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   2021| July-September  | Volume 4 | Issue 3  
    Online since September 30, 2021

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Preoperative exercise therapy preventing postoperative complications following complex abdominal wall reconstruction: A feasibility study
Elske H M Berkvens, Johannes A Wegdam, Rhijn J A Visser, Nicole D Bouvy, Simon W Nienhuijs, Tammo S de Vries Reilingh
July-September 2021, 4(3):103-108
PURPOSE: The population undergoing complex abdominal wall reconstructions (CAWR) tends to have significant associated, multiple comorbidities, complicating the recovery of a reconstruction. Undergoing CAWR exposes these patients to a risk for respiratory complications, which is common after CAWR. These complications are associated with an increased surgical morbidity and mortality, prolonged length of hospital stay (LOHS), an additional cost burden, and decrease in health-related quality of life (HRQoL). Improving the physical capacity before CAWR, by preoperative exercise therapy (PexT), is likely to give a better recovery and lower complication rate. In this study, we will survey the feasibility of PexT in patients undergoing a CAWR. Outcome measures will be added to demonstrate a possible effect of PexT. MATERIALS AND METHODS: A feasibility study was performed. The intervention consisted of a 3-month lasting exercise program consisting of cardiovascular, strength, and respiratory muscle training under direct supervision of a physiotherapist. The primary outcome was feasibility, defined as the occurrence of adverse events and the possibility to perform more than 80% of the intervention. The secondary outcomes were the physical capacity, HRQoL, the amount of pulmonary complications, and the LOHS. Physical capacity was measured with a cardiopulmonary exercise test (CPET) before and after the intervention and after surgery. RESULTS: Nine males and two females were included with a median age of 59 years [95% confidence interval (CI) 51–71] and a median body mass index of 31.6 kg/m2 (95% CI 28.1–36.7). The median width of the ventral hernia was 16.0 cm (95% CI 15.0–23.0). No adverse events occurred and all patients could complete the intervention. Both physical capacity and HRQoL improved after the intervention. All patients had a successful reconstruction with fascial closure. CONCLUSION: Intensive PExT is feasible in patients waiting for a CAWR. A randomized controlled trial needs to be conducted to objectivate the effect of PExT to prevent pulmonary complications and to reduce LOHS in this population.
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Chronic groin pain in young sportsmen: Algorithm of assessment and treatment
Osvaldo Santilli, Marco Ostolaza, Hernan Santilli, Nicolas Nardelli, Hernan Etchepare, Rodolfo Scaravonati, Mara Estevez, Alejandro Rolon, Tomas Pascual, Alvaro Siedi, Ricardo Munafo Dauccia, Agustin Perea
July-September 2021, 4(3):109-116
Background: Chronic groin pain (CGP) is a syndrome characterized by pain in the pubic and inguinal-crural regions, resulting in a functional deficit that can lead to severe impairment of different motor tasks. Objective: The main objective of this study is to describe and analyze an algorithm used for the assessment and treatment of chronic groin pain in young sportsmen used for 10 years. Methods: Descriptive, observational, and retrospective study, adapted with recommendations of the STROBE Declaration (Strengthening Reporting of Observational Studies in Epidemiology) for its design. The study was carried out at an Hernia Pathology Center. It is a multidisciplinary team formed by surgeons, physiotherapists, orthopedists, and imaging specialists, with extensive experience in the research field. This team had developed an assessment, diagnosis, and treatment algorithm for CGP which was implemented for more than 15 years. Results: After clinical examination and complementary imaging, 3,858 patients were included to follow the algorithm. A total of 3,289 patients completed the sports physiotherapy and rehabilitation protocol. The most frequent clinical entities registered were tendinopathies: 1,649 iliopsoas-pectineus-related groin pain (42.7%) and 1,522 adductor-related groin pain (39.5%). A total of 569 patients with sportsman’s hernia diagnosis required surgical intervention. There were no intraoperative complications; furthermore, all patients discharging after 6 hours of hospital stay. Conclusions: The assessment, diagnosis, and treatment algorithm used by a multidisciplinary team to treat patients with chronic groin pain has proven to be safe and successful.
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Management of incisional hernias in liver transplant patients: Perioperative optimization and an open preperitoneal repair using porcine-derived biologic mesh
Sullivan Ayuso, Sharbel A Elhage, Maria B George, Meshka Anderson, David M Levi, B Todd Heniford, Vedra A Augenstein
July-September 2021, 4(3):95-102
PURPOSE: The purpose of this study is to describe an optimal management strategy for incisional hernias in liver transplant patients. METHODS: Patients were identified who underwent open preperitoneal hernia repair for incisional hernia following liver transplantation. Perioperative management and surgical technique were described; wound complications and hernia recurrence were the primary outcomes assessed. RESULTS: A total of 17 patients met our criteria. All patients were on immunosuppression, and one patient (5.9%) had sirolimus stopped prior to the operation. One patient (5.9%) quit smoking, and two patients (11.8%) required optimization of their diabetes to have an A1c ≤7.2. Two patients (11.8%) received botulinum toxin A preoperatively due to significant loss of domain. The mean size of the biologic mesh was 818.8 ± 210 cm2, one patient (5.9%) received an anterior component separation and four (23.5%) received a panniculectomy. Postoperatively, three patients (17.7%) developed wound complications and one patient required reoperation for seroma. There were no 30-day readmissions and no hernia recurrences with mean follow-up time of 21.6 ± 11.6 months. CONCLUSION: The use of preperitoneal biologic mesh is an effective method for the management of incisional hernia in liver transplant patients; perioperative optimization and care are also influential in assuring positive outcomes for patients.
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A short-term preliminary evaluation of ventral hernia repair using a new prosthetic mesh
Rajavi S Parikh, Justin D Faulkner, Jordan A Bilezikian, W Borden Hooks, William W Hope
July-September 2021, 4(3):90-94
BACKGROUND: Syneco® (W.L. Gore and Associates, Flagstaff, AZ) is a new permanent synthetic mesh made of a combination of an absorbable synthetic component and a permanent synthetic component that can be used intraperitoneally or within the abdominal wall layers. Currently, there are little data on outcomes related to this mesh product. AIMS AND OBJECTIVES: The purpose of this project is to review our medical center’s outcomes using Synecor® mesh in ventral hernia repair. MATERIALS AND METHODS: We retrospectively reviewed all patients at our single medical center undergoing ventral hernia repair using Synecor® mesh included in the Americas Hernia Society Quality Collaborative (AHSQC) database from April 2016 through September 2019. Demographic, perioperative, and short-term outcomes (surgical site infection [SSI], surgical site occurrence [SSO], surgical site occurrence requiring procedural intervention [SSOPI]) were reviewed, and descriptive statistics were calculated. RESULTS: Forty-eight patients who underwent ventral hernia repairs using Synecor® mesh met study inclusion criteria. The average age of our patient population was 59 years (range: 29-78) with 50% female and 85% Caucasian. Ninety-six percent of cases were classed as clean cases. Comorbidities were present in 73% of patients. Open repairs were completed in 56% of cases and included retrorectus repair in 67% and transversus abdominis muscle release (TAR) in 30% of open cases. Repairs were laparoscopic in 27% of cases and robotic in 17%, with 85% having closure of the defect during repair. At 30 days follow-up, the rate of SSI was 8%, SSO 17%, and SSOPI 13%. There was an overall complication rate of 29%, a hernia recurrence rate of 4%, and an average follow-up of 97 days (range: 0 days to 1 year). CONCLUSION: Synecor® mesh is a new synthetic mesh that can be used for ventral hernia repair in an open, laparoscopic, or robotic approach. Short-term, preliminary results appear favorable; however, more study is needed to fully evaluate this new mesh prosthetic.
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Complicated Littre hernias
Mariana Rita Afonso Matias, Madara Kronberga, Assad Aghahoseini
July-September 2021, 4(3):83-89
BACKGROUND: Meckel’s diverticulum (MD) is the most prevalent congenital anomaly of the gastrointestinal tract with an estimated prevalence ranging from 2% to 4%. The diverticulum is a remnant of the vitelline duct, which leads to the formation of a true diverticulum containing all the layers of the small intestine. The condition is usually clinically silent; however, it can present with unusual symptoms and signs and therefore can result in a delayed diagnosis, particularly in adults. The aim of this study is to review the most updated literature reporting Littre hernias (LHs) in adults, the diagnostic approach, and its subsequent management. This is a literature review, complemented by an unusual clinical case of an adult who presented with a complicated umbilical LH which required emergency surgery. MATERIALS AND METHODS: Literature reviews using PubMed, Web of Science, and other reliable sources use the possible combinations of the following keywords: Meckel’s diverticulum, Littre hernia, umbilical hernia, adults, complications, surgical treatment. RESULTS: The herniation of an MD through a potential opening in the abdominal wall is defined as an LH, representing a rare complication of the diverticula. Due to their rarity, they remain underdiagnosed, often leading to suboptimal treatment with substantial morbidity and mortality. CONCLUSION: An MD, despite being a rare clinical entity in adults, can theoretically be found in any hernia, with patients experiencing a wide range of potential complications.
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Recurrence lumbar lipoma: Misdiagnosis of a Grynfelt-Lesshaft hernia: Case report
Ramon Liron, Sergio Annese, Melody Baeza, Lidia Betoret
July-September 2021, 4(3):125-127
Lumbar hernias of the lateroposterior abdominal wall have a low prevalence, being described in the scientific literature as sporadic cases or short series. Initially, they manifest as a painless tumor that can be confused with other more frequent pathologies such as soft-tissue tumors, lipomas, hematomas, or abscesses. We present the case of a 72-year-old female patient who, after removal of a lumbar lipoma by dermatology, was referred to our clinic for recurrence of tumor. An ultrasound scan showed a recurrence of the lipoma. The anamnesis and physical examination suggested lumbar hernia. Computerized axial tomography scan confirmed the clinical diagnosis, and surgery was indicated.
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Laparoscopic transabdominal preperitoneal mesh repair of two posterior rectus sheath hernias: A first case series in the published literature
Kendell Pon, Yagan Pillay
July-September 2021, 4(3):128-132
Posterior rectus sheath hernias are a rare type of interparietal hernia previously described in a limited number of case reports. There has only been one published case report of a laparoscopic mesh repair. We present a case series of two posterior rectus sheath hernias diagnosed at laparoscopy. A preperitoneal mesh herniorrhaphy was performed to repair the defects. To our knowledge this is the first time such a repair has been performed for this type of hernia. Both hernia necks were infra-umbilical in position. In all previously reported case reports the hernial necks were supraumbilical in position.This is the first case series to be published of this exceedingly rare type of interparietal hernia.
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Evaluation of long-term impact of education program Hernia Help—Hernia Repair for the Underserved (HRFU) in Brazil
Luca Giovanni Antonio Pivetta, Renata Yumi Lima Konichi, Victor Kenzo Fujikawa, João Paulo Venancio de Carvalho, Jessica Zilberman Macret, Eduardo Rullo Maranhão Dia, Maurice Youssef Francis, Hamilton Brasil Ribeiro, Pedro Henrique de Freitas Amaral, Rodrigo Altenfelder Silva, Sergio Roll
July-September 2021, 4(3):117-121
AIM: Hernia HelpHernia Repair for the Underserved (HRFU) is a non-governmental organization (NGO) that has the following objectives: (1) to provide free hernia surgery to underserved populations, (2) to train local surgeons in a competency-based training program, and (3) to assist local authorities in creating self-sustaining hernia repair teams that can provide further care to the community. We aim to report a quality research of the training program of Hernia Help. Materials and Methods: Fifty-five surgeons who took the courses promoted by Hernia Help were contacted by email or telephone and invited to participate in the study. Those who accepted by signing their own and individual terms will answer a standardized questionnaire (10 closed questions) that evaluates the training course, as well as the incorporation of the technique taught in the participant’s daily practice. Results: Hernia HelpHRFU trained 55 surgeons in Brazil, of which 33 responded to the contact and agreed to participate in the study; 16 did not return the contact; 2 refused to participate in the study; and 4 could not be reached for lack of means of contact. Of this group, all see Hernia Help as a good experience to them, and it has fulfilled the scope of teaching the modified Lichtenstein technique (MLT), and 88% adopted the technique in their daily practice. Of the group that adopted the MLT (29 participants), 6 (20.6%) admitted that they do not follow every step as it was taught. Additionally, 9 (31%) also reported that they have altered, to some degree, the technique when performing it in their daily practice. In addition, 4 (13.7%) admitted that they need another course. In contrast, 26 (89.6%) feel confident to teach the MLT, and 22 (75,8%) manifest the intent to participate as instructors in other occasions. Conclusion: Those results may indicate the need to develop new forms to help these students become proficient and perform the MTL following the steps. Besides, the study shows that Hernia HelpHRFU is a valuable initiative to educate surgeons—in developing countries—to build a sustainable inguinal hernia program in their communities.
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Intestinal obstruction due to a broad ligament (Lg latum) hernia: Case report and literature review
Elena Viejo Martínez, Carlos Ortiz Johansson, Alicia Ruiz de la Hermosa García Pardo, María Luisa de Fuenmayor Valera, Gloria Paseiro Crespo
July-September 2021, 4(3):122-124
Hernias of the broad ligament consist in the protrusion of an intra-abdominal viscus through a defect of the broad ligament. Its cause can be congenital or acquired. They are classified as fenestrated or pouched (Hunt classification) or as their location within the broad ligament (Cilley classification). It is an infrequent cause of internal hernia to be considered in the differential diagnosis of acute intestinal obstructions in women, especially with no surgical history. The high clinical suspicion can help early diagnosis and early treatment, thus avoiding the need for intestinal resection due to ischemia of the herniated intestinal segment. Preoperative diagnosis is difficult due to imaging tests, so laparoscopy can be a useful tool for diagnosis and treatment. We present a clinical case of internal hernia through a defect of the broad ligament, diagnosed and treated by minimally invasive surgery.
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