bluuebunny/crossref_metadata_2025_split huggingface dataset:
INGUINAL HERNIA WITH ADULT NEMATODE WORM
Authors: González-Valverde F M , Rodríguez-Lucas J M , Medina-Manuel E , Valero Soriano M , Sandoval-Marin J , Moreno-García C , Jimenez-Moreno I M , Hurtado Vázquez A M , Del Valle-Ruiz S R 
Published: May 2024

Abstract

Clinical case
A 32-year-old black male patient from Cameroon with a diagnosis of inguinal hernia. During dissection of the hernia sac, a sheathed structure resembling a suture thread was found. After opening the capsule, it was found to be formed by a coiled adult worm, which measured approximately 4 cm when extended. Hernioplasty was performed without immediate complications and the patient did not return for revision.

Comment
Filariasis is a group of parasitic diseases due to infestation by filarial nematodes that invade blood vessels and lymph nodes as well as subcutaneous and deep tissues. They are classified according to the location of the adult worm and are endemic in tropical regions of Asia, Africa and Central and South America. They are extremely rare in western countries.
Microfilariae are found in the blood of infected individuals and are ingested by haematophagous insects where, after completing part of their life cycle, they are transmitted to healthy individuals through a new bite. In this case, and given the location, it may have been an adult worm of Onchocerca volvulus.
Pharmacological treatment of filariasis is based on an anthelmintic such as albendazole, which requires the simultaneous administration of ivermectin or diethylcarbamazine to eliminate the microfilariae.
TRAUMATIC DIAFRAGMATIC HERNIA
Authors: González-Valverde F M , Rodríguez-Lucas J M , Medina-Manuel E , Valero Soriano M , Sandoval Marin J , Moreno García C , Jimenez-Moreno I M , Hurtado Vázquez A M , Del Valle-Ruiz S R 
Published: May 2024

Abstract

Introduction
Traumatic rupture of the diaphragm is an infrequent injury, produced as a consequence of blunt or penetrating trauma. We present 3 cases treated by laparoscopic approach.

Case 1
26-year-old male with stab wound in the 9th–10th left intercostal region. CT scan showed pleural effusion. Exploratory laparoscopy showed a 5 cm diaphragmatic rupture through which the gastric fundus was ascending. Frenorrhaphy was performed with continuous non-absorbable suture. Perforating wounds were found on the anterior and posterior gastric wall, which were also sutured.

Case 2
35-year-old male admitted after an accident with a broken femur. CT scan showed an intrathoracic stomach. Laparoscopic approach was performed, reducing the stomach to the abdominal cavity through a 10 cm diaphragmatic rupture. The gap was repaired with continuous non-absorbable suture and a titanised polypropylene mesh fixed with tackers.

Case 3
A 29-year-old man was admitted to the ICU after being run over. The CT image was interpreted as a "pulmonary hydatid cyst". Laparoscopically, a complete herniation of the stomach into the thorax was found with a defect of 8–10 cm. We repaired the rupture with continuous polypropylene suture and porcine dermis mesh fixed with loose stitches.

Conclusions
Laparoscopic correction of traumatic diaphragmatic hernias is an appropriate method in haemodynamically stable patients who do not require laparotomy or thoracotomy for other causes, as it is a technique that respects the principles used in open surgery.
ABDOMINAL WALL RECONSTRUCTION AFTER NEUROFIBROSARCOMA RESECTION
Authors: Gotor Santos T , Galán Raposo L , Sánchez-Brunete Medina V , Sutil Reguera N , Gómez Shevyakova O , Gisbert Aparicio M , de Diego Domínguez A , Fernández Fernández-Rebollos A , Medrano Montero I , Herrera Kok J H , Diago Santamaría M V 
Published: May 2024

Abstract

Neurofibrosarcoma (NFS) is a highly malignant neurogenic neoplasm that can arise anywhere in the body. It is most common in adults, with an incidence of 2–29% in patients with neurofibromatosis type 1 (NF1).

Aim
To describe the reconstruction of the abdominal wall after excision of a NFS.

Material and Methods
We present a case of a 27-year-old patient with NF1 and a diagnosis of NFS located between the greater and lesser oblique muscles of the left flank. After performing a complete extension study, the tumour was excised en bloc including the last costal arches, lateral abdominal wall and left iliac blade. The left deep epigastric artery was preserved to ensure perfusion of the muscle flap. The peritoneum was sutured using polyglycolic acid mesh. Subsequently, biosynthetic trimethylene carbonate mesh and irreabsorbable polyvinylidene fluoride mesh were interposed. Then, a left latissimus dorsi muscle free flap and a free skin graft were performed.

Results
Postoperative course without complications, discharge after 20 days. Histological result confirmed complete excision with a minimum margin of 1 cm. Treatment was completed with adjuvant chemotherapy. At 2 years follow-up there were no recurrences or incisional hernia.

Conclusions
NFS is a rare and invasive neoplasm that requires an aggressive and complex procedure. Its approach requires a multidisciplinary team with experience in the treatment of soft tissue sarcomas.
INTRODUCING ROBOTIC ABDOMINAL WALL SURGERY IN A GERMAN HERNIA CENTER – ONE YEAR EXPERIENCE
Authors: Gröger C , Kundel L , Adam U , Köckerling F , Riediger H 
Published: May 2024

Abstract

Background
Robotic surgery is the latest innovation in abdominal wall surgery. After implementing robotic surgery at our hernia center, we want to analyze our experience and present the perioperative data.

Method
We present our 1-year experience of robotic abdominal wall surgery regarding the type of operations and perioperative data.

Results
Between January 2023 and December 2023, we performed 59 robotic hernia operations. Consecutively, 20 inguinal hernias and 4 umbilical/epigastric hernias were repaired with preperitoneal mesh placement (TAPP-technique). Altogether 28 incisional hernias were treated either with preperitoneal or retromuscular mesh placement. Furthermore, seven parastomal hernia repairs (Pauli procedure) were performed. Additionally, one Morgagni Hernia was repaired with preperitoneal Mesh placement. Altogether, in 25 cases transversus abdominis release (TAR) was necessary for tension free closure of the defect and sufficient mesh overlap. In the postoperative course, there were three minor complications (haematoma, wound infection, intestinal paralysis). One patient underwent diagnostic laparoscopy to rule out any bowel injury. Another patient underwent laparotomy for repair of a small bowel injury after extensive adhesiolysis. Even though anticoagulated one patient developed severe pulmonary embolism. The mean hospital stay was 2,6 days (range: 1–9).

Conclusion
The implementation of robotic abdominal wall surgery in a hernia center with well-founded experience is safe and shows promising results. Regarding operative trauma and postoperative outcome, preperitoneal approaches for primary ventral hernia as compared with conventional methods seems a promising alternative due to the limited dissection. Patient selection and cost effectiveness as well as long term outcomes needs further investigation.
PERITONEAL FLAP CREATION FOR INCISIONAL HERNIA REPAIR VIA eTEP
Authors: Guevara Martínez J , Zapata C , Gutiérrez E , Abad R , Asencio L , Monjde B , Fondevila C , Salido S 
Published: May 2024

Abstract

Background
Peritoneal flaps assist in achieving abdominal wall closure, eliminating the need for mesh bridging and component separation techniques such as the endoscopic transverse abdominis release (eTAR). While maintaining the same concept as the open approach, in eTEP repair, the flap remains anchored to the preperitoneum and posterior rectus sheath (PRS) through its most distal dissection angle rather than its laterals.

Aim
To describe the peritoneal flap creation for incisional hernia repair via eTEP.

Materials and Methods
During hernia dissection via eTEP, we create a flap anchored to the distal angle of our midline preperitoneal dissection, releasing it from the PRS along both lateral edges if required. Following a complete retromuscular dissection, we close the PRS commencing from the most distal angle where the flap remains anchored. Subsequently, we close each lateral aspect of the peritoneal and PRS defect towards the proximal angle while incorporating the flap.

Results
We present 39 patients with midline incisional hernia out of a total of 62 hernia repairs via eTEP. Twenty-eight percent of cases were recurrent, and 30,9% were classified M3. The median width of the defects was 70 mm in both groups, with a maximum of 104 mm for the non-eTAR group and 143 mm for eTAR. Only 17,9% required TAR. We observed a 26,3% complication rate (4 cases) within the eTAR group while no complications in the non eTAR (p = 0,617). Complications included seroma and hematoma.

Conclusions
Peritoneal flap is a helpful technique for incisional hernia repair via eTEP, allowing midline closure without the need of eTAR.
UNCOVERING THE MYSTERY OF THE OBTURATOR HERNIA: THE OVERLOOKED ENTITY IN ABDOMINAL WALL SURGERY
Authors: Gutiérrez C , Serrano A , Guerrero P , Carreno-Sáez O , Garcia-Pastor P , Bueno-Lledo  , Pous-Serrano S 
Published: May 2024

Abstract

Background
We present a paradigmatic clinical case of a female patient, attended in the emergency room for small bowel occlusion due to an incarcerated obturator hernia.

Material and Methods
80-year-old woman with abdominal distension, pain and nausea for several days. She went to the emergency department on two occasions, with a clinical diagnosis of constipation and treatment with laxatives. On the fourth day, the patient associated vomiting and absolute oral intolerance. The CT scan shows a strangulated obturator hernia as responsible for the obstructive condition.
Laparoscopic approach was initially attempted to achieve reduction of the hernia. However, intestinal ischemia and perforation are identified, so we converted to open surgery. A 10 cm segment of small bowel was resected; the hernia defect was treated by primary closure of the obturator hole.

Results
Postoperative evolution was complicated by persistent ileus and the two abdominal collections that were drained by interventional radiology. In addition, infection and dehiscence of the upper third of the surgical wound, treated with negative pressure therapy cures. Fortunately, after the torpid evolution, the patient is well and six months later there is no hernia recurrence.

Conclusions
Obturator hernia is an uncommon pathology. It appears in old, thin women, mainly on the right side. Its diagnosis is based on physical examination and imaging tests (CT is the gold standard test), although clinical suspicion from the first moment is essential to make an early diagnosis and treatment to avoid complications (strangulation, resection). Treatment is based on primary closure of the hernia or the use of flaps or prostheses.
COMPARISON OF LAPAROSCOPIC VERSUS ROBOTIC HERNIA REPAIR OUTCOMES
Authors: Hayward R , Alhadad Z , Smith J J , Muirhead L J , Warren O J 
Published: May 2024

Abstract

Background
Use of robotics in hernia surgery is increasing. Comparison of outcomes between traditional laparoscopic and novel robotic procedures is vital to determine safety and inform cost-benefit decisions.

Method
Prospective data capture on patients undergoing inguinal hernia repair during one surgeon’s transition from an exclusively laparoscopic practice to one incorporating robotics.

Results
28 robotic transabdominal preperitoneal and 79 laparoscopic totally extraperitoneal inguinal hernia repairs were performed in the calendar year 2023.
In the robotic arm, median age was greater (69 vs. 58 years, p &lt;0.001) and more patients had history of abdominopelvic surgery (robotic n = 20 (71%), laparoscopic n = 28 (35%), p = 0.001).
There were no blood transfusions, mesh infections or removals. There was one conversion to open (robotic arm). One robotic patient was readmitted, returned to theatre and sadly died within 60 days with pathology unrelated to his groin hernias.
Recovery was complication-free for 24 (86%) robotic and 78 (99%) laparoscopic procedures (p = 0.004). There was one superficial infection (laparoscopic). Complications in the robotic arm included urinary retention (n=3) and persisting numbness (n = 1).
17 (61%) robotic procedures were day-case versus 67 (85%) laparoscopic (p = 0.008). A robotic learning curve was demonstrated through decreased operative time between the first and second half of operations (49 vs. 37 minutes, p &lt;0.001).

Conclusion
Transition to robotic practice has a significant learning curve requiring comprehensive training. Patients selected for robotic repair were significantly older and more complex, increasing perioperative complication risk. Nonetheless, length of stay, complications, re-admission and recurrence rates are within acceptable parameters, supporting the feasibility of this approach.
LAPAROSCOPIC TOTALLY EXTRAPERITONEAL HERNIA REPAIR IN PATIENTS WITH A HISTORY OF PREVIOUS ABDOMINOPELVIC SURGERY
Authors: Hayward R , Smith J J , Qiu S , Muirhead L J , Warren O J 
Published: May 2024

Abstract

Background
A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic (AP) surgery, to determine the feasibility of totally extra-peritoneal (TEP) repair within this population.

Method
All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals were retrospectively analysed to assess perioperative outcomes.

Results
308 patients were operated on between 2017 and 2024; 86% male, median age 58 years. 110 patients (36%) had a history of previous AP surgery.
298 patients (97%) achieved complication-free recovery. Superficial infection requiring antibiotics occurred in 4 cases (1.3%), all in the non-AP arm (p = 0.113). 2 patients (0.6%), one from each arm, reported ongoing post-operative pain. Recurrence occurred in 4 cases (1.3%) (1.8% in the AP vs. 1.0% in the non-AP arm, p = 0.548). 247 patients (80%) underwent day-case surgery (77% in the AP vs. 82% in the non-AP arm, p = 0.338).
There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to the testicle, or persisting numbness. There were no requirements for blood transfusion, or returns to theatre. There was one conversion to open. One patient was readmitted within 30 days and sadly died.

Conclusion
In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low complication rates, thus should be considered as standard for patients regardless of a history of AP surgery.
ESTABLISHMENT OF LAPAROSCOPIC INGUINAL REPAIR AT A SWEDISH TERTIARY CENTER: PERI-OPERATIVE DATA, RECURRENCE AND PATIENT-REPORTED OUTCOME BETWEEN 2015 AND 2020
Authors: Hedlund F , Norgren A , Cengiz Y 
Published: May 2024

Abstract

Background
TAPP was introduced in Sundsvall County Hospital, Sweden in late 2014. The results of either open tension-free mesh technique or TAPP consecutively performed between 2015 and 2020 was studied.

Methods
650 consecutive patients were studied retrospectively with prospectively collected data from Swedish Hernia Registry. Patient demographics, peri-operative data, recurrence and patient reported outcome were studied.

Results
231 TAPP and 419 open procedures were performed for 588 (90,5%) primary hernias and 62 (9,5%) recurrent hernias. 598 (92,0%) repairs were elective and 555 (85,4%) were treated in day care. Mean operation time for a TAPP was 48,7 minutes (SD 21,7) and for open repair 75,8 minutes (SD 27,8), p &lt;0.05. Repair of recurrent- and bilateral hernia were more common with a TAPP (p &lt;0.001). Of 219 operations performed by residents, 204 (93,2%) were open repairs and 15 (6,8%) TAPP (p &lt;0.001). Postoperative complications occurred in 29 (4,5%) cases, of which 21 after open repair (p &gt;0.05). Surgeon's competence was not associated with postoperative complications. Recurrence occurred in 2 (0,9%) TAPP and in 5 (1,2%) open repairs, the differences not significant.

Conclusion
Despite reflecting results from the department´s learning curve, TAPP was faster and produced comparable low rates of complications and recurrence as those from open repair. More than half of the inguinal hernia repairs were performed by specialists in surgery.
COMPARISON OF COSTS BETWEEN ROBOTIC VERSUS LAPAROSCOPIC APPROACH TO INGUINAL HERNIA. IS IT SUSTAINABLE?
Authors: Hinojosa-Ramirez F , Martinez-Nuñez S , Tallon-Aguilar L , Tinoco-Gonzalez J , Arteaga-Sanchez A , Morales-Conde S 
Published: May 2024

Abstract

Aim
There has been a rapid growth in the robotic approach to inguinal hernia. This is because it has demonstrated similar results to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in Spanish National Health System.

Materials and Methods
A retrospective single-center comparative study of cost on inguinal hernia repair using a robotic approach versus laparoscopic approach.

Results
98 patients who underwent inguinal hernia repair were analyzed between October 2021 and July 2023. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p &lt;0.001), an extended hospital stay (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p &lt;0.007), as well as higher procedural costs (2810.15€ ± 218.10€ vs. 725.81€ ± 158.91€, p &lt;0.001) and total hospitalitation costs (3792.49€ ± 326.06€ vs. 1497.20€ ± 375.68 €, p &lt;0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias.

Conclusions
The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.
EFFECTS OF OBESITY ON OUTCOMES OF LAPAROSCOPIC TAPP INGUINAL HERNIA REPAIRS: A RETROSPECTIVE ANALYSIS
Authors: Janik M , Sroczyński P , Jędras K 
Published: May 2024

Abstract

Background
This study investigates the impact of obesity on surgical outcomes of laparoscopic Transabdominal Preperitoneal Patchplasty (TAPP) inguinal hernia repair.

Method
A retrospective analysis was conducted on patients who underwent TAPP inguinal hernia repair from January 2022 to March 2023. Patients were divided into two groups based on their BMI: those with obesity (BMI ≥30 kg/m², n = 20) and a control group (BMI &lt;30 kg/m², n = 176). The study focused on surgical duration, hospitalization length, hernia recurrence, and postoperative complications.

Results
Patients with obesity had a significantly higher body mass (mean 101.05 kg) and BMI (mean 33.22 kg/m²) compared to the control group (mean body mass 78.87 kg, mean BMI 25.43 kg/m²). However, there were no significant differences in surgical duration (mean 52.06 vs. 45.06 minutes) and hospitalization length (mean 3.23 vs. 3.244 days) between the two groups. Both groups experienced primarily Class I complications according to the Clavien-Dindo classification, with no significant differences in surgical site infection rates. Hernia recurrence at 6 months post-surgery was slightly higher in the obesity group (5%) compared to the control group (0.3%), but this was not statistically significant.

Conclusion
This study suggests that obesity does not significantly impact the short-term outcomes of laparoscopic TAPP hernia repair, with similar operative times, hospital stay lengths, and complication rates observed in both obese and non-obese patients. These findings support the safety and efficacy of TAPP hernia repair in obese patients, although further research with larger sample sizes and longer follow-up is needed for comprehensive conclusions.
PNEUMOMEDIASTINUM AS A SEQUELA OF PRE-OPERATIVE PROGRESSIVE PNEUMOPERITONEUM — A RARE PHENOMENON
Authors: Jha A K , Kumar M , Priyadarshi R , Badani A 
Published: May 2024

Abstract
Surgeons typically use pre-operative progressive pneumoperitoneum (PPP) in cases of complex incisional hernias. With the advent of preoperative botulinum toxin and component separation techniques, rarely preoperative progressive pneumoperitoneum is required to facilitate midline closure. Subcutneous emphysema and pneumothorax can happen after PPP. However, pneumomediastinum as a sequela of PPP is an extremely rare phenomenon.
We herein describe a case of a 42-year-old gentleman, who presented with recurrent c incisional hernia with loss of domain. A CECT abdomen revealed a midline defect of 20 × 20 cm along with a loss of domain. In view of the large hernial defect with loss of domain, an injection of botulinum toxin A was given in the lateral abdominal wall muscle to facilitate midline closure. However, even after botulinum toxin A injection, the desired lengthening of the lateral could not be achieved. Therefore, we had to switch to pre-operative progressive pneumoperitoneum to enable midline closure. We used to instill 800 to 900 ml of air daily for 8 days. However, on the eighth day, the patient started experiencing mild chest pain, and the chest x-ray revealed pneumomediastinum. In addition, the CECT chest was also performed and it was suggestive of pneumomediastinum. Thereafter, we stopped further insufflation of air, and the pigtail catheter was left open to decompress the abdomen. We waited for approximately one week, and a repeat chest x-ray confirmed the resolution of the pneumomediastinum. Thereafter, a successful hernia repair was performed.
This case highlights the fact that pneumomediastinum can occur during preoperative progressive pneumoperitoneum, and a high index of suspicion is required to detect it early. In most cases, it resolves spontaneously.
DEVELOPMENT OF A REGIONAL AUTOMATED HERNIA REGISTRY: FIRST RESULTS
Authors: Kravchenko A , Kakotkin V , Agapov M 
Published: May 2024

Abstract

Background
In recent years, the concept of Learning Health Systems (LHS) has continued to develop. The existing hernia registries do not fully meet the requirements of the LHS. The aim of the study was to develop an automated hernia registry.

Method
The study is a prospective register-based (clinicaltrials.gov ID is NCT05920200). To maintain data quality, structured data entry forms have been developed and integrated into Medical Information System of Kaliningrad region (preoperative examinations, perioperative data, treatment results). Postoperative complications, recurrences, quality of life (EuraHS Qol Score) and pain levels (IPQ) scale were monitored. The approach to the work with the register was based on the principles of Big Data.

Results
During the first year, 43009 records from 995 patients diagnosed with ICD-10 K40-K43 were included. There were 327 (32.8%) females, 668 (67.2%) males. The emergency surgeries rate – 26.8%. The frequency of application of MIT was 9.74%. Intraoperative complications rate – 0.9%. Postoperative complications rate – 2.7%. Pain in 24 hours after surgery (VAS) – 3[1; 5], pain in 48 hours after surgery – 2 [0; 6]. Quality of life at 2 months after surgery: Pain – 2 [0; 8], Restriction of activities – 3 [0; 20], Esthetical discomfort – 3 [0; 9].

Conclusion
The automatic registry made it possible to evaluate the results of treatment of 100% of patients in public hospitals. Postoperative complications rate does not exceed that of HerniaMed. The level of quality of life corresponds to the data of publications. The automated registry is an effective tool for evaluating healthcare technologies in hernia surgery.