Laparoscopic Surgical Repair Research Articles

A case series analysis of spigelian hernia: A diagnostic dilemma and its successful laparoscopic repair.

A Spigelian hernia is an uncommon, atypical protrusion of the peritoneum or abdominal contents via a defect (Spigelian fascia), consisting of the internal oblique aponeuroses and the transversus abdominis. With a frequency ranging from 0.12% to 2% of all abdominal wall hernias, Spigelian hernias are extremely rare. It usually arises from a condition that increases intra-abdominal pressure, the degeneration of the abdominal aponeurotic layers or trauma to the abdominal wall. Herein, we present a case series of patients with varying presentations of Spigelian hernia who presented, who were promptly diagnosed and who were managed successfully with laparoscopic surgical repair.

Laparoscopic repair for a recurrent epigastric incisional hernia following xiphoidectomy: A case report

Introduction: Xiphodynia is a rare musculoskeletal disorder characterized by epigastric or anterior chest pain, for which xiphoidectomy is considered as a definitive treatment. This procedure and its complications are not well researched, particularly within Australasian populations. We describe the novel laparoscopic incisional hernia repair from a xiphoidectomy complicated by recurrent epigastric hernias. Case Report: A 49-year-old female presented with chronic epigastric pain post-xiphoidectomy for xiphoidynia. The patient previously underwent open mesh repair for an incisional epigastric hernia, complicated by infection and subsequent removal of the mesh. A vacuum-assisted closure device was then utilized, followed by delayed primary closure. However, she experienced ongoing pain, a recurrent mass, and hypertrophic scarring, confirmed by abdominal computed tomography (CT) scan. Our laparoscopic approach involved a standard supine position with three ports and preperitoneal dissection similar to transabdominal preperitoneal (TAPP) hernia repair. The defect was 5 × 8 cm in size. A simple prolene mesh (9 × 12 cm) was secured with AsorbaTack and Glubran 2, followed by peritoneal closure with a 3/0 V-Loc suture. At two months follow-up, the patient had no evidence of recurrent hernia, no ongoing pain, and satisfactory wound healing. Conclusion: Laparoscopic surgical repair using a TAPP approach is a safe alternative to open repair of an incisional recurrent epigastric hernia post-xiphoidectomy.

Risk Factors for Pfannenstiel Incisional Hernia Following Cesarean Delivery and Outcomes after Laparoscopic and Open Surgical Repair

Risk Factors for Pfannenstiel Incisional Hernia Following Cesarean Delivery and Outcomes after Laparoscopic and Open Surgical Repair

Health-related quality of life postventral hernia repair: Retrospective analysis

Abstract BACKGROUND: Laparoscopy has gained widespread adoption for ventral hernia repair, mirroring the trend seen in numerous intra-abdominal surgical procedures. The objective of this study was to evaluate the quality of life (QoL) of patients who underwent laparoscopic versus open surgical repair. MATERIALS AND METHODS: Patients who underwent surgery between January 2020 and December 2022 were included in this time-bound study. Of the 202 patients who underwent hernial repair over 3 years, all eligible patients were contacted and invited to participate in the study. The response rate was 77%, 155 patients completed the study questionnaire, which collected sociodemographic data, as well as the EORTC QLQ-C30 version 3.0 questionnaire, which assessed QoL. RESULTS: The mean age of the participants was 47.0 ± 13.0 years, with a range from 15.0 to 76.0 years. Among them, 67.7% were female, and 60.0% had comorbidities. Additionally, a lower proportion of laparoscopic cases required drain placement compared with the open group (12.9% vs. 26.9%). Patients who underwent laparoscopic surgery had shorter hospital stays within “1 day” (46.8% vs. 36.6%) or “2 days” (22.6% vs. 19%) and experienced a quicker return to activity, with a higher proportion resuming normalcy after 2 weeks (27.4% vs. 20.4%). Furthermore, patients in the open group reported higher pain scores, higher constipation, and insomnia scores than those in the laparoscopic group. CONCLUSIONS: This study showed that laparoscopic repair had fewer complications than open repair in terms of hospital stay, return to activities, and pain score. Regarding the QoL scale, the laparoscopic approach shows a far better QoL profile compared with the open technique.

Laparoscopic versus open surgical outcomes repair for inguinal hernia: A combined prospective and retrospective cohort study

Laparoscopic versus open surgical outcomes repair for inguinal hernia: A combined prospective and retrospective cohort study

Comparison of Single-incision Laparoscopic Percutaneous and Cystoscope Forceps Assisted Morgagni Hernia Repair Techniques

ObjectiveOur goal was to compare single-incision laparoscopic percutaneous and cystoscope forceps-assisted Morgagni hernia repair techniques. Materials and methodsA total of 40 patients were allocated to two groups, each with 20 patients. Group 1: Single incision (port) laparoscopic surgical percutaneous Morgagni hernia repair (with a 5 mm Storz laparoscopic scope entered through the umbilicus). Group 2: Single incision (port) laparoscopic surgical percutaneous Morgagni hernia repair (with an 11 Fr [3.6 mm] cystoscope entered through the umbilicus + using forceps + sac plication, and sac cauterization). In Group 1; the sac was not removed. In group 2; we advanced the forceps through the cystoscope, caught the sac, pushed the needle through the sac, plicated the sac, and then cauterized the sac with Bugbee electrode. ResultsOf the 40 patients, 70 % (n = 28) were male. The symptoms at admission included repeated chest infections (40 %), dyspnea (30 %), vomiting (22 %), and abdominal pain (22 %). No difference was found between groups in terms of age, gender symptomatology, or associated anomalies. The operation time was shorter in group 2 compared to group 1 (p < 0.05; 25 min vs 40 min). Although there was one recurrence in Group 1, no recurrence was reported in Group 2. The recurrence incidence did not differ between groups (p > 0.05). ConclusionsCystoscope-assisted repair of Morgagni hernia was found to be superior in terms of safety and shorter operation time. Level of evidenceType III. Type of the studyRetrospective study.

The surgical treatment of Morgagni hernias in adults: a systematic review for the standardization of laparoscopic surgical repair.

A Morgagni hernia is a congenital diaphragmatic hernia that is rarely diagnosed in adults, and the technique for its repair has not yet been standardized. This review will give an overview of the different laparoscopic methods reported by other authors, highlighting the key points indicating a good repair to help standardize the technique. A systematic review of the available articles on PubMed was conducted according to PRISMA 2020 by two authors independently in May 2022. Only articles written in English were included. A total of 180 case reports of laparoscopic Morgagni's hernia repair procedures were found; direct repair was performed in 59 patients, mesh was used in 119 patients, and mesh was not used in 2 patients. The hernia sac was removed in 71 patients, and the defect was closed before mesh placement in 49 patients. Nonabsorbable, dual or biologic mesh was used. The mean operative time was 92.65 min for direct repair and 84.11 min for mesh repair. One recurrence was reported in the direct repair series. The optimal method of repair has not yet been identified. The laparoscopic approach is associated to fewer complications and facilitates a faster recovery than the open approach. Several manoeuvres have been reported to help surgeons, who are not trained in laparoscopic knotting, perform extracorporeal knotting. Mesh should be placed when tension is too high after a direct repair or when primary closure cannot be achieved.

779 Endoscopic Repair of a Chronic Duodenal Perforation Complicated by a Contained Collection: A Case Report

Abstract Duodenal perforations are a surgical emergency with high mortality. Most perforations require open or laparoscopic surgical repair, whereby the ulcer is oversewn, sometimes using a Graham patch. However, surgery is not without complications. We report the case of a 70-year-old man with a chronic, perforated duodenal ulcer that was repaired endoscopically. The patient presented with a 1-month history of epigastric abdominal pain, exacerbated by eating, and associated with a weight loss of 3.5 stones. Examination revealed a hard, irregular mass in the epigastrium. CT imaging showed a 6.8cm x 5.2cm x 4.1cm collection with an air-fluid level communicating with the D2 duodenum and extravasation of contrast into the collection. The collection was unable to be drained under radiological guidance due to difficulty in visualising and accessing it. Surgical intervention was deemed difficult to due to the site and chronicity of the perforation. The patient underwent endoscopic repair. Two interrupted sutures were placed using an Apollo overstitch system. APC was applied to the edges of the perforation and an OVESCO clip was placed ontop. Repeat CT imaging did not show any evidence of recurrent perforation. Endoscopic repairs have mainly been performed as an adjunct to surgical repair or during ERCP procedures, primarily using endoclips. We present a case where endoscopic repair alone was successful in sealing a duodenal perforation whilst leaving the collection intact. We believe this case is interesting and with advances in endoscopy, endoscopic repair could provide a minimal invasive option for managing duodenal perforations, especially complicated, chronic ones.

Clinical analysis of laparoscopic treatment of chronic traumatic diaphragmatic hernia in 29 cases

Objective: To examine the safety and effectiveness of laparoscopic individualized surgical treatment for chronic traumatic diaphragmatic hernia (CTDH). Methods: The clinical data and follow-up data of 29 CTDH cases admitted to the Qilu Hospital of Shandong University or the First Affiliated Hospital of Shandong First Medical University from June 2015 to January 2023 were retrospectively analyzed. There were 21 males and 8 females, aged (49.4±17.8) years (range: 19 to 79 years). The main clinical manifestations were symptoms of the digestive system and respiratory system, and only 4 cases were asymptomatic. All patients received laparoscopic treatment (conversion to open surgery was not excluded). Intraoperative exploration (location of the hernia, contents of the hernia, diameter of the hernia ring), surgical conditions (surgical repair plan, operation time, blood loss, postoperative complications) and postoperative follow-up were analyzed and discussed. Results: Laparoscopic repair was successfully completed in 27 cases, including simple suture in 6 cases, suture and patch repair in 17 cases, the anterior abdominal wall muscle flap reversal suture and patch repair of in 3 cases, and patch bridge repair in 1 case. The operation time was (112.8±44.7) minutes (range: 60 to 200 minutes). The amount of bleeding (M(IQR)) was 35 (58) ml (range: 10 to 300 ml). The other 2 patients were converted to laparotomy. Except for one patient with transverse colon strangulation necrosis who died of aggravated pulmonary infection after surgery, the remaining 28 patients were discharged successfully. The follow-up time was 36 (24) months (range: 1 to 60 months). During the follow-up period, only two patients had occasional left upper abdominal discomfort. Twenty-seven patients with left diaphragmatic hernia had no recurrence, and the symptoms of 1 patient with right diaphragmatic hernia were relieved. Conclusion: Customized laparoscopic surgical repair for CTDH according to the location and size of the diaphragmatic defect can achieve good surgical results.

Studying the surgical stress in open and laparoscopic treatment of inguinal hernia in children.

Studying the surgical stress in open and laparoscopic treatment of inguinal hernia in children.

Ergonomic Laparoscopic Surgical Repair of three large external herniae through just three optimally placed working ports – A Case report with Review of Literature

Currently, hernia repair is the most frequent procedure performed by general surgeons. Like many other abdominal operations, the laparoscopy revolution has influenced the surgical repair of external herniae as well. Laparoscopic repair of groin and ventral hernia have become more and more popular over the years. Ventral herniae are mostly repaired trans-peritoneally while groin herniae can be repaired both trans- as well as extra-peritoneally. Herein, we describe the case of a 60-year old man who presented to us with large umbilical and large bilateral inguinal herniae. All the three large external herniae were repaired laparoscopically, through just 3 carefully selected trocar sites. The purpose of this paper is to highlight the importance of ergonomics in optimum laparoscopic trocar placement, so as to achieve maximum results with minimum number of port sites.

Analysis of Reported Adverse Events Associated with Over-the-Scope Endoscopic Suturing System: an FDA MAUDE Database Study.

The over-the-scope endoscopic suturing system (ESS) (OverStitch™) is one of the most widely utilized endoscopic suturing systems in current clinical practice; however, data on the adverse events associated with this device is scarce. Our study aims to evaluate the adverse events and complications associated with the over-the-scope ESS using the FDA's Manufacturer and User Facility Device Experience (MAUDE) database. We analyzed the post-marketing surveillance data from the FDA MAUDE database for the over-the-scope ESS from January 2008 through June 2022. Eighty-three reports were filed from January 2008 to June 2022. Adverse events were classified as device-related complications and patient-related adverse events. Seventy-seven device-related issues and 87 patient adverse events were identified. The most common device-related issue was difficulty to remove after deployment (n=12, 15.58%) followed by mechanical problem (n=10, 12.99%), mechanical jam (n=9, 11.69%), or entrapment of device (n=9, 11.69%). Of the 87 patient-related adverse events, the most common was perforation (n=19; 21.84%), followed by device embedded in tissue or plaque (n=10; 11.49%), and abdominal pain (n=8; 9.20%). Of the 19 patients who experienced perforation, two required open surgical repair and one required laparoscopic surgical repair. The overall adverse events from the over-the-scope ESS remain acceptable as evidenced by the number of reported cases since 2008. However, it is important to note that adverse event rates might increase as the use of the device increases; therefore, it is essential for endoscopists to be aware of the potential common and rare adverse events associated with the use of the over-the-scope ESS device.

Laparoscopic Surgical Repair of a Giant Hiatal Hernia with Prothesis: How We Do It (with Video)

Laparoscopic Surgical Repair of a Giant Hiatal Hernia with Prothesis: How We Do It (with Video)

Minimally Invasive Surgery for Genitourinary Trauma: A Nationwide Outcomes-Based Analysis

IntroductionBladder and ureteral injuries are uncommon in trauma patients but are associated with increased morbidity and mortality. Patients presenting with such injuries may undergo either open surgical repair or laparoscopic repair. We aimed to compare outcomes of open surgical approach and laparoscopy in trauma patients with isolated bladder and ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes. MethodsWe performed a 2017 review of American College of Surgeons Trauma Quality Improvement Program and identified trauma patients with bladder and ureteral injury who underwent open surgical repair or laparoscopy. A 1:1 propensity score matching was performed adjusting for demographics, emergency department vitals (systolic blood pressure, heart rate, Glasgow Coma Scale), mechanism of injury, Injury Severity Score, each body region Abbreviated Injury Scale score, and transfusion units. Outcomes were rates of in-hospital major complications and mortality. ResultsOf the 1,004,440 trauma patients, 384 patients (open: 192 and laparoscopy: 192) were matched and included. The mean age was 36 ± 15 y, Injury Severity Score was 27 [27-48], 77% were males, and 56% of patients had a blunt mechanism of injury, and 44% had penetrating injuries. Overall mortality was 7.3%. On univariate analysis, mortality was lower in the open group as compared to the laparoscopy group (10.4% versus 4.2%, P = 0.019) and survivor-only hospital length of stay was longer in the open group (8 [8-9] versus 7 [5-11], P = 0.008). There was no difference in overall major complications (23% versus 21%, P = 0.621). On multivariate analysis, open surgical repair was independently associated with lower odds of mortality (adjusted odds ratio: 0.405, 95% confidence interval: [0.17-0.95], P-value = 0.038) ConclusionsIn our analysis open surgical repair of bladder and ureteral injuries was associated with lower mortality with other outcomes being similar when compared to laparoscopy. Laparoscopic surgical repair may not have an advantage over the open surgical repair for bladder and ureteral injuries. Further prospective studies are needed to delineate the ideal surgical approach for these injuries.

Incidental finding of a recurrent Bockdalek hernia with an intra-thoracic kidney

Bockdalek hernia is a rare type of congenital diaphragmatic hernia which was firstly described by Vincent Alexander Bockdalek in 1848.[1] The hernia sac is more commonly located on the left due to protection of the right side of the diaphragm by the liver, and contents can include spleen, small bowel, liver, colon or kidney.[1] Bockdalek hernia with intra-thoracic kidney is extremely rare and the reported incidence is less than 0.25%.[2] During embryogenesis the developing kidney which is located in the pelvis migrates upwards to fuse with the adrenal glands. Sometimes, this upward migration of the developing kidney does not stop at its designated point and thus the kidney reaches into the thorax. [3] Treatment options for Bockdalek hernia may include open or laparoscopic surgical repair, which involve the reduction of the herniated organs and closure of diaphragmatic defect with or without prosthetic mesh.[4] Herein we report a rare case of recurrent Bockdalek hernia including an intra-thoracic left kidney in a 59 year old lady with a past history of a Bockdalek hernia that was repaired at the age of 3, who presented to our hospital with severe lower abdominal pain and vomiting.

Uterine Dehiscence: Laparoscopic Uterine Repair in Early Pregnancy

<h3>Study Objective</h3> This is a video demonstrating a case of complete uterine dehiscence in early pregnancy. The objective of this video is to describe the approach to complete uterine dehiscence in the first trimester, review current literature and to demonstrate surgical uterine repair in early pregnancy to facilitate a term live birth. <h3>Design</h3> Compilation of anatomy schematics, medical imaging and surgical video clips that introduces a case of complete uterine dehiscence, the workup and imaging involved in counselling followed by demonstration of a laparoscopic surgical repair. <h3>Setting</h3> Tertiary Care Academic Center. <h3>Patients or Participants</h3> This video is a case presentation of a single patient encountered in our clinical practice. Surgical video and medical images have been extracted from this patient's chart after consent was obtained. <h3>Interventions</h3> Anatomy schematics and dissection video clips demonstrating the diagnosis, anatomy and surgical intervention while repairing the caesarean scar defect in this patient. <h3>Measurements and Main Results</h3> The video shows the diagnosis of alarge 2.6cm uterine scar defect in early pregnancy and through ultrasound guided surgical repair we are able to demonstrate that there is restoration of approximately 8mm of myometrial thickness across the defect on follow up. This case resulted in a term live birth delivery via caesarean section. <h3>Conclusion</h3> With an increased number of caesarean sections and improved quality of ultrasound imaging, we are seeing an increase inincidental findings of caesarean scar defects. The risk of spontaneous pre-labour uterine rupture remains unknown as there is a literature gap in this area regarding the appropriate standard of care. In this video we demonstrate that ultrasound guided laparoscopic repair is possible; however, further studies are required to establish safety and efficacy of the approach.

Combined laparoscopic and thoracoscopic surgical repair of Bochdalek hernia in an adult: a case report

BackgroundBochdalek hernia is a rare disease in adults. Diaphragmatic hernia in adults has been repaired using minimally invasive surgery through laparoscopy or thoracoscopy. However, the literature regarding the combined use of laparoscopy and thoracoscopy for the repair of Bochdalek hernia is limited.Case presentationA 26-year-old man diagnosed with Bochdalek hernia was managed through combined abdominal and thoracic endoscopic surgery. On laparoscopy, the omentum prolapsed into the left thoracic cavity through the posterolateral area of the left diaphragm. On thoracoscopy, no adhesions of the omentum were seen in the thoracic cavity. The omentum was drawn back to the abdominal cavity, and a 4 × 3-cm hernial orifice was identified. The hernia orifice was repaired through simple closure with sutures laparoscopically. The patient’s postoperative course was uneventful with no recurrences within the first year post-surgery.ConclusionCombined laparoscopic and thoracoscopic surgery is a safe and effective method for Bochdalek hernial repair in adults.

A study of the effectiveness of the bilateral and contralateral occult inguinal hernia repair by total extraperitoneal repair with intraperitoneal examination.

Of the various methods used, the laparoscopic surgical repair of inguinal hernias is widely performed. We aimed to estimate the incidence of bilateral and contralateral occult inguinal hernias in our surgical population and to compare the results of total extraperitoneal repair (TEP) for bilateral and unilateral inguinal hernias, occult and non-occult hernias. We retrospectively reviewed data of patients who underwent TEP for the repair of adult inguinal hernias from January 2012 to November 2018 in our hospital. Of the data of 259 patients included, 134 (51.7%) and 125 (48.3%) had unilateral and bilateral inguinal hernias, respectively, while 70 patients (27%) were found to have a contralateral occult inguinal hernia, intraoperatively. The mean operative time was 129 ± 48 minutes (range, 43-300 minutes) and 167 ± 55 minutes (range, 85-390 minutes) for the unilateral and bilateral groups, respectively, indicating a significantly longer duration of surgery for the bilateral group (P < .05). Recurrence occurred in 1.5% (5/134) and 0.4% (1/250) of the operated hernias in the unilateral and the bilateral groups, respectively, indicating a significantly lower rate of recurrence in the latter group (P < .05). The two groups showed no statistically significant differences with respect to the remaining perioperative data. The incidence of postoperative complications in occult hernias was not significantly different from that in non-occult hernias. Our TEP method, involving a laparoscopic exploration from the intraperitoneal side, can be safely and effectively utilized for the repair of both bilateral and contralateral occult inguinal hernias.

The role of laparoscopy in the treatment of perforated gastro-duodenal ulcers

Introduction:The incidence of peptic ulcer disease decreased due to proton pump inhibitors and Helicobacter pylori eradication. Bleeding from peptic ulcer decreased, as well, although perforation did not decrease and it is permanently between 2–10%. This is a potential surgical emergency, the mortality can reach up to 25% and the morbidity 50%, respectively. Urgent surgical intervention in the right time can improve the results.Aim:To compare the morbidity, mortality, the length of hospital stay and duration of operating time in open and laparoscopic repair of perforated peptic ulcer.Results:A cohort of 55 patients were operated on with perforated peptic ulcer from 01.01.2017 to 30.06.2019 31 open (51.36%) and 24 laparoscopic (43.63%) operations were performed from which 4 (16.6%) needed conversion to open approach. The average age of 23 men and 8 women were 56.3 and 70.3 years respectively in the open operations group, while 13 men and 11 women with average age of 49.7 and 53.7 years was in the laparoscopic operations group. Within 30 days the number of complications were 5 in the open and 2 in the laparoscopic group (p= 0.45). The average duration of operation was 51.95 minutes (30–85) in the open and 63.41 minutes (25–110) in the laparoscopic group (p= 0.13). 6 from the open group with average age of 74.3 years and 2 from the laparoscopic group with average age of 68.5 years died within 30 days (p= 0.44). The average length of stay was 7.13 (5–16) days in the open and 6.19 (4–13) days in the laparoscopic group (p= 0.24). The average size of the perforation was 7.4 mm (3–20) in the open and 5.3 mm (3–10) in the laparoscopic group (p= 0.14). Free air was seen in the abdominal cavity in 25 cases (80%) of the open and in 11 cases (54%) of the laparoscopic group.Conclusion:Early diagnosis, prompt supportive care and antibiotic treatment and urgent surgical intervention are essential to improve outcomes. The standard operation is the simple suture with pedicled omental flap which can be performed by either open or laparoscopic surgical repair. Laparoscopic method spreads slowly, the learning curve is longer and it needs more expertise but the morbidity is lower than that of the open surgery. The morbidity does not increase after conversion according to the literature so if there is no contraindication and there is enough expertise it should be suggested as the first choice.

Laparoscopic vs. Open Surgical Repair of Subxiphoidal Hernia Following Median Sternotomy for Coronary Bypass - Analysis of the Herniamed Registry.

Introduction: The repair of subxiphoidal incisional hernia following median sternotomy is technically demanding due to the specific anatomic situation and the lateral distracting forces in this region. Published data are available from retrospective reports with limited number of patients only. The aim of this study was to evaluate the outcome of subxiphoidal hernia repair comparing laparoscopic and open surgical approach.Materials and Methods: This analysis of Herniamed registry data of patients with subxiphoidal incisional hernia following sternotomy for coronary bypass assesses the perioperative and 1 year follow-up outcome of laparoscopic and open repair. Demographic data and perioperative outcomes were stratified by surgical approach (laparoscopic vs. open) and compared as unadjusted analyses using Chi square and Students t-tests.Results: Of 208 patients identified for the analysis 69 patients (33.2%) underwent laparoscopic and 139 (66.8%) patients had open repair. Concerning demographic data (gender, age, BMI, ASA score), risk factors and hernia size there were no significant differences between laparoscopic and open repair group. For intraoperative, postoperative and general complications as well as complication related re-operations no significant differences were seen between the groups. No significant advantage could be stated for laparoscopic repair regarding duration of operation and hospital stay. The recurrence rate at 1 year follow-up was higher in the laparoscopic group (7.2 vs. 2.2%; p = 0.072). No significant differences were reported in the 1 year follow-up evaluation of pain at rest, pain on exertion and pain requiring treatment.Conclusion: The repair of subxiphoidal incisional hernia is safe in both open and laparoscopic technique. With regard to the lower recurrence rate preference can be given to open repair.