Treatment Of Hernia Research Articles

First report of robotic retromuscular incisional hernia repair with Hugo Ras™ surgical system.

Treatment of incisional hernia is a rapidly evolving field of surgery, with actual trends being oriented toward retromuscular/preperitoneal mesh placement. The diffusion of robotic surgery is constantly growing in different surgical specialties and is gaining widespread acceptance for abdominal wall reconstruction. Recently, novel robotic platforms have entered into the market. In this study, we present the first transabdominal retromuscular incisional hernia repair performed with the new Hugo RAS™ system (Medtronic, Minneapolis, MN, USA). The surgical team had previous robotic experience and completed an official 2-day session running incisional hernia repair on human cadaver lab. Operating room setting and trocar layout were planned. The patient presented a 4 × 4cm midline incisional hernia and was scheduled for transabdominal retromuscular incisional hernia repair at our Institution. A description of the operative room setup, robotic arm configuration and docking/tilt angles is provided. Docking time, operative time, and console time were 15, 95, and 75min, respectively. All the surgical steps were completed without critical surgical errors or high-priority alarms. Neither intraoperative complications nor conversion to open surgery was recorded. Postoperative course was uneventful and the patient was discharged on postoperative day 2. The safety and the feasibility of these procedures will require further analysis and larger patients' sample sizes for procedural standardization and potential integration into minimally invasive abdominal wall reconstruction programs.

КОНСЕРВАТИВНЫЕ МЕТОДЫ ЛЕЧЕНИЯ ГРЫЖ МЕЖПОЗВОНКОВЫХ ДИСКОВ

In the modern world, herniated intervertebral discs are one of the most common pathologies, often occurring among the working-age population. Protrusion of the intervertebral disc beyond the cross-section of the vertebra can lead to severe pain (even disability) due to mechanical compression of the nerve root and, with extrusion of the nucleus pulposus, inflammatory reactions. Thus, to date, pain syndrome that has developed as a result of a hernia occurs in 9% of the world's population. Thus, the treatment of intervertebral hernias is one of the pressing problems of the modern world. Radical treatment - surgical, is associated with a number of complications and does not always lead to the desired results. For this reason, surgical treatment should be carried out only if conservative methods are ineffective, among which physiotherapy occupies a special place. The purpose of this work is a literary analysis of physiotherapy methods currently used for the treatment of herniated intervertebral discs and to determine their place in the complex therapy of this pathology. The review examines the nature of intervertebral hernias, some of the physiological reactions they cause, in particular, the mechanisms of pain syndrome formation are indicated. We also described in detail the main methods of physiotherapy currently used for herniated intervertebral discs, such as electrophoresis, balneological procedures, spinal traction; the mechanisms of their influence on the damaged intervertebral disc are indicated, allowing to eliminate or reduce the intensity of the pain syndrome; The need for an integrated approach in the treatment of the pathology under study was determined.

Robotic transversus abdominis release using HUGO RAS system: our initial experience.

Transversus abdominis release (TAR) is an effective technique for treating large midline and off-midline hernias. Recent studies have demonstrated that robotic TAR (rTAR) is technically feasible and associated with improved outcomes compared to open surgery. There is no published experience to date describing abdominal wall reconstruction using the novel robotic platform HUGO RAS System (Medtronic®). All consecutive patients who underwent a rTAR in our institution were included. Three of the four arm carts of the HUGO RAS System were used at any given time. Each arm configuration was defined by our team in conjunction with Medtronic® personnel. rTAR was performed as previously described. Upon completion of the TAR on one side, a redocking process with different, mirrored arms angles was performed to continue with the contralateral TAR. Operative variables and early morbidity were recorded. Ten patients were included in this study. The median BMI was 31 (21-40.6) kg/m2. The median height was 1.6m (1.5-1.89m). A trend of decreased operative time, console time, and redocking time was seen in these consecutive cases. No intraoperative events nor postoperative morbidity was reported. The median length of stay was 3 (1-6) days. Robotic TAR utilizing the HUGO RAS system is a feasible and safe procedure. The adoption of this procedure on this novel platform for the treatment of complex abdominal wall hernias has been successful for our team.

ĐÁNH GIÁ CÁC YẾU TỐ LIÊN QUAN ĐẾN BIẾN CHỨNG SAU PHẪU THUẬT NỘI SOI ĐẶT TẤM LƯỚI TRƯỚC PHÚC MẠC ĐƯỜNG VÀO Ổ BỤNG ĐIỀU TRỊ THOÁT VỊ BẸN

Laparoscopic surgery with transabdominal preperitoneal mesh placement (TAPP) has been the primary choice for inguinal hernia treatment. This method has been approved to be safe with a low complication rate. This study was conducted to evaluate preoperative risk factors that may contribute to an escalation in immediate and distant complications in patients undergoing TAPP surgery. For patients undergoing TAPP surgery, the incidence of intraoperative complications was 3.8%, and the failure rate was 1.9%. Postoperative complications occurred in 10.5% of patients. Complications within the first month predominantly included fluid accumulation (15.4%), while pain and sensory disturbance in the abdominal region were observed in 26.9% during the follow-up of distant complications. Multivariate logistic regression analysis revealed that overweight patients (BMI > 24.9 kg/m2) were more likely to experience postoperative complications at one month (OR=3.2; p=0.03) and distant complications (OR=2.4; p=0.02) compared to the normal-weight group (BMI<24.9 kg/m2). Postoperative complications are generally mild and can often be managed conservatively, primarily involving pain and sensory disturbances in the abdominal region. The current study also highlights that overweight and obesity are risk factors contributing to an increased incidence of postoperative complications, emphasizing the need for thorough counseling regarding these risks for patients

Self-organising maps in the analysis of strains of human abdominal wall to identify areas of similar mechanical behaviour

The study refers to the application of a type of artificial neural network called the Self-Organising Map (SOM) for the identification of areas of the human abdominal wall that behave in a similar mechanical way. The research is based on data acquired during in vivo tests using the digital image correlation technique (DIC). The mechanical behaviour of the human abdominal wall is analysed during changing intra-abdominal pressure. SOM allow to study simultaneously three variables in four time/load steps. The variables refer to the principal strains and their directions. SOM classifies all the abdominal surface data points into clusters that behave similarly in accordance with the 12 variables. The analysis of the clusters provides a better insight into abdominal wall deformation and its evolution under pressure than when observing a single mechanical variable. The presented results may provide a better understanding of the mechanics of the living human abdominal wall. It might be particularly useful when selecting proper implants as well as for the design of surgical meshes for the treatment of abdominal hernias, which would be mechanically compatible with identified regions of the human anterior abdominal wall, and possibly open the way for patient-specific solutions.

Analysis of the Effect and Efficiency of Tension-Free Hernia Repair and Traditional Surgery in The Treatment of Hernia

Objective: To analyze the efficiency of tension-free hernia repair and traditional surgery in the treatment of hernia. Methods: A total of 80 patients with hernias were selected and randomly into a control group (traditional hernia repair) and an observation group (tension-free hernia repair), of 40 cases each. The perioperative indicators, pain, physiological stress indicators, complications, and recurrence rates between the two groups were compared. Results: The perioperative indexes of the observation group were better than those of the control group (P < 0.05). The postoperative pain score, postoperative physiological stress index level, incidence of complications, and recurrence rate of the observation group were lower than those of the control group (P < 0.05). Conclusion: In the surgical treatment of hernia, tension-free hernia repair was less traumatic and had a better effect than traditional hernia repair.

Previous inguinal hernia surgery does not limit the likelihood of choosing prostatectomy as primary prostate cancer therapy

We evaluated whether previous inguinal hernia repair may affect the choice of prostate carcinoma treatment in a population-based cohort. It has been suggested that previous laparoscopic inguinal hernia repair (LIHR) could limit the subsequent possibility of performing a prostatectomy. Several small studies have suggested otherwise. The study cohort included all new prostate cancer cases in Finland 1998–2015 identified through the Finnish cancer registry. Data on the treatment of prostate cancer and surgical inguinal hernia repairs in 1998–2016 was obtained from the HILMO hospital discharge registry. After linkage, the study cohort included 7206 men. Of these, 5500 had no history of inguinal hernia, 1463 had an open hernia repair, and 193 had a minimally invasive repair (LIHR). Compared to men with no history of hernia repair, those with previous hernia repairs were more likely to undergo prostatectomy over radiation therapy as the primary treatment for prostate cancer HR 1.34 (CI 95% 1.19–1.52). The association did not depend on the method of hernia repair, HR 1.58 (CI 95% 1.15–2.18), in men with previous LIHR. The increased likelihood of choosing prostatectomy over radiation therapy concerns all type prostatectomies. Previous hernia repair is not a limiting factor when choosing treatment for prostate cancer.

A rare differential of acute abdomen: a case of internal hernia presenting as small bowel obstruction

Internal hernias, though uncommon, are crucial to consider when diagnosing intestinal obstruction. They typically arise from developmental abnormalities, less frequently from acquired issues. Developmental causes include abnormal or incomplete development of the mesentery or gut rotation. Surgery is the most common cause of acquired internal hernias, particularly laparoscopic gastrojejunostomy or duodenojejunostomy repair procedures. Internal hernias usually present with intestinal obstruction symptoms. Imaging plays a vital role in diagnosis. While an upright abdominal X-ray may show signs of obstruction, CT scanning is the definitive investigation. This report describes an 18-year-old male who presented with generalized abdominal pain for eight days and no stool or gas passage for the past three days. After confirmation of a mesenteric hernia through ultrasound and CT imaging, emergency laparotomy surgery was performed. Due to gangrenous bowel, resection was not possible, so an ileostomy was created. The tissue sample was sent for histological examination. Surgery remains the definitive treatment for internal hernias.

Lichtenstein versus laparoscopic transabdominal preperitoneal (TAPP) hernia repair: Retrospective study, our experience

Abstract: Surgical correction of inguinal hernias is the most commonly used surgical procedure in the world. Currently only three surgical techniques have been validated, that is the Shouldice technique, the Lichtenstein technique, and laparoscopic techniques such as transabdominal preperitoneal (TAPP) hernioplasty and totally extraperitoneal endoscopic hernioplasty (TEP).The aim of the study: The aim of this study is to show the results in terms of postoperative recovery, complications, length of hospitalization after inguinal hernia surgery in patients who underwent the Lichtenstein and the laparoscopic (TAPP) methods.Material and methods: This is a monocentric, retrospective cohort study, conducted in the period from 2019 to 2023. The research period covered 70 patients who underwent surgery at the Clinic for General and Abdominal Surgery with Glandular Surgery, of the University Clinical Center, Sarajevo. The patients were divided into two groups: Group 1: 20 patients who underwent the TAPP method and Group 2: 50 patients who underwent the Lichtenstein method. All patients underwent surgery performed by two doctors.Results: One woman (1.4%) and 69 men (98.6%) participated in the research. Of the total number, 50 patients (72.5%) were treated with the Lichtenstein technique, and 19 (27.5%) were treated with the TAPP technique (p=0.539). The statistical results did not show a significant difference in the average age between patients who underwent the Lichtenstein and the TAPP technique (T=0.759; p=0.450).Discussion: There was no significant difference in relation to age and type of surgery (T=0.759; p=0.450). There was no statistical difference in the choice of surgical approach in relation to the laterality of the hernia (P<0.001), nor any statistically significant difference between the TAPP and Lichtenstein surgical procedures in relation to BMI T=0.613; p=0.542. Our analyses showed that patients treated with the TAPP technique had a statisticallysignificantly higher probability of shorter postoperative hospitalization compared to those treated with the Lichtenstein technique (B=0.245; p=0.019). Two patients in the study had complications within 30 days (Clavien-Dindo Grade I and Grade IIIB).Conclusion: Using an individual approach for each patient, surgical treatment of hernia using laparoscopic TAPP can be the first choice in patients without comorbidities, without previous pelvic surgery, bilaterality or recurrence of previous surgery (anterior approach). Patients treated with the laparoscopic technique (TAPP) have a shorter hospitalization time, which ultimately affects the economic aspect.

Early results of eTEP access surgery with preperitoneal repair of primary midline ventral hernias and diastasis recti. A 33 patient case series of "PeTEP".

This article aims to share the initial experience of the preperitoneal eTEP approach and its potential benefits in a selected group of patients. The eTEP Rives-Stoppa is a proven minimally invasive surgical technique for the treatment of ventral midline and off-midline hernias that has shown to be a solid, durable, and reproducible repair. The preperitoneal eTEP repair is a surgical technique that brings together the extraperitoneal access surgery with a preperitoneal repair for primary midline hernias avoiding posterior rectus sheath division and preservation of the retrorectus space while being able to treat simultaneous diastasis recti. The analysis included 33 patients operated with thepreperitoneal eTEP approach from September 2022 to September 2023 in patients with primary small to medium (< 4cm) midline hernias, single or multiple defects with or without diastasis recti. Age, gender, hernia characteristics, operative time, and surgical site occurrences will be discussed, as well as fine details and landmarks in the operative technique. 33 consecutive patients were operated, 19 female (57.5%) and 14 males (42.5%) between 32 and 63years of age, the most common comorbidity found was obesity (BMI > 30). In 70% of the cases, operative time was 90min ± 25min. The average hospital stay was one day, while 12 went home the same day, and so far, no reoccurrences have been reported. We believe the preperitoneal eTEP approach for small to medium primary midline hernias is an effective and solid repair that combines excellent features of proven surgical techniques and eliminates the need for posterior rectus sheath division while saving the retrorectus space, among other benefits that will be discussed. The reproducibility of the technique remains to be proven.

Assessment of myofascial medialization following intraoperative fascial traction (IFT) in a cadaveric model.

Intraoperative fascial traction (IFT) for the treatment of large ventral hernias and loss of domain (LOD) hernias is a promising tool in abdominal wall surgery. However, little is known about the extent of gain in myofascial advancement especially for the anterior rectus sheath. We, therefore, used a cadaveric model to determine the medialization during IFT. 4 fresh frozen specimens were used. Retromuscular preparation was carried out followed by IFT with diagonal vertical traction for 30min. Medial advancement of the anterior rectus sheath was measured after 15 and 30min as well as traction forces. Total medialization for anterior rectus sheath after 30min of IFT was 10.5cm (mean). The mean traction force was 16.28kg. Total medialization was significantly higher during the first 15min of vertical fascial traction (p < 0.05). IFT provides significant medialization for the anterior rectus sheath in the cadaveric model. The findings align with results from a retrospective case study. Therefore, we see IFT as a beneficial tool in abdominal wall surgery.

Use of autologous pericardial patch graft for treatment of large congenital peritoneopericardial diaphragmatic hernia in two cats

AbstractPeritoneopericardial diaphragmatic hernia is a congenital structural anomaly that results in a communication between the pericardial sac and the peritoneal cavity. About 50% of cats are asymptomatic at the time of diagnosis, and the remaining animals may show respiratory (dyspnoea, tachypnoea, exercise intolerance), gastrointestinal, cardiac tamponade or non‐specific clinical signs. Median celiotomy for herniorrhaphy without tension (primary closure, muscle flaps, synthetic mesh, pericardium) is the treatment of choice for symptomatic patients. Two cats were referred with respiratory signs, secondary to a peritoneopericardial diaphragmatic hernia. A pericardial patch graft was obtained and sutured to the diaphragm as an alternative technique to close the large defect and not cause excessive tension on the diaphragm and caval foramen. Patients recovered well without any complications after surgery. Re‐examination and thoracic radiographs at 1 week, 2 weeks, 3 months, 6 months and 3 years postoperatively showed no signs of recurrence and the patients remained asymptomatic.

Computational Analysis and Classification of Hernia Repairs

Problems related to ventral hernia repairs (VHR) are very common, and evaluating them using computational methods can assist in selecting the most appropriate treatment. This study is based upon data from 3339 patients from different European countries observed during the last 12 years (2012–2023), which were collected by specialists in hernia surgery. Most patients underwent standard surgical procedures, with a growing trend towards laparoscopic surgery. This paper focuses on statistically evaluating the treatment methods in relation to patient age, body mass index (BMI), and the type of repair. Appropriate mathematical methods are employed to extract and classify the selected features, with emphasis on computational and machine-learning techniques. The paper presents surgical hernia treatment statistics related to patient age, BMI, and repair methods. The main conclusions point to mean groin hernia repair (GHR) complications of 19% for patients in the database. The accuracy of separating GHR mesh surgery with and without postoperative complications reached 74.4% using a two-layer neural network classification. Robotic surgeries represent 22.9% of all the evaluated hernia repairs. The proposed methodology suggests both an interdisciplinary approach and the utilization of computational intelligence in hernia surgery, potentially applicable in a clinical setting.

Evaluation of the efficacy of freeze-dried bovine pericardium and acellular bovine skin in the treatment of diaphragmatic hernia in dogs

Evaluation of the efficacy of freeze-dried bovine pericardium and acellular bovine skin in the treatment of diaphragmatic hernia in dogs

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment.

The aim was to examine the quality of online patient information resources for patients considering parastomal hernia treatment. A Google search was conducted using lay search terms for patient facing sources on parastomal hernia. The quality of the content was assessed using the validated DISCERN instrument. Readability of written content was established using the Flesch-Kincaid score. Sources were also assessed against the essential content and process standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision making support tools. Content analysis was also undertaken to explore what the sources covered and to identify any commonalities across the content. Fourteen sources were identified and assessed using the identified tools. The mean Flesch-Kincaid reading ease score was 43.61, suggesting that the information was difficult to read. The overall quality of the identified sources was low based on the pooled analysis of the DISCERN and Flesch-Kincaid scores, and when assessed against the criteria in the NICE standards framework for shared decision making tools. Content analysis identified eight categories encompassing 59 codes, which highlighted considerable variation between sources. The current information available to patients considering parastomal hernia treatment is of low quality and often does not contain enough information on treatment options for patients to be able to make an informed decision about the best treatment for them. There is a need for high-quality information, ideally co-produced with patients, to provide patients with the necessary information to allow them to make informed decisions about their treatment options when faced with a symptomatic parastomal hernia.

Application of bridging mesh repair in giant ventral incisional hernia.

Achieving ideal abdominal wall reconstruction in giant ventral incisional hernia has been a challenging for surgeons. This study aimed to verify the safety and efficacy of bridging repair by comparing it with primary fascial closure (PFC) repair in the treatment of giant ventral incisional hernia. We retrospectively analyzed the clinical data of 92 patients with giant ventral incisional hernia who underwent mesh repair at our medical institution from January 1, 2014 to December 31, 2020. Patients were divided into 2 groups: the bridging repair group with 40 patients in whom repair was completed using the bridging technique and the PFC group with 52 patients in whom primary fascial closure was achieved and all patients underwent mesh reinforcement during the operation. The main outcome measures were recurrence rate and morbidity, especially intra-abdominal hypertension (IAH). Follow-up time of both groups lasted at least 24months after surgery. After a median of 46months and 65months of follow-up, respectively, in the two groups, bridging repair did not increase the long-term recurrence rate (2.56%) in the larger defect area group compared to the PFC group (1.96%). There were no significant differences in perioperative morbidity, IAH, incidence of postoperative chronic pain, and sensory impairment of the abdominal wall between both groups. The application of bridging surgery in the treatment of complex giant ventral incisional hernias is safe and effective and does not significantly increase the postoperative recurrence rate.

Petersen's hernia after gastric cancer surgery: Unravelling clinical characteristics and optimal management approaches.

Petersen's hernia is a rare and serious complication that can occur after radical gastrectomy and digestive tract reconstruction for gastric cancer. This article summarises the symptoms, diagnosis and treatment of Petersen's hernia after surgery for gastric cancer. A retrospective analysis was conducted on 11 male patients who were diagnosed with Petersen's hernia and underwent surgical treatment at our hospital from January 2020 to December 2022. Their clinical manifestations, perioperative conditions and follow-up after treatment were collected. The median age was 58.5 years (range: 45-73), and the median time since gastrectomy was 24 months (range: 4-125). Open distal gastrectomy (45.5%) and open total gastrectomy (27.3%) were the most common procedures. Roux-en-Y (81.8%) was the predominant anastomosis method. All patients underwent emergency surgery within a median time of 30 h (range: 4-45). Intestine necrosis occurred in 36.4% of cases, with a perioperative death rate of 27.3%. Petersen's hernia after gastric cancer surgery can quickly lead to necrotising intestinal obstruction and poor prognosis. Enhanced abdominal computed tomography should be performed as soon as possible, and early exploratory laparotomy should be done to avoid intestinal necrosis. Routine closure of the mesenteric defect after gastric cancer resection can prevent the occurrence of Petersen's hernia. This article highlights the need for increased awareness and preventive measures to minimise the occurrence of Petersen's hernia in gastric cancer patients. It emphasises the importance of early detection and appropriate management strategies for improved patient outcomes.

Results of surgical treatment of hernias of the anterior abdominal wall in patients with connective tissue dysplasia syndrome

Relevance. The problem of surgical treatment of hernias of the anterior abdominal wall remains relevant. Despite the introduction of new technologies, the results of surgical interventions cannot be considered satisfactory. The development of hernias and their relapses is facilitated by connective tissue dysplasia syndrome, which manifests as phenotypic signs, disorders of the autonomic nervous system, and morphological changes in the structure of the connective tissue.Objective. To improve the results of surgical treatment of hernias of the anterior abdominal wall in patients with connective tissue dysplasia syndrome.Materials and methods. The study was based on clinical observations and studies of 497 patients with hernias of the anterior abdominal wall. Inguinal (29 %) and postoperative hernias (21 %) predominated. In the structure of recurrent hernias, postoperative (47 %) and inguinal (42 %) hernias were more often observed. Hernioautoplasty was performed in 31 %, plastic surgery using a mesh endoprosthesis — in 54 %, endoscopic hernioplasty — in 15 % of patients. The severity of the clinical, morphological, and metabolic signs of connective tissue dysplasia syndrome was assessed. The concentration of free hydroxyproline in the blood was determined as a marker of connective tissue metabolism. The state of the autonomic nervous system was assessed using variational pulsometry. To assess the state of collagen in connective tissue, a morphological study of the aponeuroses of the muscles of the anterior abdominal wall was performed in the clinic and experiment.Results. The overall incidence of dysplasia in hernias of the anterior abdominal wall was 48 %. The highest incidence of connective tissue dysplasia was detected in recurrent hernias (70 %). Studies of the level of free hydroxyproline in abdominal hernias have shown the dependence of this marker on the degree of connective tissue dysplasia. In cases of recurrent hernias, the highest intensity of collagen biodegradation was observed. A study of the functional state of the autonomic nervous system revealed a predominance of sympathetic activity in abdominal wall hernias with an increase in the tension index by more than 4 times. An increase in the severity of dysplasia is accompanied by an increase in sympathetic activity. Histological studies in patients with abdominal hernias revealed characteristic changes in the morphological structure of the connective tissue. The average thickness, specific area, brightness of staining, and orientation of collagen fibers in postoperative and recurrent hernias were significantly different compared to the group with primary hernias (p˂0.05). Additionally, an experiment was performed on 30 laboratory animals (white rats) to determine the optimal conditions for healing of the aponeurosis of the anterior abdominal wall. The activating effect of prozerin on the process of histogenesis in the wound was revealed. Based on the results of the study, the surgical treatment of hernias was assessed depending on the type of hernioplasty and the severity of connective tissue dysplasia. It has been established that with increasing severity of dysplasia, the frequency of relapses increases by 2.2–3.4 times. With the progression of dysplasia, the frequency of relapses increased by more than twice. The use of the endoscopic hernioplasty method reduced the risk of recurrent hernias by 9 times.Conclusion. In externally localized hernias, the incidence of connective tissue dysplasia ranges from 34 % to 70 %. In patients with connective tissue dysplasia syndrome after hernia autoplasty, the frequency of hernia recurrence is 3.4 times higher. Drug correction of sympathetic activity along with alloplasty increased collagen synthesis intensity by 36 %. The choice of hernia repair method should be determined by the type of hernia, the age of the patient, and the severity of connective tissue dysplasia.

Chronic postsurgical pain (CPSP): an underestimated problem after incisional hernia treatment.

Chronic postsurgical pain (CPSP) is a potential long-term problem following open incisional hernia repair which may affect the quality of life of patients despite successful anatomical repair of the hernia. The aim of this manuscript was to identify the incidence and outcome of patients following open incisional hernia repair in respect of risk factors to develop CPSP. A single-center retrospective analysis of patients who underwent open incisional hernia repair between 2015 and 2021 was performed. Pre-existing conditions (e.g., diabetes mellitus and malignancy), hernia complexity, postoperative complications, and postoperative pain medication were analyzed using the local database. Quality of life and CPSP were assessed using the EuraHS Quality of Life (QoL) questionnaire. A total of 182 cases were retrospectively included in a detailed analysis based on the complete EuraHS (QoL) questionnaire. During the average follow-up period of 46 months, this long-term follow-up revealed a 54.4% incidence of CPSP and including a rate of 14.8% for severe CPSP (sCPSP) after open incisional hernia surgery. The complexity of the hernia and the demographic variables were not different between the group with and without CPSP. Patients with CPSP reported significantly reduced QoL. The analgesics score which includes the need of pain medication in the initial days after surgery was significantly higher in patients with CPSP than in those without (no CPSP: 2.86 vs. CPSP: 3.35; p = 0.047). The presence of CPSP after open incisional hernia repair represents a frequent and underestimated long-term problem which has been not been recognized to this extent before. CPSP impairs QoL in these patients. Patients at risk to develop CPSP can be identified in the perioperative setting by the need of high doses of pain medication using the analgesics score. Possibly timely adjustment of pain medication, even in the domestic setting, could alleviate the chronicity or severity of CPSP.

A new approach to the treatment of large and giant hiatal hernia

Objective. To retrospectively analyse the results of a new technique of laparoscopic surgery for large and giant hiatal hernias of the esophageal orifice of the diaphragm, which consists in the use of diaphragmatic incisions and mesh implants to reduce the incidence of recurrence and complications.&#x0D; Materials and methods. During the period from 2010 to 2023, laparoscopic interventions were performed in 62 patients, 43 (69.4%) women and 19 (30.6%) men, with large and giant hiatal hernias of the esophageal orifice of the diaphragm. The average age of the patients was 62.8 years. The diagnostic criteria used to select patients were the size of the hiatal opening and clinical symptoms. Fibroesophagogastroduodenoscopy, abdominal computed tomography, and contrast radiography were used to assess the size of the hernia and plan surgical intervention. During the operation, we performed loosening incisions of the diaphragm to reduce the tension during suturing of hiatus defects. Progrip self–locking meshes were also used to close the diaphragmatic defects, which allowed them to be securely fixed without tension and reduce the risk of recurrence.&#x0D; Results. Most patients had comorbidities that required a special approach during surgery. The average duration of the operations was 132 minutes, which indicates their technical complexity. The postoperative course in most patients was uncomplicated with a minimal recovery period. The average hospital stay was 5.2 days. Recurrence of hernia was detected in 2 (3.2%) of 62 patients, which indicates the effectiveness of the new technique.&#x0D; Conclusions. The use of a new concept of laparoscopic surgery for large and giant hernias of the esophageal orifice of the diaphragm, which involves the performance of laxative incisions of the diaphragm and the use of self–locking mesh, significantly reduces the incidence of recurrence and complications, which ensures high treatment efficiency and improves the quality of life of patients. The results of the study confirm the importance of an individual approach to the treatment of hiatal hernias and the possibility of optimising laparoscopic techniques to improve their effectiveness.