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Aim To analyze the safety, feasibility, and effectiveness of a systematized laparoscopic transabdominal preperitoneal approach for a recurrent inguinal hernia. Material & Methods A retrospective observational analysis of a database between July 2012 and July 2022. Inclusion: all patients with a standard laparoscopic tapp approach to treat a recurrent inguinal hernia. The variables were compared with our results in primary inguinal hernias: laparoscopic finding (cause and type using the EHS classification) conversion rate, cause of conversion, complications, and quality of life outcomes. Demographic analysis of the population Age, BMI, and a number of recurrences. Results In this period, 5452 patients underwent a tapp laparoscopic approach to treat an inguinal hernia. 372 (6.82%) were registered as recurrent hernias. Men (98.4%). BMI: (26). When comparing the patients with a previous anterior approach: 316 patients (90%), there were no differences with the results of the primary hernia. Patients with the antecedents of the posterior approach were 39 patients (10,4%). Reviewed case by case, the effectiveness in diagnosis was (100%), and the conversion rate of 8 patients (20,5%). The cause of conversion was severe mesh adhesions to the vascular triangle and vesical preperitoneal space. There were no significant differences when comparing the results between patients who underwent tapp repair in primary and recurrent hernias. There was also no significant difference according to the number of recurrences. Conclusions The laparoscopic systematized approach in recurrent hernias shows effective rates in providing safe diagnosis and treatment while maintaining the quality of life standards.

Aim To analyze the results collected by the multidisciplinary program. Material & Methods The diastasis post-pregnancy program used a systematic evaluation that included an abdominal wall surgeon, plastic surgeon, physiotherapist, nutritionist, and radiologist. The physiotherapist used tests to analyze the strength, stability, and functionality of the abdominal wall, also evaluating synergy with the diaphragm and pelvic floor. The same tests were used to check up on the treatment, plus the ultrasound evaluation. We propose a classification, adapting the specific treatment depending on the degree of the patient's condition. Grade I (Increase in Waist): performed physiotherapy; Grade II (Bulge): started physiotherapy plan, with associated surgical treatment due to lack of response; Grade III (Herniation): underwent surgery as the first treatment in addition to physiotherapy protocol. Endoscopic Rives-Stoppa has been used to repair midline hernias and diastasis. Results From January 2017 and June 2022, 1344 patients completed the program. The average age was 42. The most frequent clinical entity for consultation was: cosmesis discomfort (84%). According to the Clinical classification: Grade I: 941 patients (70%)only performed physiotherapy treatment. Grade II: 307 patients (22%), surgical treatments were necessary on 113 patients (36%). Grade III: 96 patients (7%) and 34% require a dermolipectomy. The bulging with functional test deficits is related in all patients. Physiotherapy tests and ultrasound check-ups post-treatment showed improvement in 77% of patients. Conclusions The diastasis recti must focus from three points of view: anatomical, functional, and cosmesis. The multidisciplinary approach concept showed good initial results.

Aim Lumbar hernias are a rare clinical entity and surgical treatment is constantly evolving and changing. We propose a systematization step-by-step guiding a safe and effective repair with similar conditions to the inguinal region. Material & Methods The patient lies down in a dorsal decubitus position with a 45° elevation of the hernia side. The first port is in the umbilicus access, and the accessory ports are along the middle line. Start the dissection by marking the anatomical limits that involve the semilunar lines, epigastric vessels, spine, and imaginary line between the iliac crest and 11 th rib. Releasing the peritoneal flat until visualizing the psoas iliacus and quadratus muscles until the 11 th ribs, preserving the avascular plane avoids nerves and vascular damage. Hernia sac reduction. Placement of a polypropylene mesh (24×22 cm) covering all the dissected areas. Mesh fixation using absorbable sutures. Closure of the peritoneum.Vacuum maneuver and bulge compression. Results Systematic standardization was applied to all patients. The mean operative time was 90 min. Outpatient surgery was achieved with a fast return to usual activity. The procedures were performed without intraoperative complications, mortality, or conversion to open surgery. Conclusions The step-by-step guide for landmarks and tips provides a safe and effective repair of this rare entity. Finally, clinical studies are needed to measure the impact of this technique's implementation in lumbar hernia repair.

Aim Innovation is to efficiently use knowledge to improve an existing process for the benefit of users and their environment. The aim is to show different innovations that we are applying in inguinal hernia repair. Material & Methods We present: 1. data from the first 500 procedures using 5mm articulated instruments. 2. Postoperative sports rehabilitation protocol designed to improve quality of life. 3. Virtual interactive visits (VIV) to teach and learn at a distance allows interaction in the operating room between a specialist and the surgeon in training. Results The articulated forceps allow angulations in order to reach areas with less pulling force and movements. The accepted benefits of robotics have been achieved without significant cost impact. The sport rehabilitation protocol after laparoscopic hernioplasty does not increase recurrence rate or complications. It probably accelerates the return to regular physical activity, improving the quality of life in the postoperative period. The (VIV) allows us to carry out the training process of specialists from Buenos Aires to Latin America and Spain, ​​modifying and improving the education and training of the new generations. Conclusions The articulated graspers, the sports rehabilitation protocol, and the virtual interactive visits allow us to innovate in tools, quality of life, and education.

Aim Chronic groin pain is a challenge for surgeons. It is the main symptom in pathologies caused by sports activities (Sportsman's Groin) and is also found as a complication after inguinal hernia repair. Currently multivariable analysis reports that : younger age (≤40 years), small hernias (EHS I: The Manchester Consensus concluded that general surgeons have límited experience on the topic and the difficulty of making randomized trials with high level of evidence The main objective is to describe a diagnostic algorithm to be used in patients with chronic groin pain and those with small hernia that are going to be repaired. Material & Methods A multidisciplinary team had developed an assessment, diagnosis, and treatment algorithm for CGP. The team is composed of surgeons, physiotherapists, orthopedists, and imaging specialists. We implement this algorithm in young patients (16–30) who consult for chronic groin pain, even those with inguinal hernia diagnosis. Results A total of 5,737 patients were assessed by the multidisciplinary team from June 2009 to June 2021. The most frequent clinical entities registered were tendinopathies: iliopsoas-pectineus- related (42.7%) and adductor-related (39.5%). In those patients with postoperative pain, (45%) reported preoperative pain and (91%) were not related to neuropathies. Conclusions The algorithm has proven to be safe and successful. It has been used in patients who consulted with pre and postoperative chronic groin pain, with a high rate of achievement

Aim Lumbar hernias are a rare clinical entity (less than 1% of all abdominal hernias) and their surgical treatment is constantly evolving and changing. The aim is to propose a technical systematization of the steps and landmarks to perform a safe and effective repair of an infrequent pathology. Material & methods We use a tapp approach. The patient is placed in a dorsal decubitus position with a 45° elevation of the hernia side. The first port in the umbilicus access and two ports are placed along the middle line. Start the dissection using novel articulated instruments marking the anatomical limits of the rectangular trapezoid that involves the semilunar lines, epigastric vessels, spine, and imaginary line between the iliac crest and 11 th rib. Releasing the peritoneal flat until visualizing the psoas and quadratus muscles until the 12th rib, preserving the avascular plane avoids nerves and vascular damage. Hernia sac reduction. Tension-free or not closure of the orifice. Placement of a polypropylene mesh covering all the dissected areas. Mesh fixation using absorbable suture. Closure of the peritoneum.Vacuum maneuver and bulge compression. Results The systematic standardization has been applied to all patients. The mean operative time was 90 min. The articulated instruments were useful and allowed safe maneuvers. Outpatient surgery was achieved with a fast return to normal activity. The procedures were performed without intraoperative complications, mortality, or conversion to open surgery. Conclusion The step-by-step guide for anatomical landmarks and proven statements offers a safe and effective repair of this rare entity.