Yegor Tryliskyy – EHS Travel Grant 2023 report
It was extreme lucky to be able to make a clinical visit to the Madrid AWR group this week. The visit was made available thanks to European Hernia Society. I cannot overestimate how much I learnt within this short period of time. I was impressed with technical abilities and enthusiasm of each group member and academic impact of the group. They are really pushing boundaries in abdominal wall reconstruction theory and practice. The number of presentations they generate for every EHS conference and prizes they take over performs any other hernia centre. At the same time, they have unique experience in teaching and sharing their knowledge with their residents and international fellows.
I had an opportunity to attend operating theatre daily by travelling between collaborative institutions. Although sadden by the Real Madrid loss in semi-final match, members of the AWR group were excelling in every operation they did regardless of complexity. In the beginning of the week, I joined Dr Lopez-Monclus and Dr Munoz-Rodriguesin Hospital Puerta de Hierro where I was able to observe whole range of MIS approaches to primary and recurrent groin and ventral hernias (TAPP, TEP, eTEP). Dr Monclus shared with me his step-wise approach to eTEP as well as tips in tricks of safe endoscopic surgery in retro-rectus space. I was also able to observe a diagnostic laparoscopy case for a chronic pain post Stoppa hernioplasty for incisional Phannenstile hernia on a patient with a CT scan not showing any hernia. Diagnostic laparoscopy identified parietal hernia. This was reduced and fixed with primary suturing.
The rest of the week was spent with the leader of the group and true inspiration Professor Garcia Urena in Hospital de Henares. It was unique experience to assist at two complex abdominal wall reconstructions utilising Madrid “approach” and Madrid technique of posterior component separation. APPROACH stands for absorbable posterior reinforcement of permanent mesh of a complex hernia. And the Madrid technique, in my view, is the best currently described anatomically justified modification of transversus abdominis release. I very look forward to see the results of comparison between standard TAR and Madrid modification on muscle atrophy postoperatively.
I encourage everyone interested in abdominal wall to look for any opportunity to visit the group and look at their extremely educational YouTube channel where you can find all information about Madrid TAR: https://www.youtube.com/@Herniatodaymadri
To read about Madrid modification of TAR:
- Robin-Lersundi A, Blazquez Hernando L, López-Monclús J, et al. How we do it: down to up posterior components separation. Langenbecks Arch Surg. 2018 Jun;403(4):539-546. doi: 10.1007/s00423-018-1655-4. Epub 2018 Mar 3. PMID: 29502282.
- Garcia-Urena MÁ, Lopez-Monclus J, de Robin Valle de Lersundi A, et al Pathways of the preperitoneal plane: from the “fatty triangle” in Rives to the “fatty trident” in extended retromuscular abdominal wall reconstruction. A tribute to Prof. Schumpelick. Hernia. 2023 Apr;27(2):395-407. doi: 10.1007/s10029-022-02602-0. Epub 2022 Apr 15. PMID: 35426573.
Yegor Tryliskyy
Specialty Registrar in General Surgery
Severn Deanery, Health Education England
