bluuebunny/crossref_metadata_2025_split huggingface dataset:
CENTRAL TENDON DIAPHRAGMATIC HERNIA LAPAROSCOPIC REPAIR WITH MESH FOUND INCIDENTALLY DURING MINIMALLY INVASIVE SURGERY FOR MULTIPLE POST-OPERATIVE ABDOMINAL HERNIAS
Authors: Kechagias A , Kirkilesis G , Hillegersberg R , Kritikos N 
Published: May 2024

Abstract

Aim
Spontaneous Hernias of the Central Tendon of the Diaphragm are extremely rare in adults. We show the operative video of the laparoscopic repair with mesh of a spontaneous Central Tendon Diaphragmatic Hernia (CTDH) found incidentally during the repair of multiple post-operative hernias in an adult patient.

Materials and Methods
A 66-year-old overweight (BMI 37.5) lady underwent laparoscopic surgery for the repair of multiple incisional hernias. Symptoms included pain from a large incarcerated incisional para-umbilical hernia, and an unexplained dull pain behind the right-lower costal area. Surgical history included open cholecystectomy and appendectomy, multiple laparoscopic gynecologic and uro gynecologic operations, and two spine operations. There was no history of accident or iatrogenic injury at the diaphragm. The CT scan showed seven incisional hernias. Our video shows the dissection of the hernias with special focus on the laparoscopic repair of a 7 cm incidental right CTDH with incarcerated abdominal fat. The hernia fat was reduced and after a partial thoracoscopy the CTDH was repaired with a dual-faced 15 × 15 cm mesh fixated with absorbable tacks. The rest of the hernias were repaired with multiple meshes using the IPOM technique.

Results
The post-operative course was uneventful. The patient was discharged at 48-hours with the need of minor analgesics. A post-operative re-evaluation of the CT scan identified the missed CTDH. Clinical examination and ultra-sound were unremarkable at three months.

Conclusions
Minimally-invasive surgery with mesh is appropriate for the repair of a CTDH. The diaphragm should be meticulously assessed in the pre-operative CT scan of obese patients with multiple hernias.
MODIFIED PORT POSITION FOR BILATERAL INGUINAL TAPP CREATING UNILATERAL PERITONEAL FLAP
Authors: Khetan M 
Published: May 2024

Abstract

Introduction
Usually, the TAPP approach for bilateral inguinal hernia requires bilateral port placement and two separate peritoneal flaps to facilitate dissection and mesh placement. Our technique with modified port placement allows bilateral repair through unilateral flap with equal ease and feasibility and thus not only reduces the efforts of two flap suturing but also mimics TEP approach for hernia contralateral to ports.

Material and Method
During a period from February 2015 to December 2022 we have managed 48 patients with this approach. Patients with bilateral, primary, reducible inguinal hernias were managed, all of them do not have any history of previous surgery. With experience even complete irreducible hernias were managed in the same manner. Ports were placed on the side of the symptomatic or bigger hernia in triangular fashion for better ergonomics.

Results
In all patient’s adequate dissection of myopectineal orifice was achieved on either side through single flap. In few patients there were accidental small peritoneal rents on contralateral side which required single suture to close them. Medium weight PP mesh of size 15 × 12 cm was used in all except few, in which either 3D meshes or self-adhesive Progrip mesh was placed. No post-operative complications were seen in the form of recurrence or seroma and chronic pain in all patients.

Discussion and conclusion
Our technique of single peritoneal flap requires small unilateral flap to be raised to deal with bilateral defects without compromising on the steps of the procedure. Modification in port placement for the approach allows better ergonomics and ease of contralateral dissection and mesh placement along with easy closure of small peritoneal flap.
ABDOMINAL WALL RECONSTRUCTION AFTER POST-RIVES INJURY OF LINEA SEMILUNARIS
Authors: Lopez-Monclus J , Munoz-Rodriguez J M , García de León L R , Grillo Marin C , Rodriguez Fernandez M , Gil Cidoncha L , Blazquez Hernando L A , Valle de Lersundi A R , Medina Pedrique M , Garcia-Urena M A 
Published: May 2024

Abstract

Aim
Recurrences after retromuscular repairs of abdominal wall defects are a surgical challenge. Posterior Component separation techniques have allowed abdominal wall surgeons to solve this situation.

Material and Methods
68-year-old female patient. Obesity (BMI 38), dislipemia, arterial hypertension. Previous open hysterectomy in 2016, open rives repair of an incisional hernia back in 2018 (wound infection in the postoperative period). Early lateral recurrence due to left semilunaris line injury. Planned open posterior component separation after preoperative optimization. Important weight loss (dropped BMI to 32) and Ipsilateral botox injection 4 weeks prior surgery. Approach throughout a transverse incision to add a functional dermolipectomy. Dissection of the lateral preperitoneal space reaching the posterior axillary line, cranial dissection pulling down the fascia diaphragmatica, caudal dissection overpassing Cooper ligament and medial dissection performing a reverse transversus abdominis release and reverse Rives to the contralateral retrorectus space. Reconstruction with a double mesh technique (combination of an absorbable biological scaffold and a 50 × 50 cm polypropylene mesh) with reimplantation of the lateral abdominal musculature and reconstruction of the linea semilunaris.

Results
No immediate postoperative complications. Discharged in the sixth postoperative day. Subcutaneous seroma which required fine needle aspiration in the outpatient clinic. No recurrence after 18-month follow-up.

Conclusion
Posterior component separation technique allows the abdominal wall surgeon to deal with complex situation as recurrences after previous retromuscular repairs. Preoperative optimization is mandatory in these complex patients.
eTEP FOR A LARGE INCARCERATED PRIMARY VENTRAL HERNIA: EXPANDING THE INDICATIONS FOR eTEP TECHNIQUE TO THE EMERGENCY SETTING
Authors: Marrero P , Fernández López L , Hernández Oramas C , Delgado Plasencia L J 
Published: May 2024

Abstract

Clinical case
66-year-old female patient; Medical history: BMI 34,7 kg/m², chronic smoker, diabetes mellitus type II; Diagnosed in 2022 of a large and reducible primary ventral hernia M3W2 with recti diastasis associated: 36 mm at epigastric and 68 mm at supraumbilical level, respectively. She presented at the emergency department with a 24 hours history of an umbilical painful and irreducible lump associated with nausea.

Investigation
Bloodtest: Leukocytes 8,8 × 109/l; prothrombin time 65%; C-reactive protein 190,85 mg/dl. Abdominal X-ray showed no abnormalities. Abdominal ultrasound showed a large umbilical sac, which contained epiplon with signs of suffering. No anaesthetic contraindication for an emergent endoscopic surgery.

Therapy and Outcome
An umbilical hernioplasty and recti diastasis correction was performed using the eTEP technique. Absorbable barbed suture 2–0 were used to close de defect and correct the recti diastasis. A macroporous polypropylene mesh was implanted without fixation, which covered entirely the dissected area and not just the hernia area. No drains were used. The patient had an uneventful hospital stay and was discharged at 36 hours after surgery. An umbilical subcutaneous seroma M3-type IV, according to the Morales-Conde Classification, was developed. No evidence of recurrence neither clinically nor radiologically at 6 months follow-up.

Conclusion
There is a lack of scientific evidence about the use of eTEP technique in the emergent treatment of complicated ventral hernia. eTEP approach to this type of hernia is a promising abdominal wall reconstruction technique. It is reproducible and safe, with short hospital stay, low morbidity and short-term effective.
SMALL BOWEL OBSTRUCTION AS A COMPLICATION OF TRANSABDOMINAL PREPERITONEAL HERNIA REPAIR – AN INTERNAL HERNIA CAUSED BY ADHESIONS TO A BARBED SUTURE
Authors: Meruje F , Monteiro R , Peliteiro J , Moutinho Teixeira M , Neves T , Fortes R , Barata P , Mega M , Paulino A 
Published: May 2024

Abstract

Background
Laparoscopic approach to inguinal hernias is advantageous as it reduces postoperative pain, length of stay and recovery time, while allowing for an easier correction of multiple hernia defects in a single operation. Laparoscopic transabdominal preperitoneal (TAPP) hernioplasty is one such technique. Bowel obstruction as a postoperative complication is rare, and can be due to inadequate peritoneal closure, herniation through disrupted peritoneum or adhesions.

Aim
We herein report on a case of postoperative small bowel obstruction caused by adhesions to a long, barbed suture.

Material and Methods
Case presentation, in video format, of a 74-year-old man admitted through the emergency department for small bowel obstruction, 7 days after laparoscopic bilateral TAPP hernioplasty and intraperitoneal underlay mesh (IPUM+) hernioplasty for correction of bilateral inguinal hernia and umbilical hernia.

Results
After examination, and an inconclusive computerised tomography scan, the patient underwent emergency laparoscopic exploration. We found a small bowel obstruction caused by adhesions to the barbed suture previously used to close the peritoneal flap on the right side. The small bowel was freed from the suture, without need for its resection. Appendicectomy was performed as well. The patient was discharged 3 days later, without further complications.

Conclusions
Adhesions after peritoneal closure may lead to postoperative small bowel obstruction. Surgeons must be aware of complications associated with any procedures performed, including the rare, since a timely diagnosis is necessary for their patients’ adequate care. Hernia surgeons can minimise this complication by improving their suture technique and avoiding bridges of exposed barbed sutures.
TOTALLY EXTRAPERITONEAL INGUINAL HERNIA REPAIR IN A PATIENT WITH CEREBRAL PALSY
Authors: Nanda A , Rao C , Gerogiannis I 
Published: May 2024

Abstract

Aim
Cerebral Palsy (CP) is a group of neurological disorders that affect movement, muscle tone and coordination with the appearance of muscle stiffness, weakness and involuntary movements. Although there is no direct correlation with inguinal hernia, people with CP may be at greater risk of developing hernias due to factors such as chronic constipation, frequent coughing, or physical stress. We present a video highlighting all the difficulties faced in this minimally invasive approach.

Material and Methods
A 66-year-old woman with CP, without mental but with many mobility problems, presented in outpatient clinic with right groin discomfort. On clinical examination, the inguinal hernia was difficult to identify, but it was confirmed by an ultrasound scan. The patient requested a laparoscopic approach hoping for faster recovery and less hospital stay.
After placing the patient on the operating table with special supports and the left leg flexed, through an incision in the right upper quadrant of the abdomen, the endoscope was inserted with a visiport of 10 mm in the retrorectus space. Preperitoneal space was dissected with CO2 and with the use of a 0 degree endoscope. Two additional 5 mm ports were inserted in the lower midline. The pubic symphysis and inferior epigastric vessels, due to their location and distorted anatomy in this area, were very difficult to identify initially. The hernia sac was identified and reduced. A mesh of 15 × 10 cm was placed in the preperitoneal area without fixation.

Results
The patient's postoperative course was smooth, but her discharge was delayed due to the need for extensive physiotherapy. At follow-up at 12 weeks, patient was well and free of symptoms from the groin area.

Conclusion
Laparoscopic inguinal hernia repair with the TEP technique in cases of patients with stiffness or movement disorders has several difficulties and requires advanced laparoscopic skills. Careful patient selection and accurate consent of the patient mentioning the increased likelihood of conversion to an open method are essential.
TOTAL EXTRAPERITONEAL ENDOSCOPIC DEEP INGUINAL EXPLORATION FOR LYMPH NODE BIOPSY
Authors: Zárate Gomez J , Álvarez de Sierra P , Peinado Iríbar B , Supelano Eslait G , Cano Alonso R , Salazar Palacio C , Gil López J M , Merello Godino J 
Published: May 2024

Abstract

Background
TEP (Totally ExtraPeritoneal) technique is used for inguinal hernia treatment. It is now considered a basic technique in minimally invasive abdominal wall surgery and the door to more complex procedures. In high volume centers this approach can be used for purposes other than reconstructive.

Method
We present the clinical case of a 44-year-old patient with a history of multiple lymph nodes located in the axilla and pelvic areas, with no pathologic histologic findings since 1992, after several surgical samplings (follicular lymphoid hyperplasia in all specimens). Bone marrow biopsy in 2020 highly suspected a non Hodgkin lymphoma, it did not correlate with periferal biopsy results, all of which rendered inconclusive results.
In 2023, in image follow-up by PET-CT scan revealed a high PDF uptake (SUV 17,9) located in a bulky node (38 × 32 mm) in the right exernal iliac area. As a highly experienced surgical group in TEP hernioplasty, an endoscopic preperitoneal exploration and lymph node biopsy was indicated to avoid open surgery.

Result
An outpatient surgery was succesfuly performed. An en-bloc sample was obtained. There were no intraoperative or postoperative complications.
Pathologic findings: Low-grade Non-Hodgkin Lymphoma IV-B IPI-2.

Conclusion
The Totally Extraperitoneal access can be used not only for inguinal hernioplasty but also for other indications such as a selective deep inguinal lymphadenectomy.
PATIENT CASE STUDY: REBUILDING A PATIENT’S LIFE NOT JUST THEIR ABDOMINAL WALL – EXPERIENCE FROM A TERTIARY HERNIA CENTRE ON THE IMPACT OF ABDOMINAL WALL RECONSTRUCTION ON QUALITY OF LIFE
Authors: Birch A , Cocciolo F , Alabbasi I 
Published: May 2024

Abstract

Introduction
Abdominal wall reconstruction is a transformative intervention, significantly improving the quality of life for individuals with complex defects. This paper focuses on sharing a patient's experience post-surgery.

Case Presentation
The patient presented with a complex incisional hernia following a laparotomy, Hartmann’s procedure and splenectomy for perforated diverticular disease. Their CT scan showed a 16.5 × 17.5 cm defect, with a separate component involving their colostomy and lateral displacement of their muscle complexes. The hernia significantly impacted the patient's quality of life, manifesting as daily moderate pain that hindered routine activities. They required daily dressings and antibiotics due to skin changes over the hernia. Furthermore, dissatisfaction with the cosmetic appearance of the hernia contributed to the overall burden on the patient.

Management and Outcomes
The patient underwent pre-operative botulinum toxin injections six weeks prior to their abdominal wall reconstruction. They received 200 units divided equally between internal and external obliques. During their surgery they required a left sided transversus abdominus release and an &gt;5cm mesh overlap was achieved in all directions. A post-operative CT scan conducted ten days after the surgery revealed no complications. The patient's recovery progressed well, leading to their discharge 12 days post-surgery.

Discussion
The patient was reviewed nine months post-surgery. Expressing high satisfaction with the surgical outcome, they conveyed a profound positive impact on their quality of life. The patient's newfound confidence in the improved cosmesis of their hernia was evident. Overall, the surgery proved transformative, liberating the patient from the burdens of frequent medical appointments and instilling a renewed sense of self-assurance.
MESH FIXATION IN INGUINAL HERNIA REPAIR: ARE WE CLOSE TO A DEFINITIVE SOLUTION?
Authors: Casali A , Latham L , Soldini G , Intelisano A , Antonini I , Musolino C , Scalambra S M 
Published: May 2024

Abstract

Introduction
Inguinal hernia repair is the most performed surgical procedure and one of the most serious post-operative complications is still chronic pain, literature describes rates of chronic pain of 5–10%.
Laparoscopic repairs can prevent post-operative pain due to a minimally invasive approach reducing the manipulation of the layers covering nerves and vessels in the inguinal area.
The use of staples to fix the mesh could cause post-operative pain, for this reason in the last decade several studies comparing glue fixation to staples have been performed, showing better results for chronic pain and no differences in recurrence rate.
In these last years a step forward has been done, the comparison between glue fixation versus no fixation at all, granted by the tridimensional shape of some meshes in order to reduce the operating costs. These studies showed no difference between glue fixation and no fixation in the recurrence rate.

Materials and Methods
From 15th of January 2023 till now we performed 100 laparoscopic inguinal hernia repairs, 55 for bilateral inguinal hernia and 45 for monolateral hernia, median age was 58 yrs old.
36 of them were treated with TEP technique (9 with non-absorbable tacks and 27 without fixation), 64 with TAPP technique (2 with non-absorbable tacks and 62 without fixation).
The median operating time was 50 minutes, in the TAPP group 18 direct hernias were detected and the difect was closed with an absorbable running suture, in the TEP group 7 direct hernias were detected and no suture of the defect was performed.
Intraoperative complications were: in the TAPP group 1 bladder lesion treated with direct suture, in the TEP group 1 mild bleeding.
Post-operative complications were: 1 rectus hematoma treated laparoscopically and 29 cases of seroma (13 bilateral, 16 monolateral).

Results
After 6 months of follow up no recurrence was detected, 1 case of moderate post-operative pain (nociceptive pain: painscore 9) was treated with anti-inflammatory medicines.

Discussion
Laparoscopic repairs of inguinal hernia nowadays should provide an easy recovery to the normal quality of life with reduction of social costs. Our results show that no mesh fixation could be performed safely with good results concerning the percentage of recurrences.
LAPAROSCOPIC REPAIR OF NON-MIDLINE VENTRAL HERNIAS: A SINGLE CENTER EXPERIENCE
Authors: Di Flumeri G , Mazzari A , Pedullà G , Tomaiuolo P M C , Sionne F , Crucitti A 
Published: May 2024

Abstract

Background
The laparoscopic intraperitoneal onlay mesh (IPOM) technique for the repair of non-midline ventral hernias (NMVH) is technically difficult and still controversial. The aim of this study is to retrospectively analyze our single center experience in the last 20 years performing the IPOM technique to NMVH.

Method
Between 2012 and 2022, 816 patients with ventral hernia underwent surgery using the IPOM technique, among these 101 were NMVH. We retrospectively analyzed peri- and post-operative complications in terms of clinical data and defect characteristics. Furthermore, NMVH data were compared with those of the midline ventral hernias group (MVH).

Results
Neither the clinical data nor the defect characteristics had a statistically significant impact on peri- and post-operative complications in the NMVH group (P &gt; .05). Post-operative complication rate was 14.8% in the NMVH group and 13.6% in the MVH group (P &gt; .05). Chronic postoperative pain was 2.9% in the NMVH group and 1.6% in the MVH group (P = .03). Recurrence rate was 2.9% in NMVH and 3.5% in MVH group (P &gt; .05).

Conclusion
Laparoscopic IPOM for non-midline incisional hernias is safe and feasible also in our experience. However, it may require the use of specific technical precautions and a more appropriate perioperative framework. Statistical analysis comparing non-midline with midline defects has documented similar rates of conversion and post-operative complications. Chronic postoperative pain has resulted statistically significantly higher in the non-midline group. Instead, the recurrence rate has resulted lower in the non-midline group, although without statistical significance.
WHICH IS THE PLACE OF BIOSYNTHETIC MESH IN COMPLEX ABDOMINAL WALL RECONSTRUCTION?
Authors: Dutu C , Florea I , Albita O 
Published: May 2024

Abstract
Incidence of incisional hernias following midline laparotomy is 20–41% after 2–4 years. CAWR (complex abdominal wall reconstruction) may be needed after due to wound contamination, loss of domain, extraction of intraperitoneal mesh, emergency enterotomies or the component separation or other complication. Biosynthetic mesh reinforcement during CAWR has significantly improved outcomes through the gradual resorption process resulting in a steady decline in mechanical strength with sufficient time to remodel.
Our aim was to review the experience of our team using both polypropylene (PP) mesh and biosynthetic mesh over 12 months. A total of 40 patients with CAWR were examined (21 with PP mesh and 19 with biosynthetic mesh). Age, sex, BMI, comorbidities, mVHWG class, previous recurrence, mesh location, presence of component separation, post-operative complications were collected. The short-term results showed a significant reduction of SSO (surgical site occurrence) and shorter hospitalization when biosynthetic meshes were used. The recurrence at 6 and 12 months was similar in both groups.
The results of this investigation demonstrate that biosynthetic mesh repair provides strength beyond the scope of its resorption profile with positive early outcomes and similar recurrence when compared to PP mesh. Furthermore, the use of a biosynthetic mesh in the context of contamination could offer a viable alternative to a permanent mesh prosthesis.
PROPHYLACTIC BIORESORBABLE ONLAY MESH FOR INCISIONAL HERNIA PREVENTION IN MIDLINE SURGERY – PRELIMINARY RESULTS
Authors: Fortelny R H , Silberhumer G 
Published: May 2024

Abstract

Background
Prophylactic mesh implantation during elective midline laparotomies has to be considered in patients at high risk of developing an incisional hernia. The implantation of a permanent synthetic mesh has been proven based on randomized controlled trials. The effectiveness of bioresorbable meshes with prevention mesh-associated complications in the long term has still to be confirmed.

Method
The design of this a prospective, single-arm, multicenter, across Austria (PROMIS-study) using a bioresorbable prophylactic mesh of poly-4-hydroxybutyrate in onlay position in patients at risk undergoing elective and emergency gastrointestinal surgery by midline incision. The primary endpoint of the study is to detect Surgical Site Infection (SSI) up to the 3-month and incisional hernia in 3 years follow-up.

Results
Up to now 30 patients were included. 73.3% (22/30) underwent colorectal surgery due to carcinoma. The incision length was median 18,5 cm and the size of the applied mesh was median 23 × 8 cm. No perioperative complications were seen. In the 3 months follow up in 3 patients SSI and in 2 patients seroma formation were detected. In the 12-month follow up of 15 pat. (50.0%) no further complications or incisional hernia were seen.

Conclusions
The results of this interim analysis of the PROMIS study obtained a low rate of SSI and seroma formation without an occurrence of an incisional hernia. Compared to the recent systematic review of prophylactic mesh the results of the interim analysis of the PROMIS study can be rated as promising.