An isolated appendix epiploica (AE) inguinal hernia remains a rare surgical entity despite laparoscopic herniorrhaphy and improved intra peritoneal visualization. The surgical disposition of the AE remains controversial with proponents for both excision and conservative management. The paucity of data, based only on case reports precludes definite guidelines in their management. The presence of infection, organ ischemia, surgeon experience, and biological mesh availability all play a role in the management of this type of hernia. We present a rare case report with a viable incarcerated, AE inguinal hernia and its laparoscopic excision, and hernia repair. This is only the third such case report in the published literature to date.
Traumatic abdominal wall hernia (TAWH) is a rare clinical occurrence, with only limited cases published since 1906. This type of hernia is primarily caused by low- or high-energy blunt force trauma, resulting in damage to abdominal wall musculature while the skin is intact. The diagnosis and management of TAWH poses a lot of challenges and complexities. Herein, we present a case of a 32-year-old male Saudi patient who sustained significant abdominal trauma as a driver involved in a front collision while wearing a seat belt. Upon arrival at the trauma center, the patient was hemodynamically stable and exhibited clinical signs of left flank bulge, seat belt sign, and abdominal bruising. First, a focused assessment with sonography for trauma (FAST) was performed, which revealed minimal free fluid in the abdomen. Subsequent contrast-enhanced IV computed tomography (CT) scan confirmed a 3.6-cm left lateral abdominal wall defect with herniation of short segments of the large and small bowel loops and adjacent subcutaneous fluid. Following initial observation, the patient developed signs of bowel obstruction. A repeat CT scan showed interval progression of the hernia, partial small bowel obstruction, and other concerning findings. An emergency laparoscopic exploration revealed a large defect at the left lumber region containing omentum and long segments of the small bowel with mild distension. The bowel and omentum were reduced. The surgical repair included herniorrhaphy and mesh placement. The patient recovered well and was discharged on the third postoperative day. This case underscores the importance of thorough evaluation and timely intervention in TAWHs. Rapid surgical management, aided by advanced imaging techniques, can lead to favorable outcomes even in complex cases involving bowel herniation and associated complications.
BACKGROUND: Minimally invasive surgery for hernia repair has advanced significantly, with techniques such as transabdominal preperitoneal repair (TAPP) and totally extraperitoneal repair for inguinal hernias inspiring similar approaches for ventral and incisional hernias. The enhanced-view totally extraperitoneal repair (eTEP) technique, introduced in the twenty-first century, demonstrated advantages in inguinal hernia repair. Leveraging the benefits of eTEP and TAPP while addressing their limitations, we developed the extended totally extraperitoneal preperitoneal repair (eTEP-PP) technique for primary midline ventral hernias. This technique combines the benefits of eTEP and TAPP, avoids specific drawbacks such as the need to divide the posterior rectus sheath or close the peritoneum, and ensures safer and more effective repair. The eTEP-PP method shows promise as a future standard for small-to-medium primary ventral hernia repairs. Further studies are needed to confirm its long-term efficacy and application.
MATERIALS AND METHODS: This retrospective study included 15 patients who underwent eTEP-PP surgery between February 2024 and June 2024 at the Department of Surgical Gastroenterology, Regency Hospital, Kanpur, Uttar Pradesh, India. Patients with primary midline ventral abdominal wall hernias were studied, noting intraoperative and postoperative outcomes.
RESULTS: All 15 patients experienced no intraoperative complications or conversions to open surgery. Two patients required conversion from eTEP-PP to eTEP due to challenges in creating the preperitoneal flap. Postoperative outcomes were excellent, with no surgical site occurrences or complications requiring intervention. There were no readmissions, mortalities, or recurrences 1 month post-surgery.
CONCLUSION: The eTEP-PP technique for primary ventral hernia repair is reproducible and has shown excellent initial outcomes. While the study’s sample size is a limitation, the technique’s potential as a future standard for small-to-medium primary ventral hernia repairs is evident. Further studies are needed to establish its long-term efficacy and broaden its application.
INTRODUCTION: Hernias, particularly groin hernias, are prevalent surgical pathologies worldwide, often necessitating surgery in cases of complications. This study investigates the safety and efficacy of performing bilateral inguinal hernioplasty when one side faces complications, addressing the lack of consensus in emergency groin hernia treatment.
MATERIALS AND METHODS: A retrospective, single-center study spanning a duration of 10 years was conducted, including adult patients who underwent emergency surgery for inguinal hernia. Propensity score matching was employed to create similar groups for comparative analysis of unilateral versus bilateral emergency groin hernioplasty. Surgical techniques, complications, mortality, and long-term outcomes were evaluated.
RESULTS: This study included 341 patients. Data obtained from the study revealed high morbidity and 90-day mortality rates, consistent with the data of existing literature. Propensity score matching yielded two comparable groups. Short-term outcomes showed no significant differences in complication rates, mortality, surgical site infection, or hospital stay between unilateral and bilateral hernioplasty groups. Bilateral surgery takes approximately 15min of the procedure time. Long-term outcomes exhibited similar recurrence rates between groups.
CONCLUSION: This study supports the practice of bilateral inguinal hernioplasty in emergency scenarios when one side faces complications. It is a safe approach without any significant increase in morbidity or hospital stay, while reducing the need for a subsequent intervention and its associated risks and costs. Further prospective research is necessary to confirm these findings.
OBJECTIVES: The purpose of this study was to develop a simplified technical modification with an attempt to standardize the extended totally view extraperitoneal–Rives Stoppa (ETEP-RS) procedure. In this article, we present the technical aspects to perform this procedure by using novel lateral three ports and the short-term results of our experience in this subset of patients.
MATERIALS AND METHODS: A retrospective analysis of 100 consecutive patients who underwent laparoscopic ETEP-RS using the lateral three-port technique between January 2022 and July 2023 was done. In this technique, three lateral ports were placed for both midline and lateral ventral hernias (VH), with no need to shift camera, working ports, and monitor positions throughout the procedure. It can be coupled with repair of associated right inguinal hernia, divarication of recti (DR), and transversus abdominis release (TAR).
RESULTS: Of 100 consecutive patients who underwent ETEP approach for VH by using our lateral three-port technique, 84 patients underwent ETEP-RS and 16 patients underwent ETEP-TAR. Out of these 100 patients, 4 patients underwent ETEP for associated right inguinal hernia. The mean operating time was 119.9min with a range from 45min to 185min. The mean defect width was 7.24cm. We used 20 cm × 15cm medium weight polypropylene mesh for most of our patients. There were no recurrences in the follow-up period. One patient required laparoscopic re-exploration for posterior rectus sheath rupture.
CONCLUSION: The laparoscopic novel lateral three-port ETEP-RS technique is safe, feasible, cost-effective, and reproducible. This can be combined with right-sided TAR, right inguinal hernias, and repair of DR. It can be standardized; however, larger studies and longer follow-up are needed to have an evidence-based answer.
BACKGROUND: Quality assessment and improvement of surgical procedures can be achieved by clinical audits that provide feedback on benchmarking of surgical outcomes. The Dutch Institute for Clinical Auditing (DICA) has successfully initiated registries with a clear impact on healthcare quality. Currently, there is no Dutch national inguinal hernia (IH) audit. This survey aimed to investigate the opinions of Dutch surgeons regarding the registration of IH care and explore potential obstacles in the implementation of a Dutch Inguinal Hernia Audit (DIHA).
MATERIALS AND METHODS: A web-based survey was sent to all (>2,000) members of the Dutch Surgical Society, including surgeons and residents.
RESULTS: Two-hundred sixty-seven respondents replied between April 14 and June 26, 2022 (hospital distribution: 36% small peripheral, 44% large peripheral, 11% academic, 2% specialized clinic). Almost two-thirds (60%) agreed that the quality of IH care should be improved. Similarly, nearly two-thirds (59%) answered that this improvement could be achieved through registration of surgical outcomes. Those opposed to registration stated fear of increased administrative burden and that the quality of care is already adequate. The majority of respondents agreed that chronic postoperative inguinal pain (CPIP; 81%) and recurrence rate (81%) should be used as quality indicators of IH surgery and registered as patient-reported outcome measures (PROMs).
CONCLUSION: The majority of respondents agree that the quality of IH care could potentially be improved by implementing a national IH registry, with registration of CPIP and recurrence rate as quality indicators. Collecting these PROMs in a digital, automated format will facilitate successful implementation by minimizing administrative burden.