Our Experience With 200 Cases of Inguinal Hernia Repair Using the Dynamic Self-Adjusting Prosthesis: A Case Series and Literature Review.

Introduction Inguinal hernioplasty (IH) is one of the most frequently performed surgical procedures globally. Today, a variety of surgical techniques and prosthesis types are available for this procedure. Methods At our center, we performed 200 inguinal hernioplasties using the dynamic self-adjusting prosthesis (protesi autoregolantesi dinamica, PAD) from May 1, 2022, to May 31, 2023. Our objective was to retrospectively analyze the outcomes and compare them with the current scientific literature on this surgical technique. Results Our results align with those reported by other authors using the same surgical technique. With the PAD technique, we assessed the type and frequency of adverse events up to 12 months following IH. All patients were male, with an average BMI of 26.6. Among the 200 hernias, 99 were right-sided, 101 were left-sided, 63 were direct, and 137 were indirect. The average length of hospitalization was one day. The most common postoperative complication was hematoma near the surgical site, but no prosthesis displacement was observed. In 71% of patients, analgesics were discontinued within 24 hours. The outcomes of our study are comparable to those reported by the inventor of this surgical technique. Conclusion The procedure has demonstrated safety and effectiveness and could serve as a viable alternative to traditional IH techniques.

Laparoscopic Approach To Treat a Hydrocele of the Canal of Nuck: A Case Report.

The hydrocele of the canal of Nuck is a rare medical condition that usually affects females during childhood and early adulthood. It is considered the female homolog to the testicular hydrocele in males, as they share similar pathophysiology. The condition is often underreported and considered an incidental finding. On many occasions, it is mistakenly diagnosed and even managed as an inguinal hernia. The hydrocele of the canal of Nuck is usually managed surgically, either by open surgery or laparoscopy. In this case report, we will discuss the hydrocele of the canal of Nuck diagnosed in a young adult female and provide a background, case presentation, and thorough discussion.

A Scoping Review of the Clinical Utility of Laparoscopic Vasectomy.

Vasectomy is a common procedure performed for family planning. Traditionally, this has been via a scrotal approach. In contrast, laparoscopic vasectomy is a documented but rarely described procedure that may minimise anaesthetic risk, surgical risk, and healthcare expenditure in patients undergoing elective laparoscopic procedures for concurrent pathology such as hernia repair. This scoping review evaluates the clinical utility of laparoscopic vasectomy. It was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Articles were identified with keywords related to laparoscopy and vasectomy. Six peer-reviewed, full-text articles published in English were included in this review. These studies encompass eight individual patient cases of laparoscopic vasectomy performed in the 1990s and early 2000s. All the cases included laparoscopy for concurrent pathology, the most common of which was inguinal hernia. There were no complications associated with laparoscopic vasectomy. For patients requiring laparoscopic surgery for alternate pathologies, synchronous laparoscopic vasectomy improves surgical efficiency by minimising anaesthetic time, operative time, and risk, in addition to lower associated healthcare costs. However, consideration is given to the limitations of this approach, and a note is made of the lack of evidence regarding safety and efficacy given the paucity of cases described in the literature.

Robotic parastomal hernia repair: A single-center cohort study.

Parastomal hernia is a common occurrence following stoma construction, necessitating surgical intervention in symptomatic cases. This study presents a comprehensive analysis of Robotic-Assisted Parastomal Hernia Repair (r-PSHR), utilizing the Da Vinci Xi™ Surgical System. Retrospective analysis was conducted on patients undergoing r-PSHR at a high-volume center. Surgical variables, complications, and recurrence rates were assessed. The primary technique involved a modified Sugarbaker intraperitoneal onlay mesh. Eighty-six patients underwent r-PSHR, predominantly females (59.3%), with mean age 60.8 years. Mean BMI was 31.0. Most patients were classified as ASA 2 (31.4%) or ASA 3 (65.1), with 64.6% having no prior PSH repair. Index procedures primarily involved laparoscopic colonic resections (27.8%) and open abdominoperineal resections (27.8%). Parastomal hernias were mainly associated with end ileostomy (50%) and end colostomy (47.7%). A hybrid modification was required in 22.1% of cases, with only one conversion to open repair. Mean operative time was 257 min. Thirty-day morbidity was 40.7% and includes ileus (24.4%), deep surgical-site infections (7.0%), acute kidney injury (5.8%), and sepsis (5.8%). Grade IIIB complications occurred in 5.8% of cases. Thirty-day readmissions were observed in 19.8% of cases. There were five cases (5.8%) of recurrence within 15 months post-surgery. This study highlights the effectiveness of r-PSHR in managing parastomal hernia. R-PSHR shows promising outcomes with an acceptable post-operative occurrence profile and a favorable recurrence rate.

Videoendoscopic assisted Rives-Stoppa technique. "Treatment for epigastric and umbilical hernias with diastasis recti".

PURPOSE: There are many surgical techniques for ventral hernias and diastasis recti, both conventional or video-endoscopic, with or without mesh placement, detailed in the literature. Using some details of the techniques proposed by Wolfgang Reinpold (Mini- or Less Open Sublay Operation, MILOS) and Federico Fiori (Totally Endoscopic Sublay Anterior Repair, TESAR) we found modifications that allowed repairing and reinforcement of the posterior fascia with a retro-muscular mesh and achieve primary fascial closure by minimally umbilical access and searching for the best anatomical, functional, and aesthetic results. METHOD: Describe the surgical technique step by step and analyze 629 surgical treatments. The cohort comprises the period January 2018 to January 2023. Our Database registered 318 men and 311 women who underwent video endoscopicassisted Rives-Stoppa techniques to treat umbilical and epigastric hernias with diastasis RESULTS: All patients were treated on an outpatient basis and discharged home on the same day. The most frequent complications were seromas with conservative management. Other complications recorded were omphalitis in 6 patients, and three patients presented hematomas, one of whom performed surgical evacuation. There were ten patients with recurrences. CONCLUSION: These hybrid approaches provide the advantages of mini-invasive techniques with a lower rate of complications and a high standard of quality of life, providing anatomical, functional, and aesthetic benefits.

Higher rates of recurrence and worse quality of life in obese patients undergoing inguinal hernia repair.

PURPOSE: Prior investigations regarding the effect of obesity on inguinal hernia repair have been mixed. The aim of our study was to retrospectively compare perioperative outcomes, recurrence rate, and quality of life between obese and non-obese patients undergoing inguinal hernia repair. METHODS: Patients who underwent inguinal hernia repair by any approach at a single institution were identified from a prospectively maintained quality database. Patients with a body mass index (BMI) greater than or equal to 30 kg/m2 were considered obese. Quality of life was measured with the Surgical Outcomes Measurement System (SOMS) and Carolinas Comfort Scale (CSS) surveys. Differences between obese and non-obese patients were assessed using independent samples t-tests, Wilcoxon rank-sum, and chi-square tests. RESULTS: Between 2010 and 2021, a total of 5575 patients underwent inguinal hernia repair. Fifteen percent of patients were identified as obese (835 patients, mean BMI 33.2 ± 3.3 kg/m2). A significantly higher percentage of obese patients were diabetic, and operative time and estimated blood loss were higher in the obese group (all p < 0.001). Rates of hernia recurrence in obese patients was significantly more likely than in non-obese patients (4.2% vs 2.0%, p < 0.001). Up to 2 years postoperatively, a greater percentage of obese patients reported worse quality of life on the SOMS and more bothersome symptoms on the CCS. CONCLUSIONS: Inguinal hernia repair in obese patients is a more technically challenging operation. Long-term follow-up revealed a greater risk of hernia recurrence and worse quality of life up to 2 years postoperatively in this patient population.

[Antireflux laparoscopic intervention]. / Primenenie antireflyuksnogo laparoskopicheskogo vmeshatel'stva.

OBJECTIVE: To study the safety and efficacy of laparoscopic fundoplication and hiatal hernia repair for gastroesophageal reflux disease following hiatal hernia. MATERIAL AND METHODS: We retrospectively analyzed 56 patients with gastroesophageal reflux disease and hiatal hernia .They underwent laparoscopic fundoplication and hiatal hernia repair between January 2020 and January 2023. RESULTS: All surgeries were successful without conversion to open surgery. Surgery time was 56-180 min (mean 68.4±3.6), blood loss 30-200 ml (mean 40.3±5.6). No mortality and severe complications occurred. All patients were followed-up for 6-24 months. The GERD-Q and De Meester scores were significantly lower after 6 months compared to baseline values (p <0.05), and resting pressure was lower. Tone of lower esophageal sphincter was significantly higher compared to preoperative level (p <0.05). In 1-2 years after surgery, symptoms completely disappeared in 48 patients and significantly improved in 6 patients. Two patients had no improvement. Contrast-enhanced examination found no recurrent hiatal hernia and digestive tract obstruction. CONCLUSION. L: Aparoscopic fundoplication and hiatal hernia repair is safe and effective for gastroesophageal reflux disease with hiatal hernia.

Preoperative botolinum toxin A (BTA) and intraoperative fascial traction (IFT) in the management of complex abdominal wall hernias.

INTRODUCTION: Preoperative botolinum toxin A (BTA) administration to the lateral abdominal wall has been widely used since its introduction for treating complex abdominal wall defects and loss of domain (LOD) hernias. Intraoperative fascial traction (IFT) is an established technique for complex abdominal wall hernias exceeding a width of 10 cm and has also shown auspicious results. We present our single center data including 143 consecutive cases combining both techniques from 2019 to 2023. Aim of the study was to develop an algorithm for a tailored approach for very large and complex ventral abdominal wall hernias. METHODS: Consecutive patients treated with preoperative BTA and IFT from August 2019 to December 2023 were identified in our prospectively maintained database and reviewed retrospectively. Metrics included intraoperative findings and short-term (30 days) postoperative outcomes. RESULTS: 143 patients were included in our retrospective analysis. The mean age was 58.9 years and 99% of all patients had an ASA Score of II or III with a mean body mass index of 32.4 kg/m2. The mean intraoperative reduction of fascia-to-fascia after BTA and IFT was 9.81 cm. 14 patients either had a lateral defect or a combination of a midline and lateral hernia. An additional uni- or bilateral transverse abdominis release (TAR) was necessary in 43 cases (30.1%). The overall surgical site occurrence rate (SSO) was 30.1% of which 13.8% were surgical site infections (SSI). Re-operation and SSO rates were significantly higher if an additional TAR was performed (both p = 0.001; α = 0.05). CONCLUSIONS: IFT in combination with BTA is a transformative and clinically proven tool in the surgeons' toolbox. It might be an easier, and less invasive alternative to other available techniques in many cases, but it should not be looked at as an ultimate stand-alone method to treat all complex W3 hernias.

Socioeconomic inequalities in patients undergoing abdominal wall reconstruction in the North-West of England, UK: a three-centre retrospective cohort study.

PURPOSE: Patients from deprived areas are more likely to experience longer waiting times for elective surgery, be multimorbid, and have inferior outcomes from elective and emergency surgery. This study aims to investigate how surgical outcomes vary by deprivation for patients undergoing elective abdominal wall reconstruction. METHODS: A three-centre retrospective cohort study was conducted across three hospitals in North-West England, including patients with complex ventral hernias undergoing abdominal wall reconstruction between 2013 and 2021. Demographic data, comorbidities, and index of multiple deprivation quintiles were recorded. RESULTS: 234 patients (49.6% female), age 57 (SD 13) years, underwent elective abdominal wall reconstruction. Significantly higher unemployment rates were found in the most deprived quintiles (Q1 and Q2). There were more smokers in Q1 and Q2, but no significant deprivation related differences in BMI, diabetes, chronic kidney disease or ischaemic heart disease. There were also higher rates of Clavien-Dindo 1-2 complications in Q1 and Q5, but no difference in the Clavien-Dindo 3-4 outcomes. Patients in Q1 and Q5 had a significantly greater hospital length of stay. CONCLUSION: The association between deprivation and greater unemployment and smoking rates highlights the potential need for equitable support in patient optimisation. The lack of differences in patient co-morbidities and hernia characteristics could represent the application of standardised operative criteria and thresholds. Further research is needed to better understand the relationship between socioeconomic status, complications, and prolonged hospital length of stay.

First Results of Pediatric Robotic Inguinal Hernia Repair with the Senhance® Surgical System: A Matched Cohort Study.

INTRODUCTION: Inguinal hernia repair (IHR) is one of the most common procedures in pediatric surgery. In children, the application of robotic surgery is limited, meaning safety and efficacy is still to be assessed. This report is the first one worldwide that describes inguinal hernia repair in children using the Senhance® Surgical System (SSS®). The aim of this matched cohort study is to assess safety and feasibility of robot-assisted IHR (RIHR) in children, compared to conventional laparoscopic IHR (LIHR). PATIENTS AND METHODS: This pilot study included 26 consecutive patients between 3 months and 8 years old who underwent RIHR (31 IH's) with the SSS® between 2020 and 2024. These cases were matched based on gender, age, and unilateral or bilateral IH, with 26 patients (32 IH's) who underwent conventional LIHR. RESULTS: There was a significant difference in total anesthesia time, which is most likely due to the extra time needed to dock the robot in the RIHR cases. No significant difference was seen in surgical time. One recurrence (3.2%) was diagnosed in both groups. One patient in the LIHR group was readmitted on the day of discharge due to a hemorrhage. No intervention was necessary, and the patient was discharged 1 day later. DISCUSSION: In this pilot study, the use of the robotic system was safe and feasible. More experience, further improvement of the system for use in very small children, and investigation in a larger sample size with long-term follow-up is necessary to evaluate efficacy.

[Laparoscopic preperitoneal and Lichtenstein inguinal hernia repair. What method is preferable?] / Laparoskopicheskaya predbryushinnaya plastika pakhovykh gryzh i gernioplastika po Likhtenshteinu. Kakoi metod predpochtitel'nee?

This review is devoted to laparoscopic preperitoneal and open Lichtenstein unguinal hernia repair. Considering the PubMed, Google, the Springer Link online library and the Cochrane Systematic Review databases, we analyzed the reviews, prospective and retrospective studies devoted to comparison of these most common methods of treating inguinal hernias. Indications and contraindications for endoscopic hernia repair, features of laparoscopic surgeries, causes of conversion to open interventions, early and long-term results of laparoscopic and open operations were estimated.

Comparative anatomic and symptomatic recurrence outcomes of diaphragmatic suture cruroplasty versus biosynthetic mesh reinforcement in robotic hiatal and paraesophageal hernia repair.

BACKGROUND: Hiatal and paraesophageal hernia (HH/PEH) recurrence is the most common cause of failure after gastroesophageal anti-reflux surgery. Crural reinforcement with mesh has been suggested to address this issue, but its efficacy remains debated. In this study, we aimed to determine the impact of biosynthetic mesh reinforcement compared to suture cruroplasty on anatomic and symptomatic hernia recurrence. METHOD: Data of patients who underwent robotic HH/PEH repair with suture cruroplasty with or without biosynthetic mesh reinforcement between January 2012 and April 2024 were retrospectively reviewed. Gastroesophageal reflux disease symptoms and anatomic hernia recurrence were assessed at short-term (3 months to 1 year) and longer-term (≥ 1 year) follow-up. Symptomatic hernia recurrence was defined as having both anatomic recurrence and symptoms. RESULTS: Out of the 503 patients in the study, 308 had undergone biosynthetic mesh repair, while 195 had suture-only repair. After the surgery, both groups demonstrated comparable improvements in symptoms. Short-term anatomic hernia recurrence rates were 11.8% and 15.6% for mesh and suture groups, respectively (p = 0.609), while longer-term rates were 24.7% and 44.9% (p = 0.015). The rates of symptomatic hernia recurrence in the same group were 8.8% and 14.6% in the short-term (p = 0.256), and 17.2% and 42.2% in longer-term follow-ups (p = 0.003). In the repair of medium and large-size hernias, mesh reinforcement resulted in a 50.0% relative risk reduction in anatomic hernia recurrences and a 59.2% reduction in symptomatic hernia recurrences at ≥ 1-year follow-up. CONCLUSION: After more than a year of follow-up, it has been found that using biosynthetic mesh for medium and large hiatal or paraesophageal hernia repair significantly reduces the likelihood of both anatomic and symptomatic recurrence compared to using only suture cruroplasty. These findings strongly support the use of biosynthetic mesh to manage larger hernias. However, further long-term multicenter randomized studies are needed to provide more conclusive evidence.

Comparison of postoperative outcomes between tissue glue and suture for mesh fixation in open tension-free inguinal hernia repair: a prospective analytical study.

Introduction: A hernia is an abnormal protrusion of the viscus through the normal or abnormal opening of its containing cavity. Lichtenstein tension-free mesh repair is a commonly performed surgery for hernia. Various studies have revealed atraumatic fixation of the mesh produces less pain without compromising the outcomes. Methods: This is a prospective analytical study conducted in a tertiary hospital over a year. Eighty patients with primary inguinal hernia undergoing open mesh repair were enrolled and divided into two groups with 40 patients in each group. Mesh fixation was done with N-butyl 2 cyano-acrylate glue in one group, while polypropylene 2-0 suture in the other group. Postoperative pain, the number of dosages of analgesia required, the incidence of hematoma/seroma formation, surgical site infection, and length of hospital stay were compared between the two groups. Data were analyzed using SPSS 25. Results: Visual analog scores were significantly reduced in the glue group at 12 h and 24 h (P<0.05) with a reduction of the mean number of analgesic doses from 6.42±0.984 in the suture group to 5.95±0.597 in the glue group (P<0.05). The operating time was significantly reduced from 70.03±4.376 minutes in the suture group to 58.43±4.540 min in the glue group (P<0.05), while there was no significant difference in the length of hospital stay. Five percent of cases in the suture group developed seroma while no SSI was reported in this study. Conclusions: This study demonstrates mesh fixation with cyanoacrylate glue in open hernioplasty for primary groin hernias is associated with reduced immediate postoperative pain, dose of analgesia required, and operating time in comparison to fixation with suture.

Weighing the benefits: Exploring the differential effects of light-weight and heavy-weight polypropylene meshes in inguinal hernia repair in a retrospective cohort study.

BACKGROUND: Inguinal hernia repair is a common surgical procedure, with more than 20 million cases yearly. Choice between mesh types varies in clinical practice. To compare light-weight polypropylene (LW-PP, 34-36 g/m2) and heavy-weight polypropylene (HW-PP, 95 â€‹g/m2) meshes. METHODS: Data from patients who underwent open inguinal hernia repair between 2020 and 2022. Selection criteria ensured homogeneity. Endpoints were to assess the impact of different mesh weights on overall health-related quality of life (HRQoL), using Short Form 36 (SF-36), and to monitor postoperative complications. RESULTS: Two hundred patients were included in both groups. Lateral and direct hernias occurred in 60.5 â€‹% and 39.5 â€‹%. According to EHS, 31.5 â€‹%, 22.3 â€‹% and 46.2 â€‹% were classified as size 1, 2, 3. Follow-up showed similar HRQoL at 30-days, with a favorable trend towards LW-PP mesh offering fewer limitations, better comfort, and improved general health after 12-months. No difference in postoperative paresthesia, wound hematoma, and interference with daily activities. CONCLUSION: 1-year after surgery HRQoL evaluation highlights the non-inferiority of LW-PP. Mesh selection should be tailored, aiming at improving outcomes and postoperative comfort.

Open versus robotic retromuscular ventral hernia repair: outcomes of the ORREO prospective randomized controlled trial.

BACKGROUND: Robotic retromuscular ventral hernia repair (rRMVHR) potentially combines the best features of open and minimally invasive VHR: myofascial release with abdominal wall reconstruction (AWR) with the lower wound morbidity of laparoscopic VHR. Proliferation of this technique has outpaced the data supporting this claim. We report 2-year outcomes of the first randomized controlled trial of oRMVHR vs rRMVHR. METHODS: Single-center randomized control trial of open vs rRMVHR. 100 patients were randomized (50 open, 50 robotic). We included patients > 18 y/o with hernias 7-15 cm with at least one of the following: diabetes, chronic obstructive pulmonary disease (COPD), body mass index (BMI) ≥ 30, or current smokers. Primary outcome was occurrence of a composite outcome of surgical site infection (SSI), non-seroma surgical site occurrence (SSO), readmission, or hernia recurrence. Secondary outcomes were length of stay, any SSI or SSO, SSI/SSOPI, operative time, patient reported quality of life, and cost. Analysis was performed in an intention-to-treat fashion. Study was funded by a grant from Society of American Gastrointestinal and Endoscopic Surgeons. RESULTS: 90 patients were available for 30-day and 62 for 2-year analysis (rRMVHR = 46 and 32, oRMVHR = 44 and 30). Hernias in the open group were slightly larger (10 vs 8 cm, p = 0.024) and more likely to have prior mesh (36.4 vs 15.2%; p = 0.030), but were similar in length, prior hernia repairs, mesh use, and myofascial release. There was no difference in primary composite outcome between oRMVHR and rRMVHR (20.5 vs 19.6%, p = 1.000). Median length of stay was shorter for rRMVHR (1 vs 2 days; p < 0.001). All patients had significant improvement in quality of life at 1 and 2 years. Other secondary outcomes were similar. CONCLUSION: There is no difference in a composite outcome including SSI, SSOPI, readmission, and hernia recurrence between open and robotic RMVHR.

Hidden hernias hurt: a plea for early diagnosis and treatment of occult inguinal hernias.

INTRODUCTION: Hidden or occult inguinal hernias are symptomatic hernias that do not present with a bulge. For some surgeons, if a bulge is not present, then no hernia repair is contemplated. We report preoperative findings of patients with occult inguinal hernias and outcomes after repair to assist in early detection and treatment of this special population. METHODS: All patients who underwent inguinal hernia repairs, 2008-2019, were reviewed. Patients were classified as having occult inguinal hernias if they (a) complained of groin pain, (b) did not have bulging on exam, (c) had supportive imaging showing an inguinal hernia, and (d) were confirmed to have inguinal hernias that were repaired intraoperatively. Presentation and outcomes were compared with the non-occult group treated during the same time period. RESULTS: Of 485 patients who underwent elective inguinal hernia repairs over 10 years, 212 (44%) had occult inguinal hernias. Patients in the occult group were significantly more likely to be female, younger, and with higher BMI compared to the non-occult group. They also had more preoperative pain for a significantly longer time. This was associated with higher incidence of pain medications usage, including opioids, in the occult group. On physical examination, those with occult hernias were twice as likely to have tenderness over the inguinal canal. Most hernia repairs (66%) were laparoscopic and 94% used mesh. Postoperatively, the occult group had 83% resolution of symptoms after hernia repair. CONCLUSION: Some surgeons hesitate recommending hernia repair to patients with occult inguinal hernias, as these patients do not fit the traditional definition of a hernia, i.e., a bulge. Our study challenges this perception by showing that discounting groin pain due to occult hernia prolongs patient's suffering and may risk increased opioid use, especially in females, although 83% cure can be achieved with hernia repair.

Predictive model for contralateral inguinal hernia repair within three years of primary repair: a nationwide population-based cohort study.

BACKGROUND: Limited reports have discussed the risk factors for contralateral inguinal hernia (CIH) repair. We generated a risk factor scoring system to predict CIH within 3 years after unilateral inguinal hernia repair. METHODS: We extracted the admission data of patients aged ≥ 18 years who underwent primary unilateral inguinal hernia repair without any other operation from the National Health Insurance Research Database. Patients were randomly divided into 80% and 20% validation cohorts. Multivariate analysis with a logistic regression model was used to generate the scoring system, which was used in the validation group. RESULTS: Overall, 170,492 adult men were included, with a median follow-up of 87 months. The scoring system ranged from 0-5 points, composited with age (< 45 years, 0 points; 45-65 years, 2 points; 65-80 years, 3 points; > 80 years, 2 points) and two comorbidities (cirrhosis and prostate disease: 1 point each). The areas under receiver operating characteristic (ROC) curves were 0.606 and 0.551 for the derivation and validation groups, respectively. The rates and adjusted odds ratios (OR) of CIH repair in the derivation group were 3.0% at 0-2 points, 5.5% (1.854, p < 0.001) at 3, 6.7% (2.279, p < 0.001) at 4, and 6.9% (2.348, p < 0.001) at 5, with similar results in the validation group [2.3% at 0-2 points, 3.8% (1.668, p < 0.001) at 3, 5.4% (2.386, p < 0.001) at 4, and 6.8% (3.033, p < 0.001) at 5]. CONCLUSIONS: The CIH scoring system effectively predicted CIH repair within three years of primary unilateral inguinal hernia repair. Surgeons could perform laparoscopic surgery with CIH scores > 2 points which enables easier contralateral exploration and repair during the same surgery, without additional incisions, to minimize the need for future surgeries. However, further prospective validation of this scoring system is required.

Short-Term Outcomes of Transabdominal Preperitoneal Ventral Hernia Repair With Rectus Aponeuroplasty (TAPPRA) for the Management of Incisional Hernias.

Introduction: Options for minimally invasive ventral hernia repair continue to evolve as a function of our understanding of the abdominal wall and the development of new techniques. We describe a robotic transabdominal pre-peritoneal repair with concurrent rectus aponeuroplasty (TAPPRA) for incisional and recurrent ventral hernias. Methods: All patients in this retrospective cohort study underwent TAPPRA repair between October 2023 and March 2024. This study aimed to determine intraoperative feasibility of the technique and to assess immediate postoperative outcomes. Results: Twelve patients underwent TAPPRA repair for incisional and/or recurrent ventral hernias at an academic hernia center. The median case duration was 135 min with no significant intraoperative complications noted. Average defect size for the hernias measures 6.5 × 8.5 cm. Polypropylene mesh was used to reinforce all defects, with the average dimensions being 19.7 × 21.5 cm. 83% of patients were discharged within 24 h of their procedure. No significant postoperative complications were noted. Conclusion: We describe the first use of a novel ventral hernia repair technique, TAPPRA, and demonstrate that it is safe, feasible, and associated with appropriate short-term outcomes for repair of moderate sized incisional hernias.

Concomitant hiatal hernia repair with transoral incisionless fundoplication for the treatment of refractory gastroesophageal reflux disease: a systematic review.

BACKGROUND: Transoral incisionless fundoplication (TIF) is safe and effective in select patients with hiatal hernias ≤ 2 cm with refractory gastroesophageal reflux disease (GERD). For patients with hiatal hernias > 2 cm, concomitant hiatal hernia (HH) repair with TIF (cTIF) is offered as an alternative to conventional anti-reflux surgery (ARS). Yet, data on this approach is limited. Through a comprehensive systematic review, we aim to evaluate the efficacy and safety of cTIF for managing refractory GERD in patients with hernias > 2 cm. STUDY DESIGN: We conducted a systematic review of studies evaluating cTIF outcomes from PubMed, EMBASE, SCOPUS, and Cochrane databases up to February 14, 2024. Primary outcomes included complete cessation of proton pump inhibitors (PPIs). Secondary outcomes included objective GERD assessment, adverse events, and treatment-related side effects. Pooled analysis was employed wherever feasible. RESULTS: Seven observational studies (306 patients) met the inclusion criteria. Five were retrospective cohort studies and two were prospective observational studies. The median rate of discontinuation of PPIs was 73.8% (range 56.4-94.4%). Significant improvements were observed in disease-specific, validated GERD questionnaires. The median rate for complications was 4.4% (range 0-7.9%), and the 30-day readmission rate had a median of 3.3% (range 0-5.3%). The incidence of dysphagia was 11 out of 164 patients, with a median of 5.3% (range 0-8.3%), while the incidence of gas bloating was 15 out of 127 patients, with a median of 6.9% (range 0-13.8%). CONCLUSION: Current data on cTIF suggests a promising alternative to ARS with comparable short-term efficacy and safety profile for managing refractory GERD with a low side effect profile. However, longer-term data and comparative efficacy studies are needed.

Prospective randomized study comparing mesh displacement in enhanced-view totally extraperitoneal versus totally extraperitoneal laparoscopic inguinal hernia repair without mesh fixation.

PURPOSE: In laparoscopic inguinal hernia repair, it is thought that the mesh can be displaced more in the enhanced-view totally extraperitoneal (eTEP) technique. The aim of this study was to compare eTEP and totally extraperitoneal (TEP) techniques without mesh fixation in terms of mesh displacement and hernia recurrence. METHODS: Between December 2022 and April 2023, 60 consecutive patients with unilateral inguinal hernia were randomized into two groups; eTEP group (n = 30) and TEP group (n = 30). There was without mesh fixation in both groups. Study was registered at http://Clinicaltrials.gov (NCT06070142). The mesh was marked with three radiopaque clips. Pelvic radiographs were performed to evaluate the displacement of the mesh. The primary outcome of this study was mesh displacement. In addition, this is the first study in the literature to compare eTEP and TEP techniques in terms of mesh displacement without fixation in laparoscopic inguinal hernia. RESULTS: There was no significant difference between the groups in terms of mesh displacement, recurrence, postoperative VAS scores, length of hospital stay, hematoma, and seroma formation. The operation time was higher in the eTEP group and was statistically significant. CONCLUSION: Without mesh fixation, the eTEP technique does not increase the risk of mesh displacement and recurrence. The eTEP technique can be safely applied without mesh fixation in laparoscopic inguinal hernia repairs. TRIAL REGISTRATION: ClinicalTrials number: NCT06070142.