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   Table of Contents - Current issue
January-March 2023
Volume 6 | Issue 1
Page Nos. 1-55

Online since Thursday, March 30, 2023

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What is new in parastomal hernia repair: An overview p. 1
Henry Hoffmann, Debora Nowakowski, Philipp Kirchhoff
Parastomal hernias (PSH) are a frequent problem mostly developing 2–3 years after index surgery impairing the life quality of affected patients. Therefore, effective prevention and treatment seems of utmost importance. However, many different surgical techniques for the treatment of PSH have been described with partially contradicting results and a low level of evidence. Therefore, this article focuses on a systematic overview of prevention and treatment for PSH. Regarding the prevention of PSH mesh-based techniques are suggested to reduce the rate of subsequent PSH, although the “keyhole” mesh, which is often used, has been shown to be ineffective for many reasons. For the treatment of PSH, the use of “funnel-shaped” meshes or Sugarbaker repair provides the most promising results. The keyhole mesh repair of PSH should be abandoned.
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Outcomes in the surgical management of giant inguinal hernias: A systematic review p. 6
Saburi O Oyewale, Azeezat O Ariwoola
Giant inguinal hernia presents a range of unique challenges in its treatment. Detailing the potential complications and outcomes of treatment can motivate patients with giant inguinal hernias (GIH) to seek an early surgical intervention and raise awareness of the risks of neglecting the condition. The aim of this review is to identify the rates of complications, especially the abdominal compartment syndrome, and the causes of mortality encountered in the treatment of GIH. Furthermore, a new classification system for GIH is proposed. The search resulted in 1,926 papers, and 10 papers were included in the study. The majority of the studies were conducted on subjects living in sub-Saharan Africa. The most frequently performed procedure was Nylon Darning, accounting for 46.5% and only 53 (12.5%) were laparoscopic repair. There were four deaths reported in two studies. Two were caused by pulmonary embolism, whereas renal failure and abdominal compartment syndrome were the causes of one death each. After a proportional meta-analysis, the pooled complication rate of the surgical interventions was 39% (95% confidence interval: 0.18–0.59) with a random effect model I2 = 82.6%. There was no recurrence in any of the studies. The complication rate for treating giant inguinal hernia is high but mortality is low. There was zero recurrence despite some subjects undergoing modified Bassini repair. Further research is needed to identify predictors of abdominal compartment syndrome and intra-abdominal hypertension. The proposed classification also requires further study on a large scale.
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Seroma-prevention strategies in minimally invasive inguinal hernia repair: A systematic review and meta-analysis p. 14
Trina Priscilla Ng, Brandon Yong Kiat Loo, Clement Luck Khng Chia
BACKGROUND: The rise of minimally invasive inguinal hernia repair has seen both the laparoscopic and robotic approaches increase in popularity in recent years. Despite this, seroma formation remains a common complication, and the aim of this study is to evaluate the current evidence on seroma-prevention strategies in minimally invasive inguinal hernia repair. MATERIALS AND METHODS: Four databases (PubMed, Scopus, Embase, and Cochrane Library) were searched from inception to November 15, 2021. All studies describing the use of intraoperative adjuncts to reduce postoperative seroma formation in patients undergoing laparoscopic or robotic inguinal and inguinoscrotal hernia repair were included. Meta-analyses were performed using Review Manager (Version 5.4). RESULTS: 2,382 articles were identified in the initial database search, and 40 articles were included in the final analysis. In this analysis, there was a significantly lower incidence of seroma formation in the drain group when compared to the no-drain group (P < 0.00001). Other strategies aimed at reducing the dead space involving the transversalis fascia (TF) and hernia sac such as TF inversion with tacking, Endoloop closure of TF, barbed suture closure of TF, distal sac fixation, and complete dissection of the sac have shown promising results as well. CONCLUSIONS: While there is currently insufficient evidence to recommend the routine use of any one of the interventions analyzed, the use of drains, the management of the TF, and the hernia sac have showed potential in reducing seroma formation.
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Epidemiology and treatment of groin and ventral hernias in the Zinder region, Niger Republic p. 23
Harissou Adamou, Ibrahim Amadou Magagi, Oumarou Habou, Amadou Magagi, Rachid Sani
OBJECTIVE: To describe epidemiological, therapeutic, and prognostic aspects of groin and ventral hernia in adults at Zinder National Hospital. MATERIALS AND METHODS: This was a retrospective data collected over a period of 10 years (January 2012–December 2021). All patients aged at least 18 years operated for abdominal wall hernia were included. A value of P < 0.05 was considered significant. RESULTS: A total of 921 patients were included. In these patients, groin hernia was present in 78.8% (n = 726), umbilical hernia in 13.25% (n = 122), linea alba hernia in 7.3% (n = 67), and Spiegel’s hernia in 6 cases (0.65%). The mean age was 48 ± 17.2 years. Men accounted for 80.9% (n = 745). Rural origin was 67% (n = 623) and poor 63.8% (n = 588). The stage of hernia strangulation represents 32% (n = 295). The median time to surgical consultation was 8 years. This delay was associated with rural origin (odds ratio [OR] = 1.42; P = 0.0142), poverty status (OR = 1.67; P = 0.0001), and inguinal location (OR = 1.75; 0.0371). General anesthesia was used in 58.7% (n = 541). Bowel necrosis was seen in 9.33% (n = 86). For all groin hernias (n = 783), 96.2% (n = 753) underwent herniorrhaphy and 3.8% (n = 30) underwent a Lichtenstein procedure. For all ventral hernias herniorrhaphy was performed in 95% (n = 245) and mesh repair in 5% (n = 13). Morbidity was 15.4% (n = 142) and mortality 1.74% (n = 16). This was associated with age over 60 years (OR = 3.06; P = 0.0341), ASAIII and ASAIV classes (OR = 5.21; P = 0.015), complicated clinical forms (OR = 4.87; P = 0.023), emergency surgery (OR = 4.51; P = 0.003), and the occurrence of bowel necrosis (OR = 4.11; P = 0.001). The median follow-up was 6 months (range: 3–36 months). Overall, hernia recurrence was recorded in 69 cases or 7.6%. This was associated with emergency surgery (OR = 6.26; P = 0.000) and age over 60 years (OR = 3.02; P = 0.000). CONCLUSION: In our context, the management of groin and ventral hernias is an important activity for the surgeon. Inguinal hernias predominate and hernia strangulation is an element of poor prognosis.
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Low back pain and motor control dysfunction after pregnancy: The possible role of rectus diastasis p. 30
Reetta Tuominen, Tiina Jahkola, Jani Mikkonen, Hannu Luomajoki, Jari Arokoski, Jaana Vironen
Purpose: Pregnancy-related low back pain is a common condition. Persistent postpartum diastasis recti may cause back pain and motor control dysfunction. The role of diastasis in pregnancy-related back pain remains debatable. This study aimed to compare participants with increased symptoms after index pregnancy with those reporting no change in back pain or subjective movement control and to analyze inter-rectus distance. Materials and Methods: This case-control study included a cohort of women who delivered 1 year earlier. We recruited participants with increased symptoms (n = 14) after index pregnancy and controls (n = 41) and recorded their inter-rectus distance using ultrasound. A questionnaire was completed, and an ultrasound performed twice for each study group. Results: At the baseline, there was no significant difference in inter-rectus distance between cases and controls (mean 2.45 ± 1.01 cm and 2.09 ± 1.03 cm, respectively). A year after index pregnancy symptomatic cases had significantly wider inter-rectus distance than controls (mean 3.45 ± 0.90 cm and 2.40 ± 0.79 cm, respectively). Motor control dysfunction test results were not associated with core stability problems or back pain in this cohort. There was a difference in the sit-up test between cases and controls (mean 4.7 ± 4.2 and 8.2 ± 3.9, respectively). Conclusion: Women who reported increased back pain and core instability after index pregnancy had wider inter-rectus diameter than controls. In the case group with more symptoms after pregnancy, the classification of rectus diastasis (RD) changed from mild abdominal RD (2–3 cm) to moderate (>3–5 cm). RD may contribute to persistent pregnancy-related lumbopelvic pain.
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Evaluation of light weight large pore mesh versus heavy weight small pore mesh in total extraperitoneal repair of inguinal hernia: A prospective randomized study p. 37
Sarabjit Singh, Kiranjot Rana, Bhupinder S Walia, Vivek Pahuja, Pankaj Dugg
BACKGROUND: The type of mesh to be used in laparoscopic groin hernia repair has always been debatable whether to use lightweight (LW) or heavyweight (HW) mesh. The study compares the lightweight large pore mesh with HW small pore mesh in total extraperitoneal groin (TEP) hernia repair and its outcome. MATERIALS AND METHODS: A total of 50 patients, who met the inclusion criteria, were randomized in the two groups. In group I (n = 25) LW large pore mesh (pore size 1 mm) was used whereas in group II (n = 25) HW small pore mesh (pore size < 0.65 mm) was used. Outcomes were observed with respect to complications, recurrence, and patient satisfaction. Statistical analysis was performed using χ2 test and student t test. RESULTS: Mean age of the patients group I was 45 ± 18.52 while in group II it was 48.88 ± 20.529 years. The complication rates were comparable between the two groups. However, seroma formation was higher in group II. The occurrence of groin pain and foreign body sensation between the two groups was comparable after 6-month follow-up. No recurrence was reported in either of the groups. CONCLUSION: Although there was no significant difference between the two groups, but the present study showed some advantage of LW mesh over HW weight mesh in TEP with respect to complications and patient satisfaction.
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Morgagni hernia presenting as constipation in the postsurgical patient: A case report p. 44
Thomas Cartwright, Patherica Charoenmins, Cole Nelson, Josiah Faustino, Shaan Jamil Akhtar
In this case report, we discuss an 83-year-old woman who presented to the emergency department with complaints of constipation and progressive abdominal pain 2 days after a right total knee arthroplasty. Chest X-ray indicated a possible hiatal hernia, but computed tomography revealed a Morgagni hernia with a portion of the transverse colon and omentum in the thoracic cavity, resulting in a large bowel obstruction. The more common presenting symptoms associated with Morgagni hernia, dyspnea, and chest pain were not present. Surgical management was pursued with a transabdominal approach, the bowel was successfully reduced and the defect was closed using sutures. This case provides an interesting insight into the many potential presentations and clinical signs of the rare Morgagni hernia.
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Enterocutaneous fistula from a mesh eroding the small bowel after incisional hernia repair: A case report p. 48
Michael L Lorentziadis, Moustafa Mahmoud Nafady Hego, Fatma Al Nasser
Tension-free hernia repair with mesh reinforcement has become the standard of care in hernia surgery. Mesh eroding the bowel with enterocutaneous fistula is a rare and serious complication. We present a case of a 46-year-old obese man with abdominal wall abscess who developed enterocutaneous fistula due to the erosion of the small bowel from a bioabsorbable coated mesh after incisional hernia repair. We discuss the biological response to hernia repair meshes as well as this challenging to treat, early or late complication of hernia surgery.
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Herniation and incarceration of the gallbladder through the abdominal drain site: A case report p. 53
Dmitry V Garbuzenko, Dmitry V Belov
A rare case of herniation and incarceration of the gallbladder through the abdominal drain site in an 86-year-old woman with degenerative aortic valve disease, a severe aortic stenosis, and an aortic insufficiency grade 2 hospitalized for transcatheter aortic valve implantation is described. An incarcerated incisional hernia through the abdominal drain site was confirmed by contrast-enhanced multislice computed tomography (MSCT) scan of the abdomen. Given the short duration of incarceration and the absence of MSCT findings of the gallbladder wall necrosis, the patient was dynamically monitored. There were no indications for emergency surgery. The presented case recalls the possibility of the formation of incisional hernias containing the gallbladder through the abdominal drain site. Literature data indicate that the diagnostic errors when they are incarcerated can lead to fatal consequences.
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