bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOES THE OPEN PREPERITONEAL HERNIOPLASTY DECREASE THE RATE OF CHRONIC GROIN PAIN? AN ANALYSIS OF OUR SERIES
Authors: Ruíz Marzo R , Otegi-Altolaguirre I , Rico-Arrastia A , Blázquez-Lautre L , Sebastián-Labayen J L , González-Tolaretxipi E , Arana-Iñiguez I 
Published: May 2024

Abstract

Background
International guidelines list an overall incidence of chronic postoperative groin pain of 10 to 12%. With the analysis of our series, we intend to demonstrate the lower rate of postoperative chronic groin pain in open preperitoneal approach.

Method
We present the retrospective analysis of the patients operated on in our centre of inguinocrural hernia between January 2017 and June 2022 using open preperitoneal hernioplasty. We include both primary and recurrent hernias, as well as those operated both on a scheduled and urgent surgery.
Regarding the surgical technique, we use polypropylene meshes fixed with stitches of long-lasting resorbable monofilament. A visit is made a month after the intervention, where postoperative pain is assessed quantitatively, among other items, using a VAS scale. We consider as chronic pain the presence of it with a VAS &gt; 3 for 6 months or more. In case of pain, we carry out follow-up and referral to the Unit of Pain.

Results
In this period studied, 544 patients (173 primary hernias and 371 recurrent hernias) were operated on using this technique. Five patients with chronic postoperative pain were registered (0.9%), who continue to be followed up by us and the Unit of Pain.

Conclusions
The open preperitoneal approach shows excellent rates of postoperative chronic pain because the preperitoneal space is accessed anatomically away from the iliohypogastric and ilioinguinal nerves.
In conclusion, both the literature and our series show that open preperitoneal approaches produce less neuroinjury than anterior or posterior laparoscopic approaches.
EVALUATION OF ROBOTIC TRANSABDOMINAL PREPERITONEAL INGUINAL HERNIA REPAIR (RTAPP) IN OUR HOSPITAL
Authors: Saito T , Ando M , Shinohara K , Ueda S , Yasui K , Osawa T , Matsumura T , Fukami Y , Komatsu S , Sano T 
Published: May 2024

Abstract

Background
Robot-assisted surgery, particularly RTAPP utilizing the da Vinci Surgical System, has been recognized for its potential to enhance surgical precision in inguinal hernia repairs. In December 2018, our hospital established a time-limited task protocol alongside initiating RTAPP. This protocol divides the surgery into three phases: peritoneal dissection, mesh placement, and peritoneal suturing, aiming to enhance patient safety and surgical efficiency.

Methods
This retrospective review analyzed RTAPP procedures from December 2018 through November 2023, assessing operative times, complication rates, recurrence rates, adherence to our innovative time-limited protocol, and the progression of the surgical learning curve.

Results
The analysis included 66 patients (101 lesions; 35 bilateral, 31 unilateral), predominantly male (62 males, 4 females), with a median age of 73 years and a BMI of 24.2 kg/m². Lesions were categorized into 55 indirect and 46 direct types. Median operative and console times were 126 and 88 minutes, respectively. Complications were minimal, including one seroma, one SSI (both Clavien-Dindo grade I), and one injury to the inferior epigastric artery, all adhering strictly to the protocol. The learning curve demonstrated stabilization after 38 procedures.

Discussion
Our protocol for RTAPP significantly improved early safety and efficiency. Strategic planning and focused training were essential for integrating this technology effectively.

Conclusions
RTAPP has effectively met the challenges of inguinal hernia repair for introduce, enhancing surgical precision and patient safety. The structured protocol facilitated rapid proficiency among surgeons, demonstrating the technique's significant potential for improving robotic-assisted surgeries.
POSTOPERATIVE RESULTS AND QUALITY OF LIFE AFTER INGUINAL HERNIA REPAIR. COMPARATIVE BETWEEN OPEN AND LAPAROSCOPIC REPAIR OF 466 INGUINAL HERNIAS
Authors: Sánchez Sáez E , Valverde E S , Mercader Bach C , Orbeal Saenz R , Silvio Estaba L , Corredera Cantarín C , Díaz Padillo A , Guasch Marcé M , Jurado Ruiz C , Pareja Nieto E , Comajuncosas Camp J 
Published: May 2024

Abstract

Objective
The objective of this study is compare the postoperative results of open and laparoscopic inguinal hernia repair.

Material and Methods
Retrospective cohorts from a prospective database of inguinal hernia repair between December 2016–December 2021. The variables analyzed are: demographic data, intraoperative and postoperative, quality of life evaluated with EVA, Carolina Comfort Scale (CCS), postoperative complications and recurrence.

Results
466 patients were included (85.4% man). 212 cases (45.5%) were open and 254 (54.5%) laparoscopic. The average follow up is 13 months (11–26). The laparoscopic treatments were trans abdominal pre-peritoneal (TAPP). There were no differences in complications (p = 0,763), Clavien-Dindo classification (p = 0,106), seroma (p = 0,155), hematoma (p = 0,152), wound infection (p = 0,463), recurrence (p = 0,290). According to quality of life at 1 month follow up there were significant differences CCS = 0 (39,1% laparoscopic vs. 11,8% open, p = 0,038), no significant differences at 6 month and 1 year follow up. The EVA scale alt 6 month follow up were less in laparoscopic but no significant (p=0,085 & p = 0,063). At 1 year the laparoscopic approach had better pain control (EVA p = 0,016 i EVA = 0 p = 0,018).

Conclusions
According to this study in our center, laparoscopic and open approach have comparable results in postoperative complications at 30 days and no differences in recurrence. The laparoscopic treatment have better quality of life at 1 month follow up and this trend remains at one year follow up with no significance.
RANDOMIZED CONTROLLED TRIAL (RCT) ON PREOPERATIVE CESSATION VS NO PREOPERATIVE CESSATION OF ASPIRIN IN LAPAROSCOPIC INGUINAL HERNIA REPAIR
Authors: See I , Lee S , Arunoda P , Wijerathne S , Loo L , Lomanto D 
Published: May 2024

Abstract

Background
The incidence of inguinal hernia is increasing in view of the ageing population worldwide. Cardiovascular and cerebrovascular co-morbidities are the commonest indications for use of anti-thrombotic agents (including aspirin) in this age group. This highlights the need to understand risk of adverse thromboembolic events like acute myocardial infarction and strokes (when ceasing aspirin) versus risk of bleeding (when not ceasing aspirin) in patients undergoing laparoscopic inguinal hernia repair.

Method
A prospective RCT was designed to recruit 100 patients with either unilateral or bilateral reducible inguinal hernia undergoing laparoscopic inguinal hernia repair in a tertiary hospital. Exclusion criteria include patients who are unfit for general anaesthesia, had obstructed or strangulated hernias. Primary outcome was post-operative bleeds while secondary outcomes included post-operative thromboembolic events, surgical-site infections, and duration of hospitalisation.

Results
Our interim results reveals 65 patients recruited since 2015. 30 have been randomised to continue aspirin preoperatively (46.2%) while 35 have been randomised to stop aspirin 5 days preoperatively (53.8%). Most patients were male, had similar mean BMI (23.6 vs. 24.0), American Society of Anaesthesiologists (ASA) grading, had primary bilateral hernias and comparable mean defect size. There was no statistically significant difference in all post-operative complications. Mean follow up duration was 190.9 days.

Conclusion
Aspirin vs. no aspirin cessation preoperatively had no statistically significant difference between post-operative bleeding or thromboembolic events. This study challenges the practice that aspirin needs to be withheld before an elective laparoscopic inguinal hernia repair.
HYBRID TECHNIQUE VS LAPAROSCOPIC IPOM FOR LARGE VENTRAL HERNIA REPAIR
Authors: Serdarov N , Ymamgulyev J , Mamenov S 
Published: May 2024

Abstract
The aim of this study is to investigate the immediate and long-term outcomes of a hybrid technique for abdominal wall repair, which combines open and laparoscopic methods, compared to the laparoscopic IPOM method.
The study involved 58 patients with ventral hernias (22 primary, 36 postoperative) who underwent surgery using either the laparoscopic IPOM method or the hybrid method (laparoscopic IPOM with open access). The patients were divided into two groups: the first group underwent the standard laparoscopic IPOM procedure, while the second group underwent the hybrid technique of operation. The size of the hernia orifice was distributed as follows: 46 patients had W2 hernias, and 12 patients had W3 hernias. The main evaluated parameters included the duration of the operation, hospital stay, the occurrence of early postoperative complications (seroma, postoperative wound infection), and the occurrence of hernia relapse.
Thirty patients underwent laparoscopic IPOM ventral hernia repair, while a combined open and laparoscopic hernia repair (hybrid technique) was used in 28 patients. The open stage of the hybride method provided separation, reduction, and closure of the hernia sac, while the laparoscopic procedure consisted of adhesion dissection, mesh placement, and fixation. A composite mesh was used in all cases.
In the first group, there were three cases of seroma formation and two recurrences. Seroma formation and hernia relapses were not detected in the second group. The use of the hybrid method in surgery for patients with W2 and W3 hernias saved time during the operation and reduced immediate postoperative complications.
A CHALLENGING CASE OF MANAGEMENT OF AN INFECTED MESH WITH LAPAROSCOPY, ADHESIOLYSIS AND REMOVAL OF THE MESH
Authors: Shah I , Kapsampelis P , Gerogiannis I 
Published: May 2024

Abstract

Aim
To present a challenging case of an infected mesh in an obese patient managed with a combination of laparoscopy and open incision.

Material and Methods
An 57-year-old woman with diabetes type 2, obstructive sleep apnoea requiring Continued Positive Airway Pressure (CPAP) and a BMI of 43 presented to be seen in the outpatient clinic. Her visits were related to a infected mesh in her right upper quadrant of the abdomen as a result of a laparoscopic repair of incisional hernia post open cholecystectomy 13 years ago. The CT scan confirmed an infected mesh.
A laparoscopy approach was used initially. Insufflation: Optic trocar COz 17 mmHg (left paramedian line).
Ports: Leftt 10 mm, 2 × 5 mm LUQ and lower epigastric (midline).
Findings: Laparoscopy: Adhesions of the omentum with the anterior abdominal wall, Cirrhotic liver, hepatic flexure below the area of the infected mesh but without any obvious colonic fistula.
Open incision for fistulectomy: Long thick tract leading to preperitoneal space. Large cavity containing an infected mesh 15 × 15 polypropylene mesh. Metallic tacks present in the cavity.

Procedure
Adhesiolysis. Findings as above. Simultaneously laparoscopy and open exploration of the area of the fistula was performed with a surgeon on each side. Fistula was removed intact. A preperitoneal cavity was found which was the source of infection. Mesh was removed intact with tacks on. Sent for micro. Very good wash of the cavity with betadine.
Exploration laparoscopically. Hepatic flexure was below the area of the infected mesh. As there was a suspicious area which might corresponded to a colonic fistula, further adhesiolysis was performed. The hepatic flexure was mobilised making sure that there was no bowel involvement. In order to maintain bowel wall and avoid injury, an area of the peritoneum was left on the bowel. Right colon was checked for injury – negative. Peritoneal defect was closed with 1 prolene (× 2) interrupted sutures with endoclose device. A 30 Fr Robinson's drain was left in the Rt paracolic gutter via the lower 5 mm port. Exsuflation of COz, extraction of trocars. Closure of the anterior abdominal wall with J PDS interrupted. 14Fr Redivas in the subcutaneous tissue.

Results
The patient's postoperative course was uneventful. She was discharged the 5th post operative day. At 3 months follow-up the patient is well and asymptomatic with a small induration of the skin in the area of the previous infection.

Conclusion
Mesh infection is a devastating complication. A surgeon with an interest and experience in abdominal wall surgery can offer a safe and efficient approach to these cases.
GIANT HIATAL HERNIA WITH ACUTE MANIFESTATION OF COMPLETE ESOPHAGEAL OBSTRUCTION: CASE REPORT
Authors: Schutz S O , Pazin J , Husarova T , Havlova K , Koblihova E , Pohnan R 
Published: May 2024

Abstract

Introduction
Hiatal hernia is a common condition with rising incidence in western society. The prevalence rises in patients with morbid obesity, age and female gender. Up to 95% are sliding hernias, often asymptomatic or causing symptoms typical for gastroesophageal reflux disease, 5% are paraesophageal hernias which according to the grading may be asymptomatic. Symptomatic hernias are associated with more severe symptoms, higher rate of complications and need of acute surgical management.

Case Presentation
We present a case of a 64-year-old female patient with BMI 39 and acute upper abdominal pain, nausea and vomiting. Computed tomography showed giant paraesophageal hernia containing the entire stomach, oral part of duodenum with D2 stenosis and head of the pancreas. We performed laparoscopic reposition of giant hernia and Nissen fundoplication. Defect was reconstructed with semi-absorbable mesh, gastropexy to diaphragm was performed and Jackson-Pratt drain was inserted in the remaining cavity. The patient was discharged on day 6. Post-operatively tolerating liquids. One month later, the patient presented with inability of per os consumption and vomiting. Computed tomography verified impacted solids in distal esophagus along with compression by seroma in mediastinum. Acute gastroscopy was performed and mechanical clearance of impacted food was accomplished. CT navigated percutaneous drainage of collection was considered, but was technically unfeasible. Further course of hospitalization was uneventful and the patient was discharged tolerating liquid diet.

Discussion
Postoperative therapy and rate of complications in grade IV giant paraesophageal hiatal hernias is challenging, burdened by high morbidity including long-term seroma formation.
SIMULATED ABDOMINAL WALL — A VALUABLE EDUCATIONAL TOOL FOR ABDOMINAL WALL RECONSTRUCTION AND SMALL BITE CLOSURE TECHNIQUES
Authors: Smith O , Ritchie C , Aylward K , Green S , Chitsabesan P , Chintapatla S 
Published: May 2024

Abstract

Background
Incisional hernia is a common complication following laparotomy and may require reconstructive repair techniques. Studies suggest that poor closure contributes to incisional hernia. European and American guidelines have suggested closing with the "small-bites technique". Junior trainees are often left to close the abdominal wall and may be unfamiliar with such techniques. Simulated training has gained traction. Reduction in theatre training hours necessitates simulated training.

This study aims to
generate a synthetic abdominal wall model use this model as a simulated training tool for general/plastic surgical trainees for closure and reconstructive abdominal wall repair techniques

Method
2021: literature search and research. Theatre observation of complex abdominal wall procedures and techniques. Cadaveric lab attendance at Leeds University.
2022: prototype – first model produced from medial grade silicone
2022: amendments – alterations to the prototype
2023: accreditation and delivery – Small Bites Course delivered and accredited by RCS Edinburgh.

Results
86% of course attendees found the abdominal wall models "as realistic as possible". Attendees felt more confident to perform small bites closure and simple abdominal wall reconstruction. Total cost saving per model compared with competitors = £1109.50.

Conclusion
Our simulated abdominal wall model is realistic and cost effective. It is an ethical and improved way to train junior surgeons in the small-bites technique and some elements of abdominal wall reconstruction. These models have been implemented on training courses for surgical trainees within the deanery.
LICHTENSTEIN INGUINAL HERNIA REPAIR WITH TRASVERSALIS PLICATION. IS PLUG STILL NECESSARY?
Authors: Soldini G , Latham L , Casali A , Intelisano A , Antonini I , Musolino C , Callipari R , Scalambra S M 
Published: May 2024

Abstract

Introduction
Inguinal hernia repair with Lichtenstein technique is one of the most widespread surgical procedure in the world.
Almost 20 million people undergoes inguinal hernia repair in a year all over the world, for what it concerns in Italy a number of 150 000 patients per year.
75% of all hernias are monolateral and the risk of having an inguinal hernia is 27% for male patients and 3% for female patients.
The golden standard technique for the open approach is the tension free approach Lichtenstein – Amid.
Some considerations need to be made for the use of the hernia plug.
In literature the use of the plug is associated to some complications: chronic pain, lesions of the deferent duct, lesions of small bowel, and some anecdotal complications as migration into the bladder and migration into the ileum or into the colon as well (Int Surg (2019) 104 (1–2): 16–20.)
To avoid these complications in the last decades some hernia centers are avoiding the use of the plug during inguinal hernia repair.

Materials and Methods
We report our experience in the open inguinal hernia repair with Lichtenstein – Amid repair without plug.
From 15th of January till now we performed 238 Lichtenstein – Amid repairs for inguinal hernia. Before positioning the mesh we performed the trasversalis recostruction with an absorbable running suture reducing the inner inguinal ring to 1 cm diameter (Gilbert classification type I).
All the inguinal hernia repairs were for primitive hernia, 234 were male patients and 4 were female patients, 20 cases were scrotal – inguinal hernias.

Results
The median operation time was 45 minutes, intraoperative complications were represented only by 1 lesion of the testicular vessels esitated in an orchiectomy. Post-operative complications were: 2 hematomas, 4 seromas, 7 moderate inguinal pain.
After 6 months of follow-up no chronic pain was detected neither major complications.

Discussion
“Modified” Lichtenstein-Amid technique, performed by experienced surgeons, is a safe procedure for inguinal hernia repair with a small risk for intraoperative and postoperative complications. It is also a fast and cheap procedure in terms of operative time and materials costs avoiding the use of plug.
THE MANAGEMENT OF INGUINAL HERNIA REPAIR DURING THE COVID-19 PANDEMIC — A NATIONWIDE, RETROSPECTIVE COHORT STUDY FROM SWEDISH HERNIA REGISTER
Authors: Stolt R , Ruiz-Jasbon F , Österberg J , Ticehurst K , de la Croix H 
Published: May 2024

Abstract

Aim
Inguinal hernia repair (IHR) in Sweden is mainly performed in elective daycare setting. As the COVID-19 spread rapidly and caused global pandemic in 2020, the Swedish healthcare initially postponed all elective surgeries to reallocate their sources. Our aim is to investigate the impact of COVID-pandemic on IHRs and the clinical outcomes in short- and long-term.

Methods
Retrospective cohort study from Swedish Hernia Register (SHR) on data from 109 656 inguinal hernia repairs between 2015–2021 to compare the quality of IHRs before and during the pandemic. The results are presented according to STROBE checklist after using multivariate logistic regression analysis to calculate the complication risks.

Results
In 2020, inguinal hernia repairs reduced by 22,3%, going from 16321 repairs/year to 12686 repairs. Notably, the percentage of acute IHRs increased from 4,8% to 5,7% as the elective surgery decreased. The risk for emergent IHR was higher for patients &gt;70 years (OR 4:53, p = 0.039) and ASA score &gt;3 (p &lt; 0.001), and highly associated with severe postoperative complications (Clavien-Dindo 3b-5) within 30 days (OR 3,85, p &lt;0.001). The 30-day mortality and recurrence rates did not differ between the groups.

Conclusions
We noticed a slightly increased number of acute IHRs for older patients with higher comorbidity during the initial phase of pandemic. Despite that, the presumed level of IHRs was reached by the end of 2021 without increased overall complication rates.
A RARE CASE REPORT OF ROBERTS-SC PHOCOMELIA SYNDROME
Authors: Tavakkoli N 
Published: May 2024

Abstract

Introduction
Phocomelia is a condition that occurs in rare cases where the proximal aspect of an extremity is absent and has been associated with various syndromes. Among them, Robert's syndrome is one of the most common cases. Roberts-SC phocomelia syndrome is a malformation that has an autosomal recessive inheritance pattern and is determined through skeletal deformations, particularly symmetrical limb reduction and craniofacial anomalies.

Case Presentation
The fetus was referred to our center followed by legal abortion in the 13th week of pregnancy. In the ultrasound report of the fetus at the 12th week, hypoplasia of the limbs and agenesis of the lower vertebrae of the spine were noted. In the physical examination, multiple congenital anomalies such as short stature, severe shortness of four limbs, oligodactyly, low-set ears, and micrognathia were seen. The family history, clinical, and radiographic examination were performed. Considering that many phocomelia syndromes were suspected in the differential diagnosis, thus WES was recommended for the evaluation of this fetus. WES was done using the Illumina platform and Agilent SureSelect V7 library preparation kit.
The homozygous (c.417del; p. Lys139AsnfsTer6) mutation in ESCO2 was identified in the fetus. Confirmation of this mutation and evaluation of the unaffected parents were done by Sanger sequencing. The parents were heterozygous.

Conclusion
Roberts-SC phocomelia syndrome can be attributed to a homozygous mutation in ESCO2, as confirmed by our findings. Genetic counselling for this couple and other relatives is highly recommended as the first line of prevention and leading to effective prenatal diagnosis.