bluuebunny/crossref_metadata_2025_split huggingface dataset:
V-005 A CASE SERIES DEMONSTRATING APPLICABILITY OF LAPAROSCOPIC MANAGEMENT OF STRANGULATED OR INCARCERATED HERNIAS IN EMERGENCY GENERAL SURGERY
Authors: Latif J , Bandlamudi N , Bhatti I , Awan A , Brazkiewicz M 
Published: October 2022

Abstract

Aims
Acute small bowel obstruction secondary to strangulated hernias is a presentation often encountered during the acute surgical take. Despite the widespread use of a minimally invasive approach for elective hernia surgery, there is a significant reduction in use of laparoscopy in the emergency setting. We aim to describe a case series on the applicability of laparoscopy in the management of emergency strangulated or incarcerated hernias.

Materials
We describe 4 cases of patients who presented with acutely strangulated or incarcerated hernias as an emergency to a single centre in the United Kingdom. The cases demonstrated include inguinal, femoral, obturator and spigelian hernias, each presenting as an acute emergency with concomitant small bowel obstruction.

Results
The patients underwent emergency surgery using a laparoscopic approach for repair of strangulated or incarcerated hernias and assessment of obstructed small bowel. Where indicated, small bowel resection and primary anastomosis was undertaken when viability of affected segment of bowel was compromised. All procedures were completed laparoscopically, with no recurrence occurring in these patients during the follow-up period.

Conclusion
Minimally invasive surgery is an important tool in the armamentarium of the acute care surgeon. A laparoscopic approach will reduce the insult of intervention in already physiologically deplete patients. This case series demonstrates the feasibility of laparoscopy in the management of strangulated or incarcerated hernias in the emergent setting, requiring advanced laparoscopic skill as demonstrated in this video.
V-006 SIMULTANEOUS TREATMENT OF VENTRAL HERNIAS & GROIN HERNIA & RECTUS ABDOMINIS DIASTASIS BY LAPAROSCOPIC E-TEP REPAIR
Authors: Trujillo Díaz J , Jezieniecki Fernandez C , Gomez Lopez J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C 
Published: October 2022

Abstract

Aims
Ventral hernias are a frequent pathology in general surgery.Its association with rectus abdominis diastasis and groin hernias is not uncommon.Currently, the minimally invasive approach of these pathologies is becoming more frequent.We present the usefulness of the e-TEP-approach to treat different types of hernias and diastasis at the same surgical-procedure.

Methods
Video-case presentation.

Results
73-year-old-man,surgical-histories:umbilical-hernioplasty with onlay-mesh and lap-sigmoidectomy. Physical-examination:midline ventral-hernia(M2–3W2:8cm),diastasis(6cm) and right groin hernia. CT-scan: midline ventral-hernia with small-bowel into the hernial-sac and small defect(15mm) in the right flank(L2).We decided to perform a laparoscopic-extraperitoneal-technique(eTEP).
We use 4 ports(2×12mm, 2×5mm).The surgery begins dissecting the left and right retromuscular space using a dissector balloon.We continue with the supraumbilical cross-over transecting the left posterior-sheath and then the right posterior-sheath and complete the dissection of the other retromuscular space.The dissection continues down to the pubis, dissecting the right groin space.We continue with the right-TAR,at this area we observe the lateral defect and continue the dissection on the preperitoneal-space.After that we continue with the closure of the posterior-sheath using 2–0 V-lock and the anterior-sheath using Monomax-loop-1.We placed a 3D-PVDF-mesh for right groin-hernia and 30×40cm-PVDF-mesh fixed with glue and left a drainage.The patient had a satisfactory evolution and was discharged in 2°POD.

Conclusions
The enhanced view totally-extraperitoneal approach (eTEP) is an effective and safe option in cases of ventral hernias associate with groin hernias and rectus abdominis diastasis,as in the case presented.Posterior component separation-techniques(TAR) allow us to achieve a correct and tension-free closure of the abdominal wall and place a wide mesh covering all hernial-defects.
V-010 LAPAROSCOPIC TAPP APPROACH OF A GRYNFELLT HERNIA
Authors: Medina Pedrique M , Aviles Oliveros A , Perez-Flecha Gonzalez M , De Robin Valle De Lersundi A , Cruz Cidoncha A , Rial Justo X , Guijarro Moreno C , García-Ureña M Á 
Published: October 2022

Abstract

Aim
To describe our laparoscopic transabdominal preperitoneal approach of a Grynfellt hernia.

Material & Methods
A female patient 69 years of age with no previous medical history came to our consultation with a chronic right lumbar bulge that produced local pain and discomfort. Preoperative CT scan showed a primary lumbar hernia with a defect estimated at 11cm. Laparoscopic approach seemed feasible and was accepted.

Results
The patient was placed on a left decubitus with the OR bed at a 45° angle. 3 trocars were used, one slightly lateral of the umbilicus for the camera, and for triangulation a subcostal 5mm and an 11mm trocar in the left flank. We started opening the peritoneum and performing preperitoneal space dissection. The hernia sac was identified and its contents were reduced. We closed the defect using a monofilament absorbable barbed suture with a running stitch. Once the defect was closed, we placed a medium-weight polypropylene mesh in a 3D “taco” configuration covering the defect with sufficient overlap. Both the mesh and the peritoneum closure were done using cyanoacrylate glue. No complications occurred and discharge was the next day.

Conclusions
Primary lumbar hernias are rare. Symptomatic hernias should be treated as they can lead to pain, discomfort, and a decrease in quality of life. Laparoscopic TAPP is a safe and simple way to access and repair these hernias, allowing an adequate space of dissection that permits the placement of a mesh tension-free with sufficient overlap, with a quick recovery time and minimal morbidity.
V-011 E-TEP RIVES STOPPA'S REPAIR USING ONLY 3 PORTS
Authors: Gadgil M 
Published: October 2022

Abstract
E-TEP RS repair has revolutionized ventral hernia surgery since the last few years.
Our modified technique uses only 3 ports (10mm, 5mm, 5mm), only one camera port, only one monitor, routinely available reusable trocars, no use of space creator balloons, only a single 10mm 30 degree telescope, no fancy energy sources; rather a novel, inexpensive autoclaveable bipolar cutter shear which not only makes it cost effective but also reproducible.
V-014 OPEN REPAIR OF PRIMARY LUMBAR HERNIA WITH PREPERITONEAL MESH
Authors: Katzen M , Sacco J , Tawkaliyar R , Colavita P , Augenstein V , Heniford B T 
Published: October 2022

Abstract
This video presents an open repair of a primary lumbar hernia with preperitoneal mesh performed at a high-volume hernia center. The patient was a 71-year-old female referred due to chronic pain from a primary hernia of the right superior lumbar triangle.
The patient was positioned in the left lateral decubitus position with the bed slightly flexed. A skin incision was created sharply, and electrocautery used to dissect subcutaneous tissue and superficial fascia, revealing the hernia contents.
Circumferential lysis of adhesions was performed with blunt and cautery dissection to release the hernia contents from the abdominal wall. Once the hernia contents were mobilized, they were then carefully reduced through the fascial defect. The hernia defect measured approximately 3.5×3.5 cm.
Next, the preperitoneal space was circumferentially developed. This was done primarily with blunt finger dissection, using a rolling motion to direct pressure towards the abdominal wall and sweep the peritoneum and other attachments down. Larger attachments are gently retracted and divided with electrocautery. The preperitoneal space was measured at 20×19 cm and the mesh trimmed to those dimensions. The mesh was carefully laid flat in the preperitoneal space. No mesh fixation was required.
Fascial edges were dissected free for 1–2cm surrounding the defect. Two running 1–0 PDS sutures were used to close the hernia defect. A closed-suction drain was placed superficial to the fascia to minimize seroma formation. The superficial fascia and dermis were closed in layers. The patient had a routine hospital course and was discharged on post-operative day 3.
V-015 ROBOTIC TARUP: TECHNICAL DETAILS AND INNOVATIVE METHOD OF FIXATION
Authors: Pecchini F , Esposito S , Casoni Pattacini G , Gozzo D , Trapani V , Piccoli M 
Published: October 2022

Abstract

Aim
With the recent evolution of minimally invasive hernia repairing techniques, robotic platform has exponentially gained consensus in the field of abdominal wall surgery, leading to the placement of retromuscolar synthetic meshes avoiding the need of extensive tissue dissection as the open approach.
Our aim was to describe the introduction of Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair (TARUP) at a referral centre for advanced mini-invasive surgery, by reporting the preliminary experience and the technical aspects of the procedure.

Material & Methods
We present a case of a 3 cm umbilical defect associated to supraumbilical diastasis in a young man undergoing TARUP with the Da Vinci Xi system. The robotic boom was placed on the patient's right side, with three trocars on the anterior axillary line. The outline for the mesh was marked by centering the hernia defect with transcutaneous needles to delineate the extent of dissection corresponding to mesh area. Intra-abdominal pressure was of 8–12 mmHg. A retromuscolar plane was created starting from the incision of the ipsilateral posterior rectus sheat. The hernia content was reduced. The junction between the anterior and posterior rectus fascia was incised to cross-over the linea alba and continue the dissection controlaterally. A 15×15 cm polypropylene mesh was positioned in the retrorectus space and fixed with cyanoacrylic glue tack.

Results
Intervention lenght was of 100 minutes. No intra- or post-operative complications occurred.
At present, no early recurrences were observed.

Conclusions
Robotic TARUP represents a safe and reproducible alternative in selected cases where retromuscolar mesh is preferred.
V-016 PARAHIATAL HERNIA: A RARE CASE OF DIAPHRAGMATIC HERNIA ROBOTICALLY REPAIRED
Authors: Pecchini F , Trapani V , Francescato A , Esposito S , Casoni Pattacini G , Gozzo D , Piccoli M 
Published: October 2022

Abstract

Aim
Parahiatal hernia is a rare type of diaphragmatic hernia, consisting in a adjacent but separated defect, lateral to the oesophageal hiatus and crus. It's not so familiar for surgeons, preoperative diagnosis is unlikely to be confirmed, and it is mostly found incidentally during intervention, leading to a complex and difficult repair.
We present a case of parahiatal hernia robotically treated with the aim of emphasizing how robotic system can successfully help surgeons in performing even unexpected confusing and challenging anatomic dissections and procedures.

Material and Methods
A 65-year-old woman underwent robotic parahiatal hernia repair at our Institution. Four robotic trocars were positioned along the transverse umbilical line with the additional Air-seal port at the periumbilical left side for assistant's use.
Dissection and isolation of both parahiatal defect and crural musculature were performed; the defect was closed with not absorbable barbed suture, conventional iatoplasty was also performed and a biosynthetic mesh was placed and fixed as a reinforcement.

Results
The duration of the intervention was of 100 minutes. No. intr- or post-operative complications occurred. Blood loss were inferior than 100 millilitres. The patient started oral intake at the second post-operative day and after discharged.
At six months no recurrences were detected.

Conclusions
Parahiatal hernia are rare entities of which surgeons should be aware. Robotic treatment is safe and feasible and it represents a good tool for a successful management.
V-022 HYBRID APPROACH E-TEP AND OPEN FOR COMBINED LUMBAR AND MIDLINE HERNIAS
Authors: Román García De León L , Polaino Moreno V , Muñoz Rodríguez J M , Serrano González J , Iglesias García E , Suárez Sánchez M , Gil Cidoncha L , López Monclús J 
Published: October 2022

Abstract

Aim
To present the case of a 61-year-old woman with a recurrent lumbar incisional hernia L4W3R (EHS Classification) associated with a primary midline hernia, as well as a proposed treatment by combined e-TEP and open approach.

Material and Methods
This is a 61-year-old woman with a personal history of obesity, with an open right nephrectomy and later onlay hernia repair.
She had a large lumbar eventration with an 11 cm defect (L4W3) associated with a primary midline hernia with rectus diasasis.
We performed a hybrid e-TEP approach for the midline hernia associated with lumbar open approach to perform a complete repair by reverse-TAR technique.

Results
The treatment of combined lateral and midline hernias remains controversial. In patients in whom the lateral hernia is the primary hernia, one of the proposed approaches would be to perform a posterior component separation from the lateral defect. This involves performing a reverse transverse abdominis release (reverse-TAR), opening the rectus sheath from the lateral preperitoneal plane.
In obese patients and with large defects, performing this step can be highly complicated due to the difficulty for correct visualization of the area.

Conclusions
We propose this combined approach, performing a minimally invasive surgery for the dissection of the midline defect, which allows us to perform in a simpler way later the approach from the side, as well as a better exposure and visualization of the area; thus allowing, despite the technical difficulty, the correct placement of a large mesh, which widely covers all the defects.
V-026 UTILITY OF THE LAPAROSCOPIC APPROACH IN INCARCERATED GROIN HERNIAS: A VIDEO-CASE REPORT
Authors: Jezieniecki Fernández C , Trujillo Díaz J , Herreros Rodríguez J , Ruiz Soriano M , Gómez Sanz T , Cabezudo Molleda G , Montes Manrique M , Beltran De Heredia Renteria J 
Published: October 2022

Abstract

Aims
Groin hernias are one of the most frequent pathologies in general surgery.Open repair remains the most widely used method.However,currently the minimally invasive approach is increasing, but the criteria or indications to use this approach in emergency surgery are still not entirely clear.

Methods
Video-case presentation.

Results
62-year-old-man,who came to the emergency-room for abdominal pain, nausea and vomiting, associated with a small painful lump in the right groin.Physical examination:abdominal distension and a painful lump in the lower region of the right inguinal-ligament, non-reducible,CT-scan:small bowel obstruction due to incarcerated femoral-hernia.We decide to perform an urgent surgical-intervention using a minimally-invasive-approach(Lap-TAPP).
A laparoscopic-TAPP-approach is performed with 3ports(1×12 and 2×5mm).An incarcerated small bowel is observed in the right-femoral-region with signs of distress and causes retrograde dilation of the small bowel loops,with meticulous pulling maneuvers reduction of the incarcerated small bowel is achieved.Peritoneal opening is performed and the Retzius and Bogros-space is dissected, subsequently the cord is dissected and the round ligament is sectioned,a 10×14cm PPL-mesh is placed.The peritoneum is closed with a 3/0V-Lock.Finally,we reviewed the small bowel and performed an invaginating suture on the incarcerated antimesenteric border.The patient presented a satisfactory evolution and was discharged the 1°POD.

Conclusion
Incarcerated inguino-crural hernia has a high risk of morbidity and mortality.The surgeon on call must have different technical resources to deal with this pathology.The Lap-TAPP approach allow us to check the viability of the incarcerated small bowel.In selected cases,experienced surgeons can perform laparoscopic small bowel resection and anastomosis in patients with necrosis or perforation.
V-029 TOTALLY ENDOSCOPIC SUBLAY (TES) REPAIR FOR L2-L3 INCISIONAL HERNIA
Authors: Munoz-Rodriguez J , Lopez-Monclus J , Roman L , Robin A , Blazquez Hernando L , Garcia-Urena M A 
Published: October 2022

Abstract

Aim
Endoscopic lateral incisional hernia (IH) repair provides advantages in terms of low infection rates and hospital stay when compared with open repair.

Material and Methods
62 years old men with a history of HTA and an open radical right nephrectomy for a renal tumor, developed a symptomatic iliac IH. L2–3 W2 according to the European Hernia Society (EHS) classification was clinically diagnosed and confirmed with a CT scan.
Full endoscopic abdominal wall repair with defect closure was proposed.
3 trocars in right retrorectus space were placed. Once the lateral edge of the rectus sheath is reached, the posterior rectus sheath is incised, access to the preperitoneal lateral plane. During hernia sac dissection, an opening of the hernia sac occurs. The posterior layer is closed by a barbed suture, an accessory trocar placement was necessary for the closure. Subsequently, the internal oblique and transversus abdominis muscles that formed the defect were approximated with a barbed suture.
During dissection, a right inguinal hernia was identified and repaired.
A trimmed 20 x15 cm polipropilene mesh is placed in the preperitoneal space without fixation.

Results
The patient was discharged on the 3rd postoperative day without complications. Follow-up in the outpatient clinic at 6 months did not show any signs of recurrence.

Conclusion
Endoscopic abdominal wall reconstruction with posterior component separation is an alternative to the open procedure for lateral IH, providing a complete abdominal wall repair. The mesh is placed extraperitoneal with the advantages in terms of less adhesions and postoperative pain.
V-030 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR OF A RIGHT SPIGELIAN HERNIA USING BIOSYNTHETIC (N-BUTYL CYANOACRYLATE) GLUE FOR MESH FIXATION AND PERITONEAL FLAP CLOSURE
Authors: Chatzimavroudis G , Kyriakidou D , Hadjichristou E , Tsompanis D , Atmatzidis S , Raptis D , Kiroplastis K , Papaziogas V 
Published: October 2022

Abstract
Spigelian hernia consists one of the most uncommon anterolateral abdominal wall hernias (&lt;1%). The defect occurs at the spigelian fascia which is located lateral to rectus abdominis muscle along the linea semilunaris and is comprised of the transversus abdominis and internal oblique aponeuroses. Most commonly the defect is located at or below the level of arcuate line. Its diagnosis may be challenging because the aponeurosis of external oblique remains intact, leading to an intraparietal hernia, with no obvious bulge on inspection or even palpation of the abdominal wall in many cases. Computed tomography (CT) is the most reliable imaging method to diagnose a spigelian hernia. Due to the high risk of strangulation, surgery should be advised to all patients with spigelian hernia. Surgery can be performed either by open or by minimally invasive techniques.
In this video we present the case of a 54-year-old female patient suffering from a symptomatic right spigelian hernia. The diagnosis was suspected during clinical examination and was confirmed with CT. The patient underwent a laparoscopic transabdominal preperitoneal repair. During the procedure, a peritoneal flap was created; the content of the hernia sac, composed from preperitoneal fat, was completely reduced; the defect was closed with 2/0 PDS sutures; a PVDF mesh, measuring 14 cm by 12 cm, was placed in the preperitoneal area and fixed with N-butyl cyanoacrylate glue; the peritoneal flap was closed also with glue.
The patient had an unremarkable postoperative period and was discharged on the first postoperative day in good clinical condition.
V-031 VICRYL MESH WITH ATRAUMATIC FIXATION AS A TECHNICAL RESOURCE FOR DIFFICULT POSTERIOR CLOSURE IN E-TEP APPROACH
Authors: Román García De León L , Muñoz Rodríguez J M , Lucena De La Poza J L , Serrano González J , Artés Caselles M , Martin Rodrigo P , Iglesias García E , López Monclús J 
Published: October 2022

Abstract

Aim
To present a technical resource as a possible solution to the posterior defect that does not allow primary closure in the e-TEP approach for ventral hernias, and which may represent an alternative to transverse abdominis release.

Material and Methods
This is a 44-year-old woman with obesity and previous hysterectomy via infraumbilical median laparotomy. She presented with an M3W1 in incisional hernia with a 4 cm defect containing the transverse colon.

Results
After performing a retromuscular dissection according to the Rives-Stoppa technique, it was found that there was a continuous tear in the most cranial area of the posterior layer, which was not corrected with the primary suture.
It was therefore decided to place an absorbable vicryl mesh to cover the defect, fixed atraumatically with cyanoacrylate.

Conclusion
During a minimally invasive ventral hernia repair, closure of the peritoneal sac can be technically complex. This leads to exposure of the retromuscular polypropylene mesh, which would come into contact with the visceral bundle, and possible herniation of intestinal contents through the posterior defect.
In these cases, one of the most proposed option is the release of the transverse abdominal muscle, but it could increase the technical difficulty and surgical time.
As an alternative to this, we propose the placement of an absorbable vicryl mesh, covering the defect, fixed atraumatically with cyanoacrylate. This, as shown in this case, ensures posterior coverage of the mesh and does not hinder subsequent extension of the mesh.
V-033 LATERAL INCISIONAL HERNIA. IPSILATERAL ENDOSCOPIC TRANSVERSUS ABDOMINAL RELEASE AND PREPERITONEAL REPAIR
Authors: Zárate Gómez J , Álvarez De Sierra Hernández P , Fernández Luengas D , Supelano Eslait G , Peinado Iríbar B , Conde Someso S , Gil López J M , Merello Godino J 
Published: October 2022

Abstract
We present the clinical case of a 58 year old patient with a left subcostal incisional hernia, years after an emergent aortic thrombectomy and aortobifemoral bypass.
The physical examination revealed a lateral subcostal bulge near the anterior axillary line. CT findings showed a left lateral 5 cm defect without significant muscular atrophy.
An endoscopic ipsilateral transversus abdominal release (TAR) and preperitoneal mesh repair was successfully performed.
1: Port placement.
We used one 10 mm port and two 5 mm ports in a left near-midline position.
2: Retrorectal and Bogros space dissection.
Locating the arcuate line and opening the posterior rectus sheath we then proceeded with the left transversus abdominal release (in a down to up direction).
3: Hernia dissection.
After the hernial sac is identified we opened it to explore the peritoneal cavity and release the possible adhesions if encountered.
4: Full space dissection.
Once the defect dissection is finished, we fully completed the TAR in order to achieve a satisfactory space for the mesh placement.
5: Defect closure.
We performed a two-plane resorbable continuous barbed suture.
6: Mesh placement.
We measured the surgical space in order to insert a tailored mesh and lay it without fixation or drain.
Clinical outcome: The patient is discharged on postoperative day 1 and took acetaminophen 3 times daily for 48 hours, due to good pain control. On the first postoperative followup (10 days) the patient had resumed usual activities, driving and was already back to work. He was advised to avoid heavy efforts.