RevistaHispanoamericana de Hernia S oc ied a d H i s p a n oa me r ic a n a d e H ernia P r o C h ir ug ia et S c i e n t i a

La técnica de Nyhus en la reparación de las hernias inguinales recidivadas: análisis de una serie de 203 pacientes Nyhus technique in the repair of recurrent inguinal hernias: analysis of a series of 203 patients

Aim The inguinal anatomy is difficult, but a correct anatomical base prevents clinical errors. We present a three-dimensional paper model the student made by himself to improve knowledge of the setup of layers and structures from the inguinal region. Material and methods It is a paper model that is made from a printed document, that is distributed in PDF format supported by a video tutorial. This model contains the layers of the inguinal region and other structures. Its usefulness has been tested with Medicine students in the Anatomy course. In a practical class, before starting, the students answer a questionnaire with questions about inguinal anatomy and the self-perception of their knowledge. The individual construction of the model is carried out and at the end of the class they answer the questionnaire again. Results The results of the 2022–23 academic year show an improvement in the self-perception of their knowledge going from an average grade of 2.54/5 before the practice to 3.42/5 and an improvement in the correct answers going from 57.5% of correct answers to 71.42% after the construction of the model. Conclusions This method has the following advantages: it is built by the student, very low cost, reproducible and it is three-dimensional. Based on the preliminary results of the past academic year, we hope that students will significantly improve their theoretical knowledge about the inguinal region, and they will have improved their confidence about the knowledge of this subject.

Aim To compare the early outcomes of two different techniques for ventral hernia repair in our abdominal wall surgery unit. Materials and Methods A prospective non-randomized review was perfomed including patients who underwent laparoscopic hernia repair from January 2018 to April 2022. All patients were followed-up for 1 month and the hernia orifice was closed in all cases. Patients and hernias characteristics, operative data and early complications were reviewed. Postoperative pain was defined as ≥4 value in Visual Analogue Scale. We compared 2 laparoscopic techniques: intraperitoneal mesh fixed with a double crown of resorbable tackers (IPOM+) and self gripping sublay positioned mesh (preperitoneal –PREP- or retromuscular –RIVES- position). Outcomes During the study period, 44 patients were assigned into 2 groups: 31 (70%) in IPOM+ group and 13 (30%) in Rives/Preperitoneal group. No differences were found in risk factors, population and hernia data between both groups. 6 patients (19%) from IPOM+ group presented postoperative pain and only 1 patient (7,7%) in Rives/Prep group (p: 0,30). There was no differences in other complications, length of stay or operative time. Conlusion Early outcomes of sublay techniques (Rives or preperitoneal) do not report more complications during perioperative time, but they could help reducing immediately postoperatorive pain.

Aim Show the possibility of training abdominal wall laparoendoscopic techniques in the animal model. Material and Methods The training consists of 3 phases; in a first phase, videos of laparoendoscopic ventral hernia surgeries are displayed. In the second phase, 3 sessions are carried out in a simulation box to practice the zenith suture with a 5 cm diameter defect. For the third phase, each surgeon has four sessions of surgery with swine models; In the first three, a retromuscular dissection procedure was performed, creating and suturing a midline defect of 15×4 cm (long and transverse diameter), placement of mesh in a retromuscular position, and closure of the posterior sheath (laparoscopic RIVES). In the 4th animal model, an extraperitoneal procedure was performed (eTEP) without closure of the posterior rectus sheath. After training, these surgical techniques have been performed on patients Results The video shows the similarity of the animal model with the patient to perform the following technical steps; opening of the posterior rectus sheath, left retrorectal space dissection, midline crossover, right retrorectal space dissection, zenith suture of the anterior rectus sheaths, retrorectal mesh positioning and posterior rectus sheath suture. Conclusion Simulation and training models of minimally invasive ventral hernia surgery are useful and necessary in the training of surgeons.

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Aim To study the usefulness of learning in simulation and animal model to incorporate laparoendoscopic techniques in ventral hernia in an abdominal wall unit. Material and Methods The training consists of 3 phases and four surgeons participate in it. In a first phase, videos of laparoendoscopic ventral hernia surgeries are displayed. In the second phase, 3 sessions are carried out in a simulation box to practice the zenith suture with a 5 cm diameter defect. For the third phase, each surgeon has four sessions of surgery with swine models; In the first three, a retromuscular dissection procedure was performed, creating and suturing a midline defect of 15×4 cm (long and transverse diameter), placement of mesh in a retromuscular position, and closure of the posterior sheath (laparoscopic RIVES). In the 4th animal model, an extraperitoneal procedure was performed (eTEP) without closure of the posterior rectus sheath. The total time of the intervention and the time used in the zenith suture are analyzed. Results With the first experimental animal, the average time used in suturing was 47.5 minutes, and in the fourth animal it dropped to 35 minutes. The time used to perform the laparoscopic RIVES in the first animal model was 102 minutes and was reduced to 72 minutes in the third. Conclusions Simulation and training models of minimally invasive ventral hernia surgery are useful and necessary in the training of surgeons and improve procedure times and skills.