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Introduction Laparoscopic transabdominal preperitoneal repair (TAPP) is widely accepted in elective inguinal hernioplasty. However, given the scarcity of data, the feasibility and safety of TAPP in strangulated hernia cases have not yet been determined. Methods We retrospectively evaluated the data from a consecutive series of 33 patients who had undergone surgery for acute strangulated inguinal hernia associated with suspected visceral ischemic damage by either TAPP (TAPP group, n = 11) or conventional open hernioplasty via the anterior approach (anterior group, n = 22). Results The TAPP group had a significant longer surgical duration than the anterior group (147 vs 84 min) and relatively less blood loss. Incision and enlargement of the hernial orifice, which enables easy reduction of the strangulated organ, was performed in the last 7 of 11 cases in the TAPP group. The morbidity was lower in the TAPP group, but the difference was not statistically significant (18% vs 23%). The TAPP group had a significantly shorter postoperative hospital stay than the anterior group (7 vs 10 days). Conclusion For surgeons with sufficient knowledge of the anatomy and expertise in reducing the strangulated organ, TAPP for strangulated inguinal hernia is at least comparable to open hernioplasty via the anterior approach in short-term outcomes.

Along with the increased use of other laparoscopic procedures, laparoscopic inguinal hernia repair has become widely used because of its minimally invasive nature. Here, we report a case of 66-year-old man who underwent transabdominal preperitoneal laparoscopic hernioplasty and developed hemorrhagic shock on postoperative day 1. CT showed postoperative venous hemorrhage from the retropubic space. Successful hemostasis of the massive hemorrhage was achieved laparoscopically. The origin of the hemorrhage was assumed to be the corona mortis vein, which was slightly injured during the operation. Despite the rarity of this complication, surgeons must be aware of the need to carefully dissect and fix the mesh in the retropubic space to avoid injuring the corona mortis. Laparoscopic hemostasis may be an effective alternative to the open approach.

SUMMARY Comparison of financial indices helps to illustrate differences in operations and efficiency among similar hospitals. Outlier data tend to influence statistical indices, and so detection of outliers is desirable. Development of a methodology for financial outlier detection using information systems will help to reduce the time and effort required, eliminate the subjective elements in detection of outlier data, and improve the efficiency and quality of analysis. The purpose of this research was to develop such a methodology. Financial outliers were defined based on a case model. An outlier-detection method using the distances between cases in multi-dimensional space is proposed. Experiments using three diagnosis groups indicated successful detection of cases for which the profitability and income structure differed from other cases. Therefore, the method proposed here can be used to detect outliers. Copyright © 2013 John Wiley & Sons, Ltd.