Hérnia U: desafios e oportunidades de uma plataforma online para educação cirúrgica

The internet has become an essential tool for education1 . Nowadays, it is widely used by physicians for obtaining medical information. There was no website for surgical education before the year 2000. The pioneer website was WebSurg, from IRCAD, France2 . There are different types of distant education: telesurgery (live or edited), live lectures, case discussions and so on2,3. These new learning methods are considered as distant education and can be integrated in the surgical curriculum2 . There are many online tools used to share knowledge: websites, mobile programs for cell phones or even social media4,5. The aim of this study is to describe an online and free surgical education tool for students, residents and surgeons who want to update their knowledge in abdominal wall surgery.A internet se tornou ferramenta essencial para a educação1 . Atualmente, é amplamente utilizada por médicos para obtenção de informações em distintas áreas de conhecimento. Não existia nenhum site para educação cirúrgica antes de 2000. O pioneiro foi o WebSurg, do IRCAD, França2 . Existem diferentes tipos de educação à distância: telecirurgia (ao vivo ou editada), palestras ao vivo, discussão de casos e assim por diante2,3. Esses novos métodos de aprendizagem são considerados educação à distância e, podem ser integrados ao currículo cirúrgico2 . Existem muitas ferramentas online utilizadas para compartilhar conhecimento: sites, aplicativos para telefones celulares ou até mesmo mídias sociais4,5. O objetivo deste estudo é descrever ferramenta online gratuita de educação cirúrgica para estudantes, residentes e cirurgiões que desejam atualizar seus conhecimentos em cirurgia da parede abdominal

Tratamento laparoscópico de hérnias femoral e obturadora concomitantes: relato de caso

Paciente sexo feminino, 68 anos, com história de dor abdominal em Fossa Ilíaca esquerda e tumoração em região inguinal ipsilateral foi submetida a tratamento laparoscópico (TAPP). Durante procedimento cirúrgico, foram identificadas hérnia femoral e obturadora esquerdas. O conteudo herniário foi reduzido e uma tela de polipropileno foi colocada cobrindo os defeitos. Paciente evoluiu bem, sem dor no pós-operatório, recebendo alta no dia seguinte.A 68 years old female with a history of abdominal pain in the left iliac fossa and buldge in the ipsilateral inguinal region. She underwent laparoscopic treatment (TAPP). During the surgical procedure, left femoral and obturator hernias were identified. The herniary sacs were reduced and a polipropilen mesh was positioned covering the defects. Patient had no further complications, without postoperative pain, being discharged on the next day

Abordagem laparoscópica subcutânea pré-aponeurótica (SCOLA) para reparo de hérnia ventral e diástese de reto abdominal : descrição técnica e resultados iniciais

Background: Diastasis of the rectus abdominis muscles (DMRA) is frequent and may be associated with abdominal wall hernias. For patients with redudant skin, dermolipectomy and plication of the diastasis is the most commonly used procedure. However, there is a significant group of patients who do not require skin resection or do not want large incisions. Aim: To describe a “new” technique (subcutaneous onlay laparoscopic approach - SCOLA) for the correction of ventral hernias combined with the DMRA plication and to report the initial results of a case series. Method: SCOLA was applied in 48 patients to correct ventral hernia concomitant to plication of DMRA by pre-aponeurotic endoscopic technique. Results: The mean operative time was 93.5 min. There were no intra-operative complications and no conversion. Seroma was the most frequent complication (n=13, 27%). Only one (2%) had surgical wound infection. After a median follow-up of eight months (2-19), only one (2%) patient presented recurrence of DMRA and one (2%) subcutaneous tissue retraction/fibrosis. Forty-five (93.7%) patients reported being satisfied with outcome. Conclusion: The SCOLA technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with DMRA.Racional: A diástase dos músculos retos abdominais (DMRA) é frequente e pode estar associada à presença de hérnias da parede abdominal. Para pacientes com excesso de pele, a dermolipectomia e plicatura da diástase é o procedimento mais comumente utilizado. Entretanto, há um grupo significativo de pacientes que não necessitam ressecção de pele ou não desejam grandes incisões. Objetivo: Descrever uma “nova” técnica (Subcutaneous Onlay Laparoscopic Approach - SCOLA) para a correção das hérnias ventrais combinada à plicatura da DMRA e relatar os resultados iniciais. Métodos: A técnica SCOLA de correção de hérnia ventral concomitante com a plicatura da DMRA por técnica endoscópica pré-aponeurótica foi aplicada em quarenta e oito pacientes. Resultados: O tempo operatório médio foi de 93,5 min. Não houve nenhuma complicação intra-operatória e nenhuma conversão. Seroma foi a complicação mais frequente (n=13, 27%). Apenas um (2%) apresentou infecção de ferida operatória. Após seguimento médio de oito meses (2-19) apenas um (2%) paciente apresentou recidiva da DMRA e um (2%) retração/fibrose do tecido subcutâneo. Quarenta e cinco (93,7%) relataram estarem satisfeitos com resultado. Conclusão: A técnica SCOLA é alternativa segura, reprodutível e efetiva para pacientes com hérnia da parede abdominal associada à DMRA

Robotic-assisted approach for complex inguinal hernias

Laparoscopic inguinal hernia repair was introduced in the early nineties as a minimally invasive alternative to the classic Lichtenstein repair. Over the decades, minimally invasive approaches have demonstrated both postoperative benefits and easy replicability. Robotic inguinal hernia repair has been shown as a safe alternative to laparoscopic repair. Furthermore, due to technical difficulties, complex inguinal hernia repairs (scrotal hernias, incarcerated hernias, recurrent hernias, mesh removal, and previous pelvic surgery) are a relative contraindication for laparoscopic repairs. In this article, we highlight the advantages of the robotic approach for complex cases of inguinal hernia

Transversus Abdominis Release (TAR) Robótico : é possível oferecer cirurgia minimamente invasiva para os defeitos complexos da parede abdominal?

We describe the preliminary national experience and the early results of the use of robotic surgery to perform the posterior separation of abdominal wall components by the Transversus Abdominis Release (TAR) technique for the correction of complex defects of the abdominal wall. We performed the procedures between 04/2/2015 and 06/15/2015 and the follow-up time was up to six months, with a minimum of two months. The mean surgical time was five hours and 40 minutes. Two patients required laparoscopic re-intervention, since one developed hernia by peritoneal migration of the mesh and one had mesh extrusion. The procedure proved to be technically feasible, with a still long surgical time. Considering the potential advantages of robotic surgery and those related to TAR and the results obtained when these two techniques are associated, we conclude that they seem to be a good option for the correction of complex abdominal wall defects.Descrevemos a experiência preliminar nacional na utilização da cirurgia robótica para realizar a separação posterior de componentes da parede abdominal pela técnica transversus abdominis release (TAR) na correção de defeitos complexos da parede abdominal e seus resultados precoces. As cirurgias foram realizadas entre 02/04/2015 e 15/06/2015 e o tempo de acompanhamento dos resultados foi de até seis meses, com tempo mínimo de dois meses. O tempo cirúrgico médio foi de cinco horas e 40 minutos. Dois pacientes necessitaram reintervenção por laparoscopia, pois um desenvolveu hérnia por migração peritoneal da tela e um teve escape da tela. A cirurgia provou ser factível do ponto de vista técnico, com um tempo cirúrgico ainda elevado. Tendo em vista as vantagens potenciais da cirurgia robótica e aquelas relacionadas ao TAR e os resultados obtidos ao se associar essas duas técnicas, conclui-se que elas parecem ser uma boa opção para a correção de defeitos complexos da parede abdominal

The Influence of an Online Platform (Hernia U) in Surgical Education and Patient Management.

Hernia U was created with the objective to expand the educational landscape of abdominal wall surgery. It is an online platform where surgeons can register with no cost and subscribe for different courses. The aim of this study is to evaluate the impact of the platform on patient management and surgical education. A questionnaire regarding the influence of Hernia U in surgical education and patient management was emailed to professionals who had previously participated in any course of the Hernia U. Variables were shown with absolute and relative frequencies. Pearson's χ2 and Fisher's exact test were performed to analyze relationships between variables as appropriate. Nine hundred three participants responded to the questionnaire. Seven hundred fifty-two (83.3%) were men; 248 (27.4%) participants were older than 50 years old; 240 (26.6%) were between 41 and 50 years old. Two hundred seventy-four (30.4%) participants had been in practice for more than 20 years, 242 (26.8%) between 11 and 20 years, and 161(17.8%) between 5 and 10 years. When analyzing the impact of time spent on the platform, spending over an hour per week was significantly associated with self-reported change in practice patterns compared to spending less than an hour per week (p  Hernia U has allowed surgeons to change their daily practice and to boost their education. Surgeons spending more than one hour weekly in the platform are more likely to adopt changes

Abordagem laparoscópica subcutânea pré-aponeurótica (SCOLA) para reparo de hérnia ventral e diástese de reto abdominal : descrição técnica e resultados iniciais

Background: Diastasis of the rectus abdominis muscles (DMRA) is frequent and may be associated with abdominal wall hernias. For patients with redudant skin, dermolipectomy and plication of the diastasis is the most commonly used procedure. However, there is a significant group of patients who do not require skin resection or do not want large incisions. Aim: To describe a “new” technique (subcutaneous onlay laparoscopic approach - SCOLA) for the correction of ventral hernias combined with the DMRA plication and to report the initial results of a case series. Method: SCOLA was applied in 48 patients to correct ventral hernia concomitant to plication of DMRA by pre-aponeurotic endoscopic technique. Results: The mean operative time was 93.5 min. There were no intra-operative complications and no conversion. Seroma was the most frequent complication (n=13, 27%). Only one (2%) had surgical wound infection. After a median follow-up of eight months (2-19), only one (2%) patient presented recurrence of DMRA and one (2%) subcutaneous tissue retraction/fibrosis. Forty-five (93.7%) patients reported being satisfied with outcome. Conclusion: The SCOLA technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with DMRA.Racional: A diástase dos músculos retos abdominais (DMRA) é frequente e pode estar associada à presença de hérnias da parede abdominal. Para pacientes com excesso de pele, a dermolipectomia e plicatura da diástase é o procedimento mais comumente utilizado. Entretanto, há um grupo significativo de pacientes que não necessitam ressecção de pele ou não desejam grandes incisões. Objetivo: Descrever uma “nova” técnica (Subcutaneous Onlay Laparoscopic Approach - SCOLA) para a correção das hérnias ventrais combinada à plicatura da DMRA e relatar os resultados iniciais. Métodos: A técnica SCOLA de correção de hérnia ventral concomitante com a plicatura da DMRA por técnica endoscópica pré-aponeurótica foi aplicada em quarenta e oito pacientes. Resultados: O tempo operatório médio foi de 93,5 min. Não houve nenhuma complicação intra-operatória e nenhuma conversão. Seroma foi a complicação mais frequente (n=13, 27%). Apenas um (2%) apresentou infecção de ferida operatória. Após seguimento médio de oito meses (2-19) apenas um (2%) paciente apresentou recidiva da DMRA e um (2%) retração/fibrose do tecido subcutâneo. Quarenta e cinco (93,7%) relataram estarem satisfeitos com resultado. Conclusão: A técnica SCOLA é alternativa segura, reprodutível e efetiva para pacientes com hérnia da parede abdominal associada à DMRA

Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies

BACKGROUND: Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia. METHODS: A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative. RESULTS: Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised. CONCLUSION: These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions