Abdominal Wall and Hernia Surgery

ORIGINAL ARTICLES
	Comparison of intraperitoneal ventralex ST patch versus onlay mesh repair in small and medium primer umbilical hernia	p. 1
	Birol Agca, Yalin Iscan DOI:10.4103/ijawhs.ijawhs_24_18   PURPOSE: Although the size of the hernia plays an active role in the use of the mesh, the counter-view is that the use of the mesh should be preferred regardless of the size of the hernia. In our study, the clinical results of two different mesh types applied under elective conditions to small-and medium-sized umbilical hernia cases were examined. PATIENTS AND METHODS: Between January 2015 and May 2018, intraperitoneal Ventralex ST repair and onlayprolene mesh repair were performed in 88 primary small and medium umbilical hernia cases. Demographic data, duration of surgery, length of hospital stay postoperative complications, and recurrence were recorded. RESULTS: Eighty-eight patients were analyzed including 54 males and 34 females – a mean age of 50.3 years. The duration of the surgery in Ventralex ST group was 35.9 ± 4.1 min. (P < 0.05). Comparing to the visual analog scale (VAS) values of the 1st day, the decrease in VAS values in both groups on the 7th day was statistically significant (P < 0.05). The rates of early and late postoperative complications, such as seroma, hematoma, wound infection, and recurrence, were similar between the procedures. The mean follow-up period was 23 months (with range 7–46 months), and no recurrence was observed in both groups. CONCLUSION: We think that the Ventralex ST mesh performed with open surgical technique under elective conditions for primitive umbilical hernias can be safely used because of its quick applicability and low rates of complication and recurrence.
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	Peritoneal closure using self-anchoring-barbed absorbable sutures during laparoscopic transabdominal preperitoneal inguinal hernioplasty: How to make it more safe?	p. 7
	Axel Gilbert, Fawaz Abo-Alhassan, Pablo Ortega-Deballon, Nicolas Cheynel, Patrick Rat, Olivier Facy DOI:10.4103/ijawhs.ijawhs_30_18   CONTEXT: Peritoneal closure with a barbed suture during laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a controversial subject due to the risk of postoperative intestinal adhesions and occlusions formed by this type of suture. This risk, however, was only reported in several case reports. The purpose of this study is to determine the incidence of postoperative intestinal obstructions related to the use of barbed suture materials in laparoscopic hernia repair (TAPP). PATIENTS AND METHODS: We included all patients that underwent laparoscopic TAPP inguinal hernia repair between October 2012 and October 2017. All peritoneal closures were accomplished using absorbable barbed sutures. Operative data were collected in a dedicated database and analyzed retrospectively. RESULTS: Only 3 out of the 320 patients included (0.9%) presented with an early postoperative intestinal obstruction and required further surgery. Two of the three patients (0.6%) were found to have intestinal incarceration in the peritoneal defects initially created during the hernia repair. However, the last patient had an intestinal volvulus due to adhesions formed with the barbed suture. None of the patient characteristics collected were significant risk factors for developing postoperative intestinal obstructions. CONCLUSION: In this study, peritoneal closure using barbed suture material did not increase the risk of early postoperative intestinal obstruction, in comparison to other suture materials reported in the literature. The use of barbed absorbable sutures for peritoneal closure during laparoscopic TAPP seems to be safe when sutures are cut short and covered by the peritoneum.
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	Local anesthesia for open mesh repair of recurrences after previous total extraperitoneal inguinal hernia repair	p. 12
	Keerthi Rajapaksha DOI:10.4103/ijawhs.ijawhs_26_18   INTRODUCTION: Optimum treatment for recurrences after laparoscopic repair of inguinal hernia (IH) is debatable. Guidelines recommend open repair under general anesthesia (GA), whereas emerging studies show relaparoscopy as a feasible option. Both require GA and incur extra cost. Does open surgery under local anesthesia (LA) is an option for recurrent hernia following laparoscopic surgery? METHODS: This is a retrospective review of medical reports of four patients who underwent open mesh repair under LA for recurrences after previous laparoscopic IH repair between May 2015 and August 2018. RESULTS: All the patients were male with a mean age of 50 years and 3 months (range 36–64 years). All the patients have primarily underwent total extraperitoneal (TEP) repair. Inadequate deperitonealization at the deep ring (n = 2), mesh migration (n = 1), and missed indirect sac were the causes for recurrences. All the patients underwent tension-free Lichtenstein repair under LA. The mean operative time was 25 min (range, 18–32 min). Tissue planes were well preserved and separation of cord structures from hernia sac and preservation of ilioinguinal nerve were possible in all cases. No conversions to GA. None of the patients had long-term morbidity or recurrences during the mean follow-up period of 1 year and 7 months (range, 1 month–2 years). All the cases were performed as day-case procedures. CONCLUSION: Open mesh repair under LA is a safe and effective option for recurrences after previous TEP repair of IH.
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	A single-blind, randomized controlled study to compare Desarda technique with Lichtenstein technique by evaluating short- and long-term outcomes after 3 years of follow-up in primary inguinal hernias	p. 16
	Hemanth Vupputuri, Satish Kumar R, Priya Subramani, Venugopal K DOI:10.4103/ijawhs.ijawhs_21_18   BACKGROUND: Lichtenstein tension-free repair is associated with postoperative complications and dysfunctions; hence, there is a need to look for a new hernia repair techniques while retaining its advantages. Desarda technique is a physiologic repair and essentially restores physiology of the inguinal canal. This single-blind, randomized controlled study was conducted to compare Desarda with Lichtenstein technique evaluating short- and long-term outcomes after 3 years of follow-up in primary inguinal hernias. MATERIALS AND METHODS: One hundred and twenty-three adult male patients with primary inguinal hernia (both direct and indirect) were randomly allocated intraoperatively to Lichtenstein repair, Mesh (M) Group or Desarda repair, nonmesh (NM) Group. Baseline characteristics were recorded before the surgery. Short- and long-term outcomes and patients responses on patient global impression of change (PGIC) and Prolo scale after surgery were recorded. RESULTS: Sixty-two patients were assigned to NM and 61 to M group. Surgery time was significantly higher for M group (P < 0.001). Postsurgical pain was significantly higher (P < 0.001) in M than NM group whereas complications were comparable. The total mean duration of follow-up for M was 35.2 months while for NM was 35.7 months. The recurrence rate was not significantly different; however, chronic groin pain was significantly higher in M compared to NM (P = 0.05). After surgery, PGIC score was consistently higher in NM group with better functionality in NM group. CONCLUSIONS: After 3 years of follow-up, Lichtenstein technique and Desarda technique results were similar. After considering the pros and cons of both the methods, a tailor-made approach is required while choosing a procedure for hernia repair.
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COMMENTARY
	Outside of guidelines: Successful Desarda technique for primary inguinal hernias	p. 23
	Ralph Lorenz DOI:10.4103/ijawhs.ijawhs_1_19
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TECHNIQUE REPORT
	Laparoscopic total extraperitoneal superior and inferior lumbar hernias repair without traumatic fixation: Two case reports	p. 25
	Junsheng Li, Xiangyu Shao, Tao Cheng DOI:10.4103/ijawhs.ijawhs_23_18   BACKGROUND: The lumbar area is limited by the bone structures (superiorly by the 12th rib and inferiorly by the iliac crest); furthermore, several important nerves, including the genitofemoral nerve, lateral femoral cutaneous nerve, and ilioinguinal and iliohypogastric nerves, are all exposed in this area after retroperitoneal dissection during lumbar hernia repair, which render the risk and challenge for lumbar hernia repair and mesh fixation. In addition, the superior and inferior lumbar hernias, although had the same name of lumbar hernia, are quite different according to the anatomical location, and there is no standard and preferred method for lumbar hernia repair. In the present study, we present our techniques of total extraperitoneal (TEP) superior and inferior lumbar hernia repair. METHODS: The TEP approaches were performed in the superior and inferior lumbar hernias. Due to the different anatomic locations of the superior and inferior lumbar hernias, the trocar sites were also different. In the present procedure, with the use of self-gripping mesh, the traumatic fixation was avoided.RESULTS: After TEP lumbar hernia repair, both patients had minimal postoperative pain and were discharged 1 day and 3 days after operation without complications, respectively. CONCLUSION: Different pathways and trocar arrangement are necessary according to the different locations of superior and inferior lumbar hernias. The use of self-gripping mesh in the retroperitoneal space avoids the traumatic fixation, and TEP could be a promising technique for primary lumbar hernia repair.
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CASE REPORT
	Laparoscopic reconstruction of traumatic lumbar hernia: A case report	p. 30
	Martynas Luksta, Marius Kryzauskas, Marius Paskonis, Kestutis Strupas DOI:10.4103/ijawhs.ijawhs_22_18   The traumatic lumbar hernia is an uncommon condition after blunt trauma. There are reported <100 cases in the English literature. Although open repair of traumatic lumbar hernia is a standard treatment, there is a possibility to use minimally invasive techniques in the laparoscopic era. We report the case of a 36-year-old male patient with a history of a blunt abdominal trauma. Seven months later, the patient was complaining of the enlarging mass and a chronic pain in a right lumbar area. A computed tomography scan revealed the traumatic lumbar hernia, with the hepatic flexure of the colon and a greater omentum inside the hernia sac. A laparoscopic intraperitoneal onlay method was chosen and the reconstruction with mesh was performed. The postoperative period was uneventful. The patient was discharged on the 3rd-day postoperatively. The laparoscopic approach can be safe and feasible for treating the traumatic lumbar hernia.
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