Background Inguinal hernia repair is one of the most frequent surgical procedures worldwide. Several minimally invasive approaches have been developed. Laparoscopic hernioplasty offers less pain, faster recovery and a lower incidence of wound infection. However, the best approach in repairing large inguinoscrotal hernias and the optimal management of the distal sac and its risks are still debated. There may be a higher risk of visceral or cord structures damage, ischemic orchitis, seroma or haematoma when opting for a complete dissection of the hernia sac which may extend deep into the scrotum. Objective To show a video of a transabdominal preperitoneal (TAPP) approach using the primary abandon of the sac technique. The aim of this is to reduce the complications above-stated. Method We report a case of a 33 year old man, without previous abdominal surgery, diagnosed with a large right inguinoscrotal hernia, which appeared 1 year ago and became painful. The patient was scheduled electively for a TAPP surgery. Results Surgery was performed by means of day surgery. No intraoperative complications. No seroma nor haematoma detected in the postoperative period. Conclusion Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. The primary abandon of the sac is a feasible and reproducible technique and is a safe manner to overcome the difficulties of the distal sac management.
Background Diastasis of the rectus abdominis muscles (DRAM) is frequent and may be associated with abdominal wall hernias. In 2017 subcutaneous onlay laparoscopic approach (SCOLA) was described which combines diastasis recti plication and abdominal wall hernia repair without requiring a great incisions nor skin resections. Objective To show a video of a SCOLA technique with open periumbilical dissection through 2.5 cm periumbilical mini-incision. The aim is to reduce operative time and to improve the quality of life with good aesthetic results by a minimal invasive procedure. Method We report a case of a 39 years old woman with 3 previous caesarian deliveries, diagnosed with umbilical hernia and diastasis recti with a 95mm internal gap. The patient was scheduled electively for a SCOLA technique. Results Surgery was performed with no intraoperative complications. Persistent hematic output through drains was seen first 24h postoperatively which required blood transfusion for anemization, but no need for reoperation, correct hemoglobin controls afterward. Small hematoma detected in 1st month control, with correct resolution on 4th month control. No recurrence of umbilical hernia nor diastasis recti observed during this short follow-up. Conclusion SCOLA technique has been proven to be a reproductive and secure technique for those patients with DRAM associated with abdominal wall hernia that do not require nor need skin resection or great incisions. The aim of the periumbilical dissection through mini-incision is to decrease surgical time. One must consider the risk of bleeding or seroma associated with the extensive dissection in cases with great diastasis gap.
Background Spiegel's hernia is a rare form of spontaneous abdominal anterolateral hernia (0.12–2% of abdominal hernias) seen in people between 40 and 70 years old. It is often found at the weak point located at the intersection between the semilunar line and the lateral end of the arched line. Traditionally, it was repaired with an open approach, currently we have multiple minimally invasive techniques (enhanced-view total extraperitoneal eTEP, transabdominal preperitoneal, intraperitoneal onlay mesh repair…) that offer less pain, faster recovery and shorter hospital stay as well as less complications risk and better cosmetic outcomes. None of these has proven superior to others but the eTEP approach requires an extensive learning curve. Aim To show a video of an eTEP approach to Spiegel's hernia. Methods We report the case of a 51 year old woman, without previous abdominal surgery, who consulted for a lump, manually reducible, in the right iliac fossa which appeared 2 years ago, and became progressively painful. She was diagnosed pre-surgically with abdominal tomography and was scheduled electively for an eTEP repair. Results After hernia sac reduction and tension-free closure of the defect with barbed suture 0, 15×15cm polypropylene mesh is placed. Conclusion Spiegel's hernia is an infrequent type of abdominal wall defect and several techniques have been developed. Adequate selection of patients is important to identify the most suitable approach for each one. The eTEP approach allows working in a large extraperitoneal space and has been demonstrated to be safe and effective although a demanding procedure.
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