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Gallstone ileus is a rare complication of cholelithiasis that occurs as a result of occlusion of the intestinal lumen by a large sized gallstone accounting for 1-4% cases of small bowel obstruction. The aim of this work is to introduce a case report that emphasize the diagnostic and therapeutic management of gallstone ileus with an enterolith impacted in jejunum (an uncommon site).

Purpose: In this study, a three-step novel surgical technique was developed for incisional hernia, in which a laparoscopic procedure with a mini-laparotomy is combined: so-called ‘three-step incisional hybrid repair’. The aim of this study was to reduce the risk of intestinal lacerations during adhesiolysis and recurrence rate by better symmetrical overlap placement of the mesh. Objectives: To evaluate first perioperative outcomes with this technique. Methods: From 2016 to 2020, 70 patients (65.7% females) with an incisional hernia of > 2 and ≤ 10 cm underwent a elective three-step incisional hybrid repair in two non-academic hospitals performed by two surgeons specialised in abdominal wall surgery. Intra- and postoperative complications, operation time, hospitalisation time and hernia recurrence were assessed. Results: Mean operation time was 100 min. Mean hernia size was 4.8 cm; 45 patients (64.3%) had a hernia of 1–5 cm, 25 patients (35.7%) of 6–10 cm. Eight patients had a grade 1 complication (11.4%), five patients a grade 2 (7.1%), two patients (2.8%) a grade 4 complication and one patient (1.4%) a grade 5 complication. Five patients had an intraoperative complication (7.0%), two enterotomies, one serosa injury, one omentum bleeding and one laceration of an epigastric vessel. Mean length of stay was 3.3 days. Four patients (5.6%) developed a hernia recurrence during a mean follow-up of 19.5 weeks. Conclusion: A three-step hybrid incisional hernia repair is a safe alternative for incisional hernia repair. Intraoperative complications rate was low.

An incisional hernia is a common complication following abdominal surgery. A hernia repair is recommended for the risk of incarceration. There are several operative methods. The laparoscopic technique is in wide use, but it is associated with a risk of enterotomy. Seroma formation is a common postoperative finding. In the hybrid technique, adhesions can be lysed and the fascial defect sutured through a mini-incision prior to mesh augmentation. In this thesis, we evaluate the complications associated with hernia repair operations, focusing on laparoscopic methods. We explore whether seroma formation and hernia recurrence could be diminished using the hybrid method. Study I was a descriptive analysis of 127 claims concerning ventral hernioplasties reported to the Finnish Patient Insurance Centre from 2003–2010. In Study II, we analysed 818 incisional hernia repairs, focusing on major complications. In Study III, the results of 38 laparoscopic and 24 hybrid operations in cases featuring complex adhesiolysis were compared. In prospective multicentre Studies IV–V, 193 operations randomised to either the laparoscopic or hybrid technique were analysed. In retrospective Studies I–III, we found that major complications were related to undetected enterotomies. Complex adhesions had a significant influence on major complications, enterotomies, and surgical site infections. In Studies IV–V, five enterotomies occurred in laparoscopic operations compared to one in hybrid operations. Adhesiolysis was described clearly more often complex in the laparoscopic group than in the hybrid group. After laparoscopy, there were significantly more seromas when compared to the hybrid operations. After one year, no difference in hernia recurrence was seen between the groups. Eleven (6.4%) recurrent hernias were detected: six in the laparoscopic group and five in the hybrid group. Laparoscopic operations carry a low complication rate, but the risk of enterotomy is still apparent, especi, Tiivistelmä Arpityrä on yleinen leikkauskomplikaatio, ja sen korjaamista suositellaan kureutumisriskin vuoksi. Leikkaustekniikoita on useita. Suosittuun tähystysleikkaustekniikkaan tiedetään liittyvän vakavan komplikaation, suolivaurion riski. Leikkausalueen nestekertymä on yleinen löydös leikkauksen jälkeen. Hybriditekniikassa kiinnikkeiden irrottelu tehdään pienen avauksen kautta ja tyräaukko suljetaan ennen verkon kiinnittämistä. Tutkimuksessa arvioimme tyräleikkauskomplikaatioita keskittyen tähystysleikkaustekniikoihin. Selvitimme voiko hybriditekniikkaa käyttäen vähentää leikkauksen jälkeisen nestekertymän muo-dostumista ja tyrän uusiutumista. Osatyö I kuvaili Potilasvakuutuskeskukseen vuosina 2003–2010 ilmoitettuja vatsan tyräleikkauksiin liittyviä vahinkoja (n = 127). Osatyössä II analysoimme 818 tyränkorjausleikkauksen tulokset keskittyen vakaviin komplikaatioihin. Osatyössä III verrattiin 38 tähystys- ja 24 hybridileikkauksien tuloksia tilanteissa, joissa todettiin hankalat kiinnikkeet. Prospektiivisessa monikeskustutkimuksessa (osatyöt IV–V) 193 potilasta leikattiin satunnaistamisen mukaan tähystys- tai hybriditekniikkaa käyttäen. Retrospektiivisissä osatöissä I–III totesimme, että tähystysleikkauksien vakavat komplikaatiot liittyivät huomaamatta jääneisiin suolivaurioihin. Hankalilla kiinnikkeillä todettiin selkeä yhteys vakaviin komplikaatioihin, suolivaurioihin ja haavainfektioihin. Prospektiivisissa osatöissä IV–V kuvattiin viisi suolivauriota tähystysleikkauksien ja yksi hybridileikkauksien yhteydessä. Kiinnikkeiden irrottelu oli selvästi hankalampaa tähystysleikkauksissa. Tähystysleikkausten jälkeen todettiin selvästi enemmän leikkausalueen nestekertymiä verrattuna hybridileikkauksiin. Vuoden kohdalla tyräuusiutumien määrässä ei ollut eroja ryhmien välillä; 11 (6,4 %) tyräuusiutumasta kuusi todettiin tähystys- ja viisi hybridiryhmässä. Toteamme, että tähystysleikkauksiin liittyviä komplikaatiota on vähän, mutta suolivaurion riski on kohonnut leikkauk

BACKGROUND AND AIMS: The Swedish National Patient Insurance Company (LÖF) can compensate patients who believe they have been exposed to an avoidable injury or malpractice in healthcare. Its register covers 95% of Swedish healthcare providers. MATERIAL AND METHODS: Data on patients operated for primary or incisional ventral hernia in Sweden between 2010 and 2015 and who had filed a claim, were retrieved from LÖF. A total of 290 cases were identified and included. Files include a copy of records, relevant imaging, and an expert advisor's opinion. RESULTS: Inadvertent enterotomy occurred during 25 repairs and in these cases, laparoscopic repair was clearly overrepresented ( p < 0.001). Complications related to the surgical site (infection and ugly scar) were predominantly related to open repairs ( p < 0.001). Twenty percentage (57/290) of the claims were directly related to an anesthetic mishap. Univariate ordinal regression showed that the odds of receiving a high reimbursement was significantly increased if laparoscopic repair was performed p < 0.001 (odds ratio: 0.37; 95% confidence interval: 0.21-0.65). Sixty-three percentage of claims were filed by women. CONCLUSION: Inadvertent enterotomy is overrepresented, and the probability that a claim filed for an avoidable injury leads to high reimbursement is greater if laparoscopic repair is performed rather than open ventral hernia repair. The high amount of injuries related to general anesthesia during umbilical hernia repair may be reduced with an increased proportion executed in local anesthesia.