bluuebunny/crossref_metadata_2025_split huggingface dataset:
FUNCTIONAL CT IN LAPAROENDOSCOPIC ABDOMINAL WALL SURGERY. KEY POINTS AND SURGICAL APPLICATION
Authors: Zárate Gomez J , Cano Alonso R , Peinado Iríbar B , Supelano Eslait G , Álvarez de Sierra P , Gil López J M , Fernández Alfonso A , Merello Godino J 
Published: May 2024

Abstract

Background
At present the abdominal wall hernia treatmen is clearly trending towards less invasive techniques and we believe the functional CT scan offers great value information for patient selection as well as for surgical planning. We descibe de image key points and landmarks we use to design the best surgical.

Method
After 5 years performing eTEP Rives-Stoppa for ventral hernia sugery, we describe the secuential standardized steps we use to evaluate a functional Ctscan to plan the surgical approach. A CT scan, without any oral or intravenous contrast, combining Valsalva maneouver images along with negative pressure will provide the best information of the dynamic behaviour of the abdominal wall. The preoperative study of the volumetric and anatomical landmarks will guide us to tailor surgery.
Defect measures:
Wide
Location
Volumen
Content
Previous mesh, fixation devices placement.
Undiagnosed diseases.
Anatomic key points
Anatomic landmarks
Diastasis
Abdominal rectus wide
Muscular atrophy
Distance to:
Pubis
Xifoid
Subcostal margin
Semilunar line
Quadratus lumborum muscle

Results
Preoperative study of the volumetric and anatomical landmarks will guide us to design our surgical strategy:
Need for surgical prehabilitation.
Patient position.
Number and port placement.
Spaces we need to approach (retrorectal, pretransversalis, preperitoneal) to repair the defect and deploy the mesh with enough overlap.
Need to perform a TAR.

Conclusion
Functional CTscan provides us basic information of the patient’s abdominal wall. Thorough anamnesis and physical examination combined with this image test will help us render the best surgical repair.
LAPAROSCOPIC VERSUS OPEN INGUINAL HERNIA REPAIR IN ELDERLY PATIENTS: ACS NSQIP ANALYSIS OF 35,539 CASES
Authors: Zeng M , Olsen N , Badiani S S , Berney C R 
Published: May 2024

Abstract

Background
There is controversy regarding the adoption of laparoscopic inguinal hernia repair in the elderly population. The aim of this study was to determine whether there is a difference in 30-days postoperative outcome in this group of patients, when compared to open herniorrhaphy, using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.

Method
Data was accessed from operative years 2015 to 2022. All patients aged ≥75 years undergoing elective inguinal hernia repair were retrieved from the database. SPSS software was used. Propensity scores were calculated and included in the multivariate analysis to adjust for selection biases.

Results
The study population included 35,539 patients. A steady increase in the utilisation of laparoscopic approach was observed, from 23% in 2015, reaching 42% in 2022. The laparoscopic group had a longer mean operative time of 12 minutes (p &lt; 0.001), but a shorter hospital stays of 0.08 days (p &lt; 0.005).
Overall, the proportion of people developing any serious postoperative complication was equivalent at 2.8% between two groups. In the laparoscopic group, there was a lower risk for superficial surgical site infection (SSI) (p &lt; 0.05). However, there was a higher risk for urinary tract infection (P &lt; 0.005) and return to theatres (p &lt; 0.05). There were no statistically significant differences for organ space SSI, pneumonia, readmission and mortality.

Conclusion
Laparoscopic inguinal hernia repair in the elderly population offers comparable outcomes to open approach, with shorter hospital stay and reduced risk of SSI, but increased chance of return to theatre.
APPROACHES TO ATYPICAL HERNIAS
Authors: Borgaonkar V 
Published: May 2024

Abstract

Atypical hernias are those located close to abdominal wall margin. They are located at the periphery of abdominal wall and are adjacent to bony structures like xiphoid, costal margins, and pelvis. Due to their locations they pose challenges for repair These challenges are due to lack of tissue mobility in these areas, sufficient mesh overlap over defect is not possible since they are at periphery, mesh fixation is an issue because use of tacks may not be possible at costal margin, diaphragm and tacks may fail to penetrate bony structures like iliac crest. Vicinity of these hernias to anatomical structure like diaphragm, pleura, pericardium and urinary bladder pose technical problem while fixation.
Atypical hernias M1, M5, L1 L2 by locations can be managed by MIS and also open techniques depending upon the patient/hernia characteristic and experience and resources of surgeon.

Case 1
Large complicated atypical hernia with loss of domain post sternotomy incision M1 M2 was managed by open TAR repair.

Case 2
L3 Hernia post laparoscopic nephrectomy hernia at specimen retrieval site was managed by open Surgery Reverse TAR Technique

Case 3
Rare case of urinary bladder herniation, hernia located at L2 position. Patient typically had history of lump disappearing after urination confirmed on CT Imaging managed by MIS technique TAPP.

Conclusions
Atypical hernias are located close to the abdominal wall margin
Technically pose difficulties for repair in view of proximity to important structures, mesh overlap is not sufficient, fixation of mesh is also challenging in these situations.
Both Open as well as MIS Techniques are feasible.
Every case of Atypical Hernias should be managed by experienced surgeons on individual merits.
Here we present our experience in dealing with these Atypical Hernias.
TWO STAGED LAPAROSCOPIC REPAIR OF INFERIOR LUMBAR HERNIA DUE TO APPENDICULAR ABSCESS
Authors: Agrawal M K , Kumar A , Pal A K , Anand A , Pahwa H S , Sonkar A A 
Published: May 2024

Abstract

Background
Often caused by an abnormality in the abdominal wall, inferior lumbar hernias are rare hernias. They may develop spontaneously following trauma or lumbar incision surgery, or they may arise during infancy (congenital defect. We describe a case of an inferior lumbar hernia that resulted from the appendicular abscess.

Method
A 59-year-old man had been experiencing right lumbar reducible swelling for nine months. The swelling was gradually increasing in size. He had an incision and drainage of an abscess at the same site in 2003 and 2013 for drainage of abscess. Examination revealed soft, smooth, non-tender, reducible swelling of size 5 × 3 cm with an overlying scar of the previous incision. Contrast-enhanced CT scan showed herniation of bowel loops, mesenteric fat and vessels through a defect of size 23.9 × 20 mm in the right lumbar region.

Results
The patient was taken for laparoscopic lumbar hernia repair in the left lateral position. The bowel was reduced from the inferior lumbar triangle. The appendix was inflamed with a tip adhered to the lateral abdominal wall along with loculated pus. Pus was drained and following a thorough lavage & herniorrhaphy was done. The patient was taken up for Laparoscopic TAPE after 3 weeks. The postoperative period and 1-year follow-up were uneventful.

Conclusion
Inferior lumbar hernias are rare due to appendicular abscess tracking to the inferior lumbar region. Two-stage Laparoscopic hernioplasty is feasible in selected cases of inferior lumbar hernia presenting with appendicular abscess.
APPROACH TO THE VISCERAL AND PARIETAL COMPARTMENTS IN ROBOTIC TRANSABDOMINAL PREPERITONEAL (TAPP) INGUINAL HERNIA REPAIR
Authors: Barranquero A G , Maestre González Y , Ruiz C G , Codina-Corrons L , Raich M S , García-González L , Olsina Kissler J J , Villalobos Mori R 
Published: May 2024

Abstract

Background
Robotic TAPP inguinal hernioplasty is increasingly popular as an introductory technique for the robotic platform, but accurate dissection is the key to achieve successful outcomes. Lourié (WebSurg, 2021) highlights the significance of the preperitoneal or intermediate fascia in delineating the visceral and parietal compartments during TAPP. The objective of the video is to demonstrate this dissection in the performance of a robotic left inguinal hernia TAPP.

Case presentation
We present the left side of a robotic bilateral TAPP hernioplasty in a male patient. After placing the robotic trocars, the peritoneum was opened from the median umbilical ligament to the iliac spine. Medial access involved dissecting the parietal compartment and safeguarding the bladder while reducing the medial hernia. Continuing to the lateral area, the dissection proceeded in the visceral compartment, preserving the intermediate fascia to protect the inguinal nerves. Both compartments were then separated by the intermediate fascia, which was sectioned to access the central area, identifying the spermatic vessels and the vas deferens. Closure involved barbed suture for the direct hernia defect and placement of a 12 × 15 cm polypropylene mesh, secured to the pectineal ligament. The left side procedure concluded with peritoneal suturing.

Conclusion
The awareness of the presence of the intermediate fascia provides us with a better anatomical approach to the myopectineal space. The dissection of the parietal and visceral compartments minimizes the risk of bladder or inguinal nerve injury in robotic TAPP hernioplasty.
LAPAROSCOPIC eTEP RS FOR RIGHT PARAMEDIAN INCISIONAL HERNIA WITH PERITONEAL FLAP
Authors: Baste N 
Published: May 2024

Abstract

60/male
Presented to OPD with swelling near previous laparotomy scar mark. Reducible swelling.
Increases in cough.
Past history of paramedian incision laparotomy for perforated appendicitis.
On examination – 7 × 6 cm defect near the scar mark.
CT shows a paramedian ventral hernia.
Plan – eTEP RS with unilateral TAR.

Surgery procedure
3 port eTEP RS.
Retrorectus space creation.
Cross over to the opposite side.
Dissection of peritoneum over scar mark.
Opening of incisional hernia sac.
Adhesiolysis of sac from contents.
Dissection of defect on the superior and inferior aspect.
Peritoneal flap creation. Right side TAR.
Closure of peritoneum without tension.
Closure of defect with nonabsorbable barned suture.
Placement of 20 × 15 cm mesh.

Strapping after surgery
Operative time 180 minutes. Blood loss – 100cc.
Patient was discharged on the 5th post-op day.
ROUTE FOR A SUCCESSFUL REPAIR IN A SEVERE EVENTRATION WITH LOSS OF DOMAIN: BOTOX-PNEUMOPERITONEUM AND MALMÖ REPAIR
Authors: Caraiman Gall M , Villalobos Morí R , Comas Isus J , Farré Font R , Guariglia C A , Pardo López S , Font Prat M , Valderrama Chacón S , Collera Ormazabal P , Díaz del Gobbo R 
Published: May 2024

Abstract

Background
Highlight the surgical challenge of rehabilitating the abdominal wall in a severe case of ventral hernia.

Method
We present a video of the safe surgical repair of a midline abdominal incisional hernia with loss of domain, employing component separation and closure according to Malmö’s technique, with previous prehabilitation with botulinum toxin infiltration and pneumoperitoneum therapy.

Results
42-year-old patient with obesity and complex abdominal incisional hernia, following a midline laparotomy for intestinal obstruction requiring resection and ileostomy due to strangulated umbilical hernia. Subsequently, an open abdomen surgery resulted when attempting ileostomy closure. Abdominal CT scan showed a large incisional hernia (M1-2-3 W3 + L1 W1) with loss of domain. We indicate prehabilitation with 20 kg weight loss, infiltration of botulinum toxin two months before surgery and progressive pneumoperitoneum therapy 12 days before final procedure involving instillation up to 13 Lt of air. Surgical repair was performed with laborious dissection of the sac and adhered bowels, without evidence of lesions. Lateral eventration of the old ileostomy’s closure is carried out with preperitoneal mesh. For midline reconstruction we choose Malmö’s technique to guarantee tension-free closure, with a retromuscular mesh. The skin was reconstructed with an inverted T incision. Thanks to the meticulous preoperative preparation combined with ERAS program, the patient was discharged on 5th postoperative day.

Conclusion
Incisional hernias with severe loss of domain require an exhaustive study and preparation, to avoid intra- and post-operative complications. Prehabilitation of the abdominal wall and patient must be taken into account prior to performing this type of reconstruction.
LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL HERNIOPLASTY (TAPP) FOR OBTURATOR HERNIA
Authors: Charef El Jari L , García Galocha J L , Fra Corral D , Gallardo Robles A , Gámez Alastuey M , López Antoñanzas L , Peña Soria M J , Torres García A J 
Published: May 2024

Abstract

Introduction
Obturator hernias are rare and represent &lt;1% of incidence of all hernias. These hernias typically affect elderly, multiparous, thin women, and those patients with increased intra-abdominal pressure. Early diagnosis of an obturator hernia is very difficult and challenging as it usually presents with non-specific symptoms and signs. It is rarely visible or palpable. However, these hernias may show up as bowel obstruction as well as dysaesthesia and pain in the groin, inner thigh and knee due to obturator nerve compression (positive Howship-Romberg sign). Computed tomography (CT) is of choice for preoperative diagnosis. Surgical treatment with a laparoscopic approach is preferred in elective interventions.

Case report
A 63-year-old woman without medical history who consults because of abdominal discomfort in hipogastric and right iliac region. At clinical examination, she has no palpable hernia. Blood tests were normal. A scheduled CT scan revealed a small right obturator bladder hernia. Intervention was performed using the transabdominal-preperitoneal approach (TAPP). This video shows the steps followed in the operation (creation of peritoneal flap, reduction of the hernia, mesh placement and fixation, peritoneal closure with barbed suture). The patient has no postoperative complications.

Discussion and conclusion
Obturator hernia, although rare, is associated with high morbimortality. Laparoscopy is of choice in elective surgery. TAPP allows placement of the mesh in the preperitoneal space, the most anatomical area, to assess the vitality of the reduced organs, and is preferable in hernias whose anterior approach is difficult to access. Laparoscopy is associated with faster postoperative recovery.
A CASE OF LAPAROSCOPIC OBTURATOR HERNIA
Authors: Ferrando L , Palomo Luquero A , Otero Rondon M , Muñoz Plaza N , Jorge Tejedor D , Cruza Aguilera I , Baudino M , Casaval Cornejo L , Dominguez Arroyo I , Polanco Pérez L , Álvarez Rico M A 
Published: May 2024

Abstract

Case History
An 86-year-old woman arrived at our center's emergency department, complaining of abdominal pain and vomiting. She had no history of abdominal surgery or injury.

Clinical Findings
The patient displayed left iliac fossa tenderness, without peritoneal irritation or fever. Blood tests showed an increase in neutrophils and C-reactive protein. A CE-CT scan of the abdomen revealed a left obturator hernia with an 8.5 mm neck.

Therapy and Progressions
Emergency laparoscopic surgery revealed that 2 cm of small intestine had become incarcerated through the obturator hole. The hernia could be easily reduced without the need for dissection and the portion of the small intestine was not necrotic. Given the patient's age and functional status, the goal was to be as quick and decisive as possible. Due to the small size of the defect, a herniorrhaphy was performed using a barbed suture. Recovery was uneventful and the patient was discharged on day 6.

Comments
Obturator hernias are rare causes of small intestinal obstruction, and early diagnosis requires high clinical suspicion. An abdominal CE-CT scan can assist in detecting strangling ileus caused by incarceration. Emergency laparoscopy is recommended for strangling ileus and a laparoscopic technique may be feasible following an early diagnosis. Laparoscopy has increased in recent years and, unless there are obvious signs of perforation or necrosis, it may be used in strangling hernia cases. If there is any doubt regarding complications, we should not be hesitant to convert to a laparotomy.
ROBOT-ASSISTED NISSEN FUNDOPLICATION WITH THE NEW HUGOTM ROBOTIC ASSISTED SYSTEM: FIRST WORLDWIDE REPORT WITH SYSTEM DESCRIPTION, DOCKING SETTINGS AND VIDEO
Authors: Ferri V , Vicente E , Quijano Y , Hernandez S. F , Duran H , Diaz E , Fabra I , Malave L , Ruiz P , Balelli L , Broglio A , Caruso R 
Published: May 2024

Abstract

Background
Robotic surgery has gained worldwide acceptance over the past decade, with several studies showing that this technique is safe and feasible.

Methods
We describe the first robot-assisted Nissen fundoplication for hiatal hernia performed with the new HugoTM RAS (Robotic assisted surgery) system (Medtronic, Minneapolis, MN, USA) in Spain. The innovation of this system is the open surgical console with a 3D-HD display, a system tower and four independent arm carts.

Results
The surgical procedures were completed without conversion. No intraoperative complications or tech- nical failures of the system were recorded. The operative time was 97 min, the docking time was 3 min, and the length of hospital stay was three days.

Conclusions
This case report shows the safety and feasibility of Nissen fundoplication for hiatal hernia with the HugoTM RAS system and provides relevant data that may assist early adopters of this surgical platform.
SUGARBAKER TECHNIQUE FOR AN UNUSUAL CASE OF ILEAL CONDUIT EVENTRATION
Authors: Font M , Díaz R , Farré R , Guariglia C , Pardo S , Caraiman M , Valderrama S , Collera P 
Published: May 2024

Abstract

Background
We present a clinical case of peristomal eventration of ileal conduit repaired with a sugarbaker technique.

Methods
A 56 years-old man, with overweight (BMI 30 kg/m2), hypertension and surgical history of radical cystectomy and Bricker reconstruction due to urothelial carcinoma.
During oncologic controls, he was diagnosed of a infraumbilical and peristomal eventration. The patient had discomfort and was referred from the urology clinic, Elective surgery was programmed after the CT scan confirmed the eventration suspicion of occupation by the colon.

Results
A peristomal eventration with the cecum and distal ileum inside. The content was carefully reduced and dissected, paying special attention to the mesenteric side to avoid ureteral lesions and devascularization. The size of the eventration was adjusted by using 0 barbed suture. Afterwards, an intraperitoneal mesh was placed around the stoma fixed with tackers.
The post-operative period occurred without complications, and on the 2nd day, he was discharged from the hospital.

Conclusions
The repair of patients with ileal conduits’ eventrations can be a true challenge due to altered anatomy and the possibility of injuring the ureters, so the laparoscopic approach offers a great advantage for evaluation and repair of these unusual cases.
LAPAROSCOPIC REPAIR OF INCARCERATED FEMORAL HERNIA AND FOLLOW UP REVIEW 9 MONTHS LATER DUE TO LAPAROSCOPIC REPAIR OF OMPHALOCELE
Authors: Fotiadis P , Papalos C , Permekerlis A , Tepelidis C , Gemousakaki E , Kouridakis P 
Published: May 2024

Abstract

Introduction
Abdominal wall hernias are an extremely common condition in surgery. It is estimated that 2/3 of all of them appear in the groin region. Femoral hernias represent 3% of all hernias in the inguinal region. As for femoral hernias, it is diagnosed at a rate of 22%–34% of all inguinal hernias in women, as opposed to 1.1% in men. They often show incarceration, in a percentage of 32%–39% of patients.

Purpose
A video presentation of an interesting case of incarcerated femoral hernia and the laparoscopic approach as an emergency treatment. Also there is a review of the operated area 9 months later due to a laparoscopic omphalocele repair.

Material and Methods
A 45-year-old woman presented to the ED due to abdominal pain of sudden onset, accompanied by episodes of vomiting and inability to eat. Clinical examination showed bulge below the inguinal ligament. An upper lower abdominal CT scan was performed which indicated an incarcerated femoral hernia. The patient underwent a laparoscopic repair with mesh. The patient's postoperative period was considered uneventful and she was discharged on the 4th postoperative day. 9 months later the same patient underwent a laparoscopic omphalocele repair and the operated site of the femoral hernia was reviewed.

Results and Conclusions
In patients with incarcerated femoral hernia, laparoscopic repair is an effective method of surgical repair.
OBTURATOR HERNIOPLASTY WITH TAPP TECHNIQUE FOR STRANGULATED HERNIA
Authors: Fra D , García Galocha J L , Peña M J , Gámez M , Gallardo A , Charef L , López Antoñanzas L , Torres A 
Published: May 2024

Abstract

Introduction
Obturator hernias are a rare entity, accounting for 0.04% of all hernias. They are almost exclusive to women, especially in the seventh and eighth decades of life. Diagnosis is often delayed, and the most common presentation is incarceration.

Clinical case
We present the case of a 78-year-old woman with no significant surgical history who came to the Emergency Department with a 72-hour history of intestinal obstruction. Abdominal CT scan revealed findings consistent with an incarcerated right obturator hernia.
Urgent surgical treatment was decided, and a TAPP hernioplasty was performed.
The procedure started with the placement of a supraumbilical Hasson trocar and two additional 5 mm trocars on both sides. The non-dilated bowel loop was followed to locate the hernial orifice, which contained a loop of small intestine that was released, showing no signs of ischemia. The peritoneal flap was created, and with traction and counter-traction maneuvers, the hernial contents were reduced. A polypropylene mesh in plug form was placed, and the flap was closed with non-absorbable barbed material.

Conclusions
Due to the rarity and challenging diagnosis of obturator hernias, it is essential to consider them, especially in cases of intestinal obstruction in elderly women, particularly those without previous surgeries.
Currently, the preferred treatment for repair is laparoscopic approach. Given the location of this hernia in the pelvis, laparoscopy allows clear visualization of the hernia contents and subsequent treatment, including assessing the viability of the incarcerated or strangulated intestine if present.
RIGHT INGUINOSCROTAL HERNIA WITH IRREDUCIBLE SIGMOID NEOPLASM: ONCOLOGICAL RESECTION AND CONCOMITANT COMPLEX ROBOTIC HERNIA REPAIR
Authors: Galiana-Montiel C 
Published: May 2024

Abstract
Concomitant colorectal and hernia surgery is controversial due to the risk of infection in clean-contaminated or contaminated environments and morbidity, even in case of minimally invasive surgery. Occasionally, we may encounter patients with symptomatic inguinoscrotal hernia and colorectal cancer.
We present a case of a 65 years-old male patient with a dolicosigmoid neoplasm found inside a large irreducible right inguinoscrotal hernia. Both complex procedures were performed by laparoscopy assisted by the robotic platform DaVinci. The uniqueness of this procedure lies in a modified trocar position (cranial than standardized) to allow their use for both complex procedures. After hernia reduction, a standard robotic TAPP with polypropylene mesh was performed at first to reduce the possibility of mesh contamination. Two more trocars were added under direct vision respecting the peritoneal flap to perform an oncological sigmoidectomy. Surgical specimen was removed through the minimally enlarged transrectal incision of the left flank trocar, avoiding a Pfannenstiel incision that affected the previously repaired area.
The patient was discharged 3 days after surgery and no complications or recurrence were reported 1 year after the procedure. In conclusion, the minimally invasive simultaneous approach of both complex procedures is safe and has a beneficial impact on patient’s morbidity and satisfaction, avoiding two separate surgical procedures and the risk of hernia complications between them.