxipi E , Arana-Iñiguez I , Blázquez-Lautre L , Aebastián-Labayen J L 
Published: May 2024

Abstract

Background
Recurrence after inguinal hernia repair remains a clinical problem in current surgery, with a rate of the 13% of all groin hernia repairs. This surgery is technically more demanding for the surgeon. The technique to be used must follow the objective of repair the hernia via virgin tissue planes.
We describe the advantages of the laparoscopic TAPP aproach in these cases.

Method
We present the clinical case of a 64-year-old woman with a multi-recurrent right inguinal hernia. The previous surgeries were: Lichtenstein's open repair and open posterior preperitoneal mesh repair twice.
We performed a preperitoneal right inguinal hernioplasty with a transperitoneal laparoscopic approach. A hernia recurrence was found in the right medial zone, juxtapubic with visceral content, R3M3 in the EHS classification for inguinal hernia. A plication of the transversalis fascia was performed, and later a 3D polypropylene mesh fixed with resorbable tacks was placed.

Results
The patient was discharged after 24 hours.
She was evaluated in an outpatient clinic one month postoperatively. She did not present hernia recurrence or other incidents.

Conclusions
As we can see, minimally invasive repair of recurrent inguinal hernia is safe and feasible. One of the most important advantages of using the laparoscopic approach in cases with recurrent inguinal hernia is that it avoids the previous operation site, avoiding injuries and difficulties in repair due to previous tissue fibrosis. Safety of the procedure is dependent on skilled and well-trained hands for this procedure.
PHASIX™ ST MESH FOR CRURAL REINFORCEMENT DURING GIANT HIATAL HERNIA REPAIR: PRESENTATION OF SURGICAL TECHNIQUE
Authors: Theodoropoulos C , Papazacharias I , Kourtidis L , Neocleus K , Chamzin A , Iordanou C , Kouroumpas E , Ayiomamitis G D 
Published: May 2024

Abstract

Aim
Crural mesh reinforcement during large hiatal hernia repair has been advocated to defend against early recurrences. However, the optimal mesh material and configuration remain in question. This study presents the rationale and surgical technique for crural repair augmentation using Phasix™ ST Mesh.

Methods
We present a case of a giant hiatal hernia and outline the rationale and surgical technique for using Phasix™ ST Mesh in the repair.

Results
A 72-year-old man presented with a giant type IV hiatal hernia. A massive mediastinal protrusion of intra-abdominal fat and viscera, and an associated crucial cardiorespiratory compromise were noted. A preoperative CT scan revealed a widened hiatus measuring 9.2 × 7.6 cm. The patient underwent laparoscopic hiatal hernia repair and Nissen fundoplication. During the procedure, following visceral reduction and hernia sac dissection and excision, a widened round hiatus and significantly thinned crura were found. To reinforce the primary crural suturing, two strips of Phasix™ ST Mesh, each measuring 1.5 × 4 cm, were used, and a U-shaped mesh was placed onlay to augment the repair. The procedure lasted 214 minutes, and the patient was discharged on the 3rd postoperative day without complications.

Conclusions
The application of Phasix™ ST Mesh in the repair of giant hiatal hernias offers the dual benefits of reconstructing the original anatomy and reinforcing the hiatus, while avoiding the implantation of permanent foreign material around the esophagus.
LAPAROSCOPIC EXTENDED TOTALLY EXTRAPERITONEAL (e-TEP) TREATMENT OF VENTRAL HERNIAS: TIPS & TRICKS
Authors: Trujillo J , Gómez J R , Concejo P , Montenegro M A , Schenone F , Jezieniecki C , Montes M , Herreros J , Martín del Olmo J C 
Published: May 2024

Abstract

Aim
Ventral hernias are a pathology with a high incidence within general surgery. Repair techniques have been evolving, and the minimally invasive approach to this type of pathology is currently on the rise due to the advantages offered by the minimally invasive surgery (laparoscopic or robotic): less postoperative pain, SSI, seromas, length of stay (LOS) and faster return to routine daily activities. We present some tips and tricks in the eTEP laparoscopic approach.

Material and Methods
Video presentation.

Results
In the following video, we present certain recommendations that will help you perform a laparoscopic e-TEP approach in a simpler and faster way.Performing an ultrasound of the abdominal wall prior to the start of surgery to locate the lateral border of the rectus.We have modified the position of the trocars, depending on whether we perform a supraumbilical or infraumbilical crossover, in such a way that it will allow us better ergonomics at the time of dissection and sutures.The closure of the anterior rectus sheath, from up to down, is performed with the needle holder in the left hand since it is a more ergonomic position and a more correct closure and better plication of the abdominal diastasis is performed.Measurement of the dissected space using a thread, to have a more accurate mesh of the dissected space.Positioning of the mesh before placing it, using vicryl and silk points, in such a way that they will help us to better extend it within the abdomen.Use of atraumatic fixation systems, such as fibrin glue, which, in addition to fixing the mesh, acts as a hemostatic agent.No drains. Use of an abdominal binder during the first 4 weeks after surgery.

Conclusions
The laparoscopic e-TEP approach is not simple, and requires skill and knowledge of the anatomy of the abdominal wall, and may initially require long times to perform a correct repair; however, applying some of the previously mentioned recommendations, surgical times can be reduced. can decrease as well as the risk of complications.
PRIMARY ABANDON OF HERNIA SAC FOR INGUINOSCROTAL HERNIA: A CASE REPORT
Authors: Trujillo J , Gómez J R , Concejo P , Montenegro M A , Schenone F , Jezieniecki C , Martín del Olmo J C 
Published: May 2024

Abstract

Aims
Surgery for inguinal hernias is one of the most performed surgical procedures around the world. A special sub-group of patients are those who have large inguinal hernias or inguinoscrotal hernias (ISH). They pose a challenge to surgeons with consistently higher rates of postoperative complications and recurrence when compared to “normal” inguinal hernias.
Generally, recommendation for ISH hernias has been to attempt to completely reduce the hernia sac. The abandonment or transection of the hernia sac has been reserved only for cases in which the complete dissection is more difficult, takes a long time or some complications such as bleeding (non-planned tactic). Recently, this approach has been questioned due to the risk of complications and the planned abandonment of the hernia sac has been recommended by some authors.

Methods
Video-case presentation.

Results
A 62-year-old male patient presented with a large right inguinoscrotal hernia that had been increasing in size and causing discomfort, so we decided to perform surgical treatment using a laparoscopic TAPP approach, leaving the sac abandoned.
3 trocars are used to perform the surgery (1 × 12 mm and 2 × 5 mm). After visualizing the large size of the hernial sac, we decided to make the abandoned sac. The first step is to perform a transection of the peritoneum at the level of the deep inguinal ring in such a way that the hernia sac is disconnected from the rest of the peritoneum that we will dissect to place the mesh. The following steps are similar to those we usually perform in a laparoscopic TAPP inguinal hernia. We perform the peritoneal opening approx. 3–4 cm above the inguinal ring, we dissect the Retzius and Bogros space, we dissect the elements of the inguinal cord (this being easier when the hernial sac is left abandoned) and after completing a correct preperitoneal dissection we place a mesh 12 × 16 cm PPL. Finally, the peritoneal flap and the peritoneal defect in the inguinal ring area are closed.
The patient presented a satisfactory evolution without complications and was discharged in 1°POD. The patient had a scrotal seroma that resolved during the 2°POM. Currently, after 18 months of follow-up, he has no signs of hernia recurrence.

Conclusion
Inguino-scrotal hernias represent a greater challenge for surgeons and are associated with a higher risk of recurrence and complications, mainly due to the difficulty in dissecting the hernia sac. Planned abandon of the hernia sac appears to be an interesting alternative in these cases, not only because it reduces the technical difficulty of the surgery but mainly because it is associated with a low rate of complications and acceptable seroma formation.