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Introduction: Diastasis recti, classically considered an aesthetic problem, is presented as an anatomic-functional problem with an increasingly requested surgical treatment in recent years, which has encouraged its minimally invasive approach. The most widespread endoscopic approach to date includes a plication of the linea alba with the placement of a supra-aponeurotic prosthesis. Material and methods: A treatment using an endoscopic approach is described. This treatment allows the repair of the diastasis by performing the plication of the linea alba, with Reinforcement of the Tension Lines (RTL), dispensing with the use of mesh. We present a preliminary series of the use of this technique in a standardized way. Results: 6 patients underwent surgery between 2021 and 2022. The patients were women with one or more previous pregnancies, with a mean age of 43.5 years and a mean BMI of 21.9. The mean diastasis was 4 cm in diameter and 5-6 patients (83.3 %) had associated ventral hernia (< W1). There were no cases of seroma, hematoma, infection or skin necrosis. Median follow-up was 8 months. To date, no patient has presented recurrence of the diastasis. Conclusion: The described technique of plication of the linea alba with reinforcement of the tension lines is a promising option that avoids the risks and complications associated with the use of superficial meshes. In our experience, this technique has proven to be safe and effective in young-adult patients. Long-term studies with a larger sample size are needed to complete the results. [ABSTRACT FROM AUTHOR]

Introduction: Spiegelian hernia is an extremely rare ventral hernia, with an incidence of less than 2 %. The laparoendoscopic approach has become the surgical method of choice, with successful use of transabdominal (IntraPeritoneal Onlay Mesh [IPOM]) and preperitoneal (TransAbdomino-PrePeritoneal [TAPP] and Totally ExtraPeritoneal [TEP]) techniques. We present our experience in the implementation of these techniques, over the last 10 years, in an outpatient and short stay surgery hospital. Methods: We present a series of 31 patients operated by laparoendoscopic approach between February 2011 and June 2021. The three techniques were used according to the location of the defect and the progressively acquired experience in laparoendoscopic abdominal wall surgery. Demographic, clinical, diagnostic, surgical and postoperative characteristics are evaluated in the short and medium term. Results: 33 hernias were operated on in 31 patients (22 females and 9 males) with a mean age of 66.43 years, all ASA I-II. 14 IPOM were performed at the beginning of the series, 11 TAPP and 8 TEP with subsequent implementation. The mean operative time was 58.14 minutes. The mean hospital stay was 24.76 hours. The most frequent complication was seroma. Follow-up was between 1 month and 2 years. All histories were reviewed and no recurrence was found in any patient. Conclusion: Laparoendoscopic surgery offers excellent results and should become the standard of care. It has not been demonstrated which technique is superior and the choice will depend on the type of patient and the surgeon's expertise, experience and results. [ABSTRACT FROM AUTHOR]

The article describes a clinical case of a patient with a deep supraforaminal hernia, a rare variant of interparietal hernia in the inguinal region. During surgery, an indirect inguinal hernia type IIIB and a lobulated and pedunculated preperitoneal lipoma were found. The hernia was repaired using the plug technique and the region was reinforced with another mesh using the Lichtenstein technique. The patient recovered successfully and there have not been many reports on this variant of hernia. [Extracted from the article]

Background: Parastomal hernia is defined as a defect at the level of the abdominal wall related to the presence of an enterostomy. It is a common complication in stoma formation. Sugarbaker's laparoscopic repair technique consists of reinforcing the posterior wall with a flat mesh that rides over the intestinal loop of the stoma as a bridge, tunneling a portion of it. Case report: We present the case of a 42-year-old patient with the presence of a 10 × 10 cm parastomal hernia and an uncomplicated umbilical hernia, undergoing repair of the abdominal wall with placement of a double-component mesh using a laparoscopic approach with the Sugarbaker technique. Conclusion: The laparoscopic approach for parastomal hernia repair using the Sugarbaker technique is safe and associated with favorable short-term outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The e-TEP approach has traditionally been used for the management of inguinal hernias and since 2017 has also been indicated for the treatment of ventral hernias. We present a modification to the e-TEP Rives-Stoppa, with technical and ergonomic advantages for the surgeon, better cosmetic results and low complications rate. Method: We present a prospective, multicenter cohort of patients with ventral hernias, primary hernias associated with diastasis recti abdominis, operated by modified endoscopic technique in two tertiary care hospitals. We analyzed demographic information, perioperative characteristics, complications, and the Carolina Comfort Scale (CCS) was applied. Results: We included 35 patients, 68.6 % had previous hernia repair, average defect area of 71.5 cm2, large meshes were used, without fixation, minimal intraoperative bleeding, minimal length of hospital stays, short disability, and low postoperative morbidity. We applied CCS preoperative, at 30, 90 and 180 postoperative days, showing improvement in the items evaluated. Follow-up was 310 ± 115 days with no recurrences, readmissions, or additional surgeries. Conclusions: The eTEP-SA approach offers technical and ergonomic improvements, excellent cosmetic results, reduces costs and operative time, compared to the classic technique, in selected cases. We suggest its implementation in the treatment of ventral hernias M1, M2, M3, L1, L2 and primary midline hernias associated with diastasis recti abdominis. We believe that eTEP-SA is a valuable option to consider. [ABSTRACT FROM AUTHOR]

Eventrations and giant hernias with waste of space are a challenge from the surgical point of view and from the anesthetic point of view. One of the useful options to consider is the ultrasound-guided preoperative administration of botulinum toxin A (BoNT). We present the case of a patient who was proposed to us by the General Surgery Service with a history of three laparotomies with secondary development of a large uncomplicated eventration, for reconstructive surgery with mesh, requesting the collaboration of the Pain Unit for the previous infiltration of BoNT in the abdominal wall muscles. Three weeks before surgery, a total of 240 IU of BoNT were infiltrated under ultrasound control, distributed among 10 points between the rectus femoris, external oblique, and internal oblique muscles, bilaterally. Subsequently, the large hernioplasty and cholecystectomy were performed successfully and without perioperative incidents. [ABSTRACT FROM AUTHOR]

Introduction: The repair of suprapubic incisional hernias represents a complexity due to its proximity to the bony flange of the pelvis and neurovascular structures such as epigastric arteries and iliac package, the difficulty of adequate adaptation and a good margin of prosthesis protection. Material and methods: Retrospective observational analysis of the HIS repaired in our hospital between January 1, 2012 to January 1, 2019. Abdominal CT was performed preoperatively in Valsalva to all patients. The variables related to the applied surgical treatment, postoperative complications and the overall recurrence rate were studied. Results: 25 patients with HIS were operated. Only 20 % of the incisional hernias were pure suprapubic (M5), the mean hernia transverse diameter being 7.7 cm. In 4 cases, preoperative administration of botulinum toxin and progressive pneumoperitoneum was necessary. All patients underwent a Stoppa repair. Postoperative morbidity was 28 %, mostly related to the surgical wound, although a patient died due to an intestinal fistula. The mean postoperative follow-up was 29 months, not finding hernia recurrence. Conclusions: In our experience, the repair of suprapubic incisional hernias is complex, with no negligible morbidity, but acceptable rates of hernia recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Post-median sternotomy subxiphoid incisional hernia is characterized by having two properties that differentiate it from the other hernias of the abdominal wall: occur in an incision previously made in a neighboring cavity, outside the abdominal cavity; and possess its own anatomical conditions appearing in an area with inextensible tissues and greater tension against a simple herniorrhaphy, the following having a higher incidence of recurrences if adequate techniques free of tension and use of prosthetic mesh are not applied. Regarding the prophylactic use of Aspirin® as an antiplatelet is usually, as a rule, suspended two weeks prior to elective surgery, with the exception of patients with coronary artery bypass grafting’s history, where the benefit of its maintenance is greater than the risk of its suspension. What the current medical literature suggests on this subject is analyzed. Case report: A 51-year-old man with a history of coronary bypass surgery for average sternotomy three years ago in treatment at the permanence of Aspirin®, who had a subxyphobic incisional hernia. Cardiologist in his preoperative evaluation confirmed maintaining Aspirin®. Double mesh hernioplasty was performed without its suspension, presenting a favorable evolution. Discussion: It’s discussed the appropriated of double mesh technique in this type of patient along with the fact of having kept treatment with Aspirin®. We insist that surgeons when operating this type of hernias, must know the characteristics of the M1 region, as well as the most suitable techniques. [ABSTRACT FROM AUTHOR]

Introduction: Complex incisional hernia is an unusual pathology, although its incidence is increasing. It requires great knowledge of the anatomy of the abdominal wall and advanced methods for its preparation and treatment. In addition, it includes greater postoperative morbidity and long-term recurrence. Material and methods: A bibliographic research was carried out from August 2009 to February 2021 using the keywords complex ventral hernia, incisional hernia, hernia with loss of domain, incisional giant hernia, progressive pneumoperitoneum, botulinum toxin A and hernia, anatomic component separation and complex abdominal wall reconstruction. A total of 68 articles in English and Spanish were used to carry out the present review. Conclusion: Complex incisional hernia is a challenge for surgeons and an important disability for patients. Advances in patient optimization, tomographic measurements, and adjuvant pre and intraoperative techniques have contributed to restoring the anatomy and function of the abdominal wall, maintaining its innervation with acceptable morbidity and recurrence. [ABSTRACT FROM AUTHOR]

Copyright of Revista Hispanoamericana de Hernia is the property of Aran Ediciones S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Abdominal compartment syndrome (ACS) is a serious complication of acute pancreatitis. Case report: We present the case of a 54-year-old obese woman, a smoker and with severe scoliosis, who underwent a scheduled intervention for incisional hernia with retraction of the wall. We performed anterior separation of components and placement of interfascial polypropylene mesh. During the postoperative period, she presented severe acute pancreatitis, which required urgent surgical decompression and laparostomy. Finally, the abdominal wall was successfully repaired with a biological replacement mesh to achieve a complete closure without tension. Conclusion: A high index of suspicion for the detection of complications, urgent surgical decompression leaving a laparostomy with a vaccum system, and defi nitive delayed closure are key points to keep in mind if we are facing an ACS after surgery on the abdominal wall. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Ventral hernias are defects of the anterior abdominal wall, the laparoscopic repair has shown some advantages compared to open repair. Aim: To evaluate perioperative outcomes of the laparoscopic ventral hernia repair and to describe risk factors associated to recurrence. Methods: Non-concurrent prospective cohort study, clinical data of all patients who underwent laparoscopic ventral hernia repair between June 2006 and May 2013 were reviewed. Univariate analyses were performed using chi-square for categorical variables and U Mann-Whitney test for continuous variables. Multivariate analysis was performed using a logistic regression model. Results: 127 patients underwent laparoscopic ventral hernia, 52% female, age of 58.1 ± 1.2 years old. Mean Body Mass Index (BMI) was 31 ± 0.5 kg/m2 and 67.7% were incisional hernias. Median operative time was 80 minutes (ranging from 30-350) and the median defect size was 6 cm (ranging from 2-20). Conversion to open surgery was necessary in 4 cases (3.9%). Median of hospital stay was 2 days (ranging from 1-15). Recurrence rate was 14.2% and the median to recurrence was 9 months. Recurrence rate was associated positively to defect size > 10 cm (p = 0.002), previous recurrence (p = 0.029) and operative time > 90 minutes (p = 0.017) in the univariate analyses. However, it was only associated to the first two in the multivariate analysis (OR 3.906; IC 1.734-13.058 y OR 5.93; IC 1.546-22.976, respectively). Conclusions: Laparoscopic repair of ventral hernia is a safe procedure with acceptable perioperative complication rates. Defect size and previous recurrence are associated to a higher recurrence rate. [ABSTRACT FROM AUTHOR]