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Repair options for ventral hernias in bariatric patients include performing a staged approach in which bariatric surgery is performed before definitive hernia repair (BS-first), a staged approach in which hernia repair is performed before bariatric surgery (HR-first), or a concomitant approach. This meta-analysis aims to determine which surgical approach is best for bariatric patients with hernias. PubMed, CENTRAL, and Embase databases. A comprehensive search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to screen for all studies that focused on outcomes of patients who underwent both hernia repair and bariatric surgery, either simultaneously or separately. Exclusion criteria included hiatal and inguinal hernia studies, case reports, and case series. 27 studies fit our inclusion criteria after identifying 1584 studies initially. Seven comparative studies were included, enrolling 8548 staged patients (6458 BS-first) and 3528 concomitant patients. A total of 7 single-arm staged studies and 13 single-arm concomitant studies were also included. Data on hernia recurrence, mesh infection, reoperation, surgical site infections, seroma, bowel complications, and mortality were abstracted. The concomitant approach was associated with decreased odds of experiencing surgical site infections, reoperation, and seromas. The staged approach (BS-first) was associated with decreased odds of mesh infection. The single-arm studies suggest a lower incidence of hernia recurrence in a staged BS-first approach than in a concomitant approach. The data suggest a concomitant approach is appropriate for hernias that the surgeon feels do not require mesh, while the staged (BS-first) approach is more appropriate if the hernia requires mesh placement. • Performing bariatric surgery before hernia repair appears to be beneficial if the hernia requires mesh placement. • Concomitant bariatric surgery and hernia repair can be safely performed in small hernias that do not require mesh, but the risk of recurrence remains. • Ventral hernia repair in bariatric patients remains complex and requires an individualized approach. [ABSTRACT FROM AUTHOR]

Introduction: Tackers are divided in two broad categories namely, absorbable and non absorbable. Absorbable tackers are believed to achieve sufficient tensile strength compared to conventional non absorbable tackers. It is a matter of debate that which type of tacker has an upper hand over the other especially in terms of postoperative pain and recurrences even after few years of clinical experience with these tackers and available clinical studies. Aim: To compare various aspects of absorbable versus non absorbable tackers for fixation of mesh in Laparoscopic Midline Anterior Abdominal Wall Hernia Repair for short period of follow-up. Materials and Methods: In this prospective randomised clinical study from November 2016 till March 2018 at ABVIMS and Dr. RML Hospital, India. Eighty patients of age =18 years with midline anterior abdominal wall hernia were included and randomised into two groups (40 patients each). Group 1: Absorbable Tackers; and Group 2: Non Absorbable Tackers. Outcomes evaluated were postoperative pain, seroma formation, paralytic ileus, early recurrence (3 months follow-up) and duration of hospital stay. The data acquired was analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Comparison of ordinal paired data was done using Wilcoxon signed rank sum test. The nominal categorical data was compared using chi-squared or Fisher'sexact test as appropriate. A p-value of <0.05 was considered statistically significant. Results: Out of 80 patients included in this study with a range of 21 to 60 years, the median age was 30 years. There was no statistically significant association noted in terms of postoperative pain (p-value >0.05), seroma formation (p-value=1), paralytic ileus (p-value >0.05), length of hospital stay (p-value=0.801) and early recurrence (3 months). Conclusion: This study has shown that both non absorbable and absorbable tackers are associated with minimal postoperative complications and have similar postoperative morbidity. Both absorbable and non absorbable tackers are comparable for fixation of mesh in laparoscopic midline anterior abdominal wall hernia with respect to the above mentioned outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Tackers are divided in two broad categories namely, absorbable and non absorbable. Absorbable tackers are believed to achieve sufficient tensile strength compared to conventional non absorbable tackers. It is a matter of debate that which type of tacker has an upper hand over the other especially in terms of postoperative pain and recurrences even after few years of clinical experience with these tackers and available clinical studies. Aim: To compare various aspects of absorbable versus non absorbable tackers for fixation of mesh in Laparoscopic Midline Anterior Abdominal Wall Hernia Repair for short period of follow-up. Materials and Methods: In this prospective randomised clinical study from November 2016 till March 2018 at Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India. Total of 80 patients of age ≥18 years with midline anterior abdominal wall hernia were included and randomised into two groups 40 patients each i.e. group 1 absorbable tackers and group 2 non absorbable tackers. Outcomes evaluated were postoperative pain, seroma formation, paralytic ileus, early recurrence (3 months follow-up) and duration of hospital stay.The data acquired was analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Comparison of ordinal paired data was done using Wilcoxon signed rank sum test. The nominal categorical data was compared using Chi-square or Fisher’s-exact test as appropriate. A p-value of 0.05), seroma formation (p-value=1), paralytic ileus (p-value >0.05), length of hospital stay (p-value=0.801) and early recurrence (3 months). Conclusion: This study has shown that both non absorbable and absorbable tackers are associated with minimal postoperative complications and have similar postoperative morbidity. Both absorbable and non absorbable tackers are comparable for fixation of mesh in laparoscopic midline anterior abdominal wall hernia with respect to the above mentioned outcomes.

Abstract: Gastrointestinal bleeding scintigraphy is a noninvasive study used to determine the presence of active bleeding, localize the bleeding site, and estimate the bleeding volume for prognostic purposes in patients with suspected gastrointestinal bleeding. However, it is important to note that false-positive results can occur due to various reasons. In this case, we present the scenario of a middle-aged woman who exhibited symptoms of gastrointestinal bleeding and underwent 99m Tc-RBC scintigraphy. The imaging revealed an accumulation of radiotracer in the hypogastric region, which was later determined to be caused by an omental hernia on SPECT/CT images. The herniated structure caused congestion in the mesenteric vessels, leading to the accumulation of 99m Tc-RBC. This case highlights the significance of considering anatomical anomalies and nonbleeding pathologies when interpreting the 99m Tc-RBC scintigraphy results for gastrointestinal bleeding., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The superior lumbar triangle is formed by the erector spinae muscles medially, internal oblique muscles laterally and the 12th rib superiorly. Herniation through this triangle can be congenital or acquired (primary or secondary). The contents of the hernial sac commonly include retroperitoneal fat, kidneys, ascending or descending colon, small intestines, stomach, spleen, etc. We present a case of an infant with congenital herniation of the left kidney through the superior lumbar triangle with an incidentally detected closed spinal tube defect. The anatomy of the lumbar triangle and a literature review of the associated hernia have been briefly described in this article., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Hernia is quite common in Pakistan. Hernia repair techniques have been of various types and have improved over the period to achieve best repair with minimal complications. Hernia repair technique such as the laparoscopic hernia repair is widely used in Pakistan and has superiority over open surgery due to short hospital stay, better cosmetic results, less postoperative pain, and less chance of wound infection. The quality of life of patients postoperatively, has thus been improving now. Methodology: The investigators interviewed the participants themselves. A total of 56 male patients aged 33.5 ± 10 years who had undergone hernia repair surgeries preoperatively and 3 months after surgery agreed to participate in the study. The questionnaire to evaluate patients' preoperatively and postoperatively had 13 questions regarding the effect of abdominal pain due to hernia on daily activities, religious activities, and impact on their health and mood. Likert scale was used to assess the difference in the quality of life of the patients and SPSS version 24 was used to analyze the data. Results: Response rate was 93.33% and the mean age is 33.5 ± 10 years. It was found out that the quality of life of patients improved after surgery so significantly that around 64.48% of people who had stopped doing work-related tasks before surgery due to hernia were then able to carry out work related tasks (87.03%). The quantity of patients with abdominal pain also decreased from 83.3% to 33.32%. Overall, the mood of the patients remained better to such an extent that before surgery, only 25.91% people could carry out daily tasks with minimal irritation but after surgery, 92.59% people started feeling better than before. Conclusion: Abdominal wall surgeries have improved the quality of life of the patients. Thus, the patients should be counseled to get their abdominal wall hernia corrected as soon as possible to lead a good quality and healthy life. Newer advanced techniques have emerged which has led to fewer complications and short hospital stay.

Background: Cardiac herniation occurs when there is a residual pericardial defect post thoracic surgery and is recognised as a rare but fatal complication. It confers a high mortality and requires immediate surgical correction upon recognition. We present a case of cardiac herniation occurring post thymectomy and left upper lobectomy., Case Presentation: Initial presentation: A 48-year-old male, hypertensive smoker presented with progressive breathlessness and was found to have a left upper zone mass confirmed on CT biopsy as carcinoid of unclear origin. PET-CT revealed avidity in a left anterior mediastinal area, left upper lobe (LUL) lung mass, mediastinal lymph nodes, and a right thymic satellite nodule. Intraoperatively: Access via left thoracotomy and sternotomy. The LUL tumour involved the left thymic lobe (LTL), left superior pulmonary vein (LSPV), left phrenic nerve and intervening mediastinal fat and pericardium, which were resected en-masse. The satellite nodule in the right thymic lobe (RTL) was adjacent to the junction between the left innominate vein and superior vena cava (SVC). The pericardium was resected from the SVC to the left atrial appendage. Clinical deterioration: Initially the patient was doing well clinically on day 1, however there was sudden bradycardia, hypotension, clamminess, and oligoanuria, with raised central venous pressures and troponins. ECG: no capture in leads V1-2, but positive deflections seen on posterior leads. Echo: no acoustic windows, but good windows seen posteriorly. CXR: left mediastinal shift. Redo operation: After initial resuscitation and stabilisation on the intensive care unit, on day 2 a redo-sternotomy revealed cardiac herniation into the left thoracic cavity with the left ventricular apex pointing towards the spine, and inferior caval kinking. After reduction and repair of the pericardial defect with a fenestrated GoreTex patch, the patient recovered well with complete resolution of the ECG and CXR., Conclusion: Cardiac herniation can even occur following sub-pneumonectomy lung resections and should be considered as a differential when faced with a sudden clinical deterioration, warranting early surgical correction., (© 2024. The Author(s).)

Purpose: Frailty has shown promise in predicting postoperative morbidity and mortality following hernia surgery. This study aims to evaluate the predictive capacity of the 11-item modified frailty index (mFI) in estimating postoperative outcomes following elective hernia surgery using the National Inpatient Sample (NIS) database., Methods: A retrospective analysis of the NIS from 2015 to 2019 was performed including adult patients who underwent elective hernia repair. The mFI was used to stratify patients as either frail (mFI ≥ 0.27) or robust (mFI < 0.27). The primary outcomes were in-hospital postoperative morbidity and mortality. The secondary outcomes were system-specific morbidity, length of stay (LOS), total in-hospital healthcare cost, and discharge disposition. Univariable and multivariable regressions were utilized., Results: In total, 14,125 robust patients and 1704 frail patients were included. Frailty was associated with an increased age (mean age 66.4 years vs. 52.6 years, p < 0.001) and prevalence of ventral hernias (51.9% vs. 44.4%, p < 0.001). Adjusted analyses demonstrated that frail patients had increased in-hospital mortality (adjusted odds ratio (aOR) 3.89, 95% CI 1.50, 10.11, p = 0.005), postoperative overall morbidity (aOR 1.98, 95% CI 1.72, 2.29, p < 0.001), postoperative LOS (adjusted mean difference (aMD) 0.78 days, 95% CI 0.51, 1.06, p < 0.001), total in-hospital healthcare costs (aMD $7562 95% CI 3292, 11,832, p = 0.001), and were less likely to be discharged home (aOR 0.61, 95% CI 0.53, 0.69, p < 0.001)., Conclusion: The mFI may be a reliable predictor of postoperative morbidity and mortality in elective hernia surgery. Utilizing this tool can aid in patient education and identifying high-risk patients who may benefit from tailored prehabilitation., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Paraduodenal Hernia (PDH) is an extremely rare cause of bowel obstruction. The true incidence of pediatric PDH is unknown since there are very few published cases of this phenomenon. PDH carries a high morbidity and mortality rate if unidentified. Proper diagnosis and prompt surgical intervention are extremely important. Our case is of a healthy 3-year-old male who presented with six days of generalized abdominal pain associated with constipation, anorexia, insomnia, and non-bloody, non-bilious emesis. Abdominal ultrasound (US) was negative for intussusception and failed to visualize the appendix. Abdominal x-ray (AXR) showed nonspecific distention of several loops of bowel with air-fluid levels. Computerized tomography (CT) scan was concerning for an internal hernia versus possible transverse colonic volvulus. The patient's abdominal pain and distension worsened after nasogastric (NG) tube placement. With the combination of physical and imaging findings, the patient underwent diagnostic laparoscopy. Intraoperatively, severely dilated bowel was encountered, which was decompressed via the appendix. After which, we discovered a PDH on the left side of the ligament of Treitz which was successfully reduced. The patient had no complications and continues tolerating a regular diet with return of normal bowel function. Our case describes successful laparoscopic surgical reduction of a pediatric left paraduodenal hernia.

Purpose: Sigmoidocele, which is a type of obstructed defecation syndrome (ODS), is a peritoneal hernia of the pelvic floor that has been seldom studied individually. This study investigated the anatomic characteristics of sigmoidocele based on imaging features., Methods: This retrospective cohort population comprised adult patients with ODS who underwent defecography between December 2017 and July 2020. Sigmoidocele was classified based on existing criteria. Novel radiological parameters including the vertical distance descended by the sigmoid colon from rest to maximum straining (RMS) and from the inferior border of the sigmoid colon to the superior border of the rectum at maximum straining (MSR) were measured., Results: Among 275 patients with sigmoidocele, 251 (91.6%) were female. The mean age was 51.53±12.99 years. We classified 26, 205, and 44 cases as grades I, II, and III, respectively. Patients with more severe sigmoidocele had greater sigmoid colon mobility (RMS: 19.13±8.54 mm, 34.45±14.51 mm, and 48.70±20.05 mm for grades I, II, and III, respectively; p < 0.001) and more pronounced compression of the rectum by the sigmoid colon at maximum straining (MSR: 35.23±8.44 mm, 26.33±13.29 mm, and 15.18±18.00 mm, respectively; p < 0.001). We regrouped the patients based on sigmoid colon alignment. Type L patients had the most severe constipation., Conclusion: Our study presents a novel sigmoidocele classification. The anatomic appearance and location of the herniated sigmoid colon observed using fluoroscopy during defecation may help improve the clinical awareness of ODS caused by sigmoidocele., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

A 72-year-old woman was admitted to our department in March 2020 for an evaluation of nausea, vomiting, diarrhea, liver dysfunction, and hypokalemia, which had persisted intermittently since 2013. Thickening of the descending duodenal wall and a sac-like appearance the intestinal tract in the vicinity of the duodenal papilla were observed in abdominal computed tomography. No duodenojejunal curvature, with two intestinal loops identified in the descending region, was detected in contrast-enhanced upper gastrointestinal imaging. Based on these imaging findings, the patient was diagnosed with intestinal malrotation (incomplete rotation and fixation) accompanied by a right paraduodenal hernia based on the Nishijima classification. Thus, surgery was performed at our hospital. Gastrointestinal symptoms did not recur, and liver dysfunction and hypokalemia improved postoperatively.

Background: Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) due to a bony defect in the EAC is rare. Such bony defects can be secondary to inflammation, neoplasm, trauma. In rare instances, TMJ herniation can occur when the Huschke foramen is constantly exposed. TMJ herniation can induce clicking tinnitus, otalgia, conductive hearing loss, and otorrhea, but can also present with no symptoms. This study reports a case of TMJ herniation., Clinical Presentation: A male patient presented with clicking tinnitus that had developed 3 years ago. Dome-shaped soft tissue was found on the anterior EAC wall, which protruded and depressed with mouth movement. The patient underwent surgical reconstruction of the bony defect with titanium mesh, and the symptoms resolved after surgery., Conclusion: This case highlights the importance of surgical reconstruction of a bony defect in the EAC using appropriate materials.

Purpose: Parastomal hernia is the most common complication after stoma formation with an incidence that approaches 50% at 2 years postoperatively. In the last decade, different approaches of minimally invasive procedures have been proposed for the treatment of parastomal hernia. Nevertheless, the superiority of one technique over the others remains still unclear. Our objective was to update and systematically analyze current state of research concerning the postoperative outcomes of the four most prevalent minimally invasive techniques., Methods: A systematic literature search of three databases (Medline, Scopus, Google Scholar) was undertaken for articles published from January 2015 to November 2022. Fifteen studies from a previous meta-analysis on the topic were included., Results: Thirty-three studies incorporating 1289 total patients were deemed eligible for inclusion in the final analysis. The keyhole technique was associated with the highest incidence of postoperative complications and recurrences (31.3% and 24.1%, respectively), followed by the Sugarbaker technique (27.6% and 9%, respectively). Operative time was among the lowest in patients operated with the 3D mesh technique, while patients undergoing the keyhole technique experienced the shortest cumulative length of hospital stay (6 days)., Conclusion: Each technique demonstrates a unique profile of effectiveness offset by the propensity towards developing postoperative complications. While no conclusive evidence on the optimal technique exist to date, newer minimally invasive techniques show promising results, albeit based on limited data. The future of parastomal hernia repair seems to rely on a highly individualized approach, tailored to the distinctive characteristics of both the hernia and the patient., (© 2023. The Author(s).)

Purpose: Obstructed defecation syndrome represents 50-60% of patients with symptoms of constipation. We aimed to compare the two frequently performed surgical methods, laparoscopic ventral mesh rectopexy and transperineal mesh repair, for this condition in terms of functional and surgical outcomes., Methods: This study is a retrospective review of 131 female patients who were diagnosed with obstructed defecation syndrome, attributed to rectocele with or without rectal intussusception, enterocele, hysterocele or cystocele, and who underwent either laparoscopic ventral mesh rectopexy or transperineal mesh repair. Patients were evaluated for surgical outcomes based on the operative time, the length of hospital stay, operative complications, using prospectively designed charts. Functional outcome was assessed by using the Initial Measurement of Patient-Reported Pelvic Floor Complaints Tool., Results: Fifty-one patients diagnosed with complex rectocele underwent laparoscopic ventral mesh rectopexy, and 80 patients diagnosed with simple rectocele underwent transperineal mesh repair. Mean age was found to be 50.35 ± 13.51 years, and mean parity 2.14 ± 1.47. Obstructed defecation symptoms significantly improved in both study groups, as measured by the Colorectal Anal Distress Inventory, Constipation Severity Instrument and Patient Assessment of Constipation-Symptoms scores. Minor postoperative complications including wound dehiscence (n = 3) and wound infection (n = 2) occurred in the transperineal mesh repair group., Conclusion: Laparoscopic ventral mesh rectopexy and transperineal mesh repair are efficient and comparable techniques in terms of improvement in constipation symptoms related to obstructed defecation syndrome. A selective distribution of patients with or without multicompartmental prolapse to one of the treatment arms might be the preferred strategy., (© 2023. The Author(s).)

An internal hernia through the foramen of Winslow represents a rare surgical pathology. This report describes a case with incipient caecal ischaemia and discusses current diagnostic and therapeutic approaches. A patient in his early 60s presented at the emergency department with abdominal pain and last bowel movement three days prior. A CT scan of the abdomen suggested an internal hernia into the lesser sac. Intraoperatively, the suspected diagnosis could be confirmed laparoscopically with a twisted mobile caecum herniating through the foramen of Winslow. Due to a suspected ischaemia and laparoscopic frustrated reduction, a right open hemicolectomy was performed. The hernia gap was closed. The postoperative course was uneventful. Despite the rarity of internal hernias in patients without prior abdominal surgery, surgeons should be aware of this entity. The diagnosis can be difficult and sometimes only established intraoperatively. Open surgery is usually required. If the gap is clearly identified, the recommendations tend towards its closure., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

A 72-year-old man who underwent aortic valve replacement by a minimally invasive cardiac surgery (MICS) approach two years ago was visited our hospital complaining of swelling and pain in the right anterior chest. A chest computed tomography (CT) scan showed that the right upper lobe protruded beyond the right second intercostal space and outside the thorax. He was diagnosed as a right intercostal lung hernia and underwent chest wall reconstruction with a substitute method. Postoperative course was uneventful without any evidence of recurrence. Postoperative intercostal lung hernias in MICS may increase with the increment in MICS, and it is necessary to accumulate cases as one of the complications.

Background: While free-flap breast reconstruction becomes more common, it is still approached with caution in older patients. Outcomes in the elderly population have not been well characterized, especially with regard to donor-site sequalae. This study compares microvascular autologous breast reconstruction outcomes in patients older and younger 60 years., Methods: A single-institution retrospective review was performed for microvascular autologous breast reconstruction from January 2004 through January 2021. Demographic, intraoperative, and postoperative variables, including breast flap and donor-site complications, were evaluated., Results: Five hundred forty-five breast free flaps were identified, of which 478 (87.8%) were performed on patients younger than 60 years (mean, 46.2 years) and 67 (12.2%) older than 60 years (mean, 64.8 years; P = 0.000). Hyperlipidemia was significantly higher in older patients (19.4% vs 9.6%, P = 0.016). Mean operative time was 46.3 minutes faster in the older cohort ( P = 0.030). There were no significant differences in free-flap loss, venous congestion, takeback, hematoma, seroma, wound healing, or infection. Interestingly, there were significantly more total breast flap complications (28.5% vs 16.4%, P = 0.038) and higher rates of fat necrosis (9.6% vs 1.5%, P = 0.026) in the younger cohort. Significantly more abdominal donor-site complications (43.3% vs 21.3%, P = 0.000) were seen in the older people, with increased wound breakdown ( P = 0.000) and any return to the operating room (20.9% vs 9.8%, P = 0.007). Older patients were also significantly more likely to require surgical correction of an abdominal bulge or hernia (10.4% vs 4%, P = 0.020). The mean follow-up was 1.8 years., Conclusions: Our data showed no worsening of individual breast flap outcomes in the older people. However, there were significantly more abdominal complications including surgical correction of abdominal bulge and hernia. This may be related to the inherent qualities of tissue aging and should be taken into consideration for flap selection. These results support autologous breast reconstruction in patients older than 60 years, but patients should be counseled regarding potentially increased abdominal donor-site sequelae., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Richter's hernia is a rare type of hernia that occurs when the antimesenteric intestinal wall protrudes through a defect in the abdominal fascia leading to ischaemia, gangrene, bowel perforation and enterocutaneous fistulae. In this article, we describe a rare case of enterocutaneous fistula due to a Richter's hernia after a Tenckhoff catheter removal. This type of complication has not been previously reported in the literature. An 82-year-old man presented with a 1-day history of enteric content at the Tenckhoff catheter insertion site. Seven weeks earlier, the catheter was removed due to peritonitis. Removal was performed using open technique, and the fascia was not closed. Computed tomography revealed a small incarcerated hernia and subcutaneous fluid collection at the previous catheter insertion site. He underwent laparoscopy, which showed a Richter's hernia with perforation of the ileum causing an enterocutaneous fistula. A laparoscopic enterectomy was performed using a primary mechanical anastomosis. The hernia was repaired by primary suture without a mesh because of wound enteral contamination and the small size of the hernia. Richter's hernia has a misleading clinical presentation and contributes to high rates of morbidity and mortality. A secure myofascial closure during catheter removal may reduce the chances of this complication.

Perineal hernias are rare complications of surgeries like abdominoperineal resections. This submission is an educational piece outlining the steps to completing a posterior perineal hernia repair with mesh., (© 2023 Royal Australasian College of Surgeons.)

Objective: To compare laparoscopic Keyhole repair with Sugarbaker repair in consecutive patients with parastomal hernia. Methods: From January 2015 to December 2021, 117 patients with parastomal hernia were treated with Keyhole or Sugarbaker laparoscopy repairs in the Department of Hernia and Bariatrci Surgery, the First Affiliated Hospital of University of Science and Technology of China, and the clinical data were retrospectively analyzed. There were 45 males and 72 females, aged (68.6±8.6) years (range: 44 to 84 years). Laparoscopic Sugarbaker repair was performed in 89 cases, and Keyhole repair was performed in 28 cases. The t -test, Mann-Whitney U test, χ 2 test and Fisher exact test were used to compare the observation indicators between the two groups, such as operation time, incidence of operation-related complications, and postoperative recurrence rate. Results: The follow-up period was ( M (IQR)) 33 (36) months (range: 12 to 84 months). Compared to the Sugarbaker group, the hernia ring area of the Keyhole group was bigger (35 (26) cm 2 vs. 25 (16) cm 2 , Z =1.974, P =0.048), length of stay was longer ((22.0±8.0) d vs. (14.1±6.2) d, t =5.485, P <0.01), and the postoperative rate of recurrence was higher (28.6% (8/28) vs. 6.7% (6/89), χ 2 =7.675, P =0.006). There was no difference in operation time and postoperative complications between the two groups. Conclusions: Laparoscopic Sugarbaker repair is superior to Keyhole repair in the recurrence rate of parastomal hernia treated with compsite mesh (not funnel-shaped mesh). There are no differences in operation time and postoperative complications between the two groups.

Paraduodenal hernia is a rare form of congenital internal hernia and can lead to small bowel obstruction. This case report describes the case of a young boy who was admitted with acute exacerbation of chronic abdominal pain.

Introduction: Internal herniation (IH) can be a life-threatening complication of Roux-en-Y gastric bypass (RYGB). Randomised controlled trials support the routine closure of mesenteric spaces at RYGB. However, there is currently no consensus on the method of closure in clinical practice. The purpose of this survey is to understand bariatric surgeons' practice in this regard., Methods: We conducted an international survey, whereby questions were created through collaboration of a consensus group of bariatric surgeons and hosted on the SurveyMonkey platform. The survey was distributed among British Obesity and Metabolic Surgery Society (BOMSS) members and international professional channels including The Upper Gastrointestinal Society (TUGS) and social media., Results: One hundred and thirty-six surgeons from 34 countries completed the survey. Of these, 49 respondents were UK-based surgeons with a cumulative experience of approximately 2500 RYGB per annum. Forty-five (91.8%) respondents reported always closing mesenteric defects, of whom 57.8% elected to use non-absorbable non-barbed sutures, followed by staples/clips in 28.9% and a selection of other methods. Most respondents used more than one method. A total of 2 UK and 14 non-UK participants reported never closing mesenteric spaces., Conclusions: This survey has shown heterogeneity among defect closure and no consensus on preferred type. Additionally, there remains a practice of non-closure of mesenteric defects. We hope these findings help to inform further needed research and consensus building among experts., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Incisional hernia is a frequent complication after loop-ileostomy closure, rationalizing hernia prevention. Biological meshes have been widely used in contaminated surgical sites instead of synthetic meshes in fear of mesh related complications. However, previous studies on meshes does not support this practice. The aim of Preloop trial was to study the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure., Methods: The Preloop randomized, feasibility trial was conducted from April 2018 until November 2021 in four hospitals in Finland. The trial enrolled 102 patients with temporary loop-ileostomy after anterior resection for rectal cancer. The study patients were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene Macro™, Medtronic) (SM) or a biological mesh (Permacol™, Medtronic) (BM) to the retrorectus space at ileostomy closure. The primary end points were rate of surgical site infections (SSI) at 30-day follow-up and incisional hernia rate during 10 months' follow-up period., Results: Of 102 patients randomized, 97 received the intended allocation. At 30-day follow-up, 94 (97%) patients were evaluated. In the SM group, 1/46 (2%) had SSI. Uneventful recovery was reported in 38/46 (86%) in SM group. In the BM group, 2/48 (4%) had SSI (p > 0.90) and in 43/48 (90%) uneventful recovery was reported. The mesh was removed from one patient in both groups (p > 0.90)., Conclusions: Both a synthetic mesh and biological mesh were safe in terms of SSI after loop-ileostomy closure. Hernia prevention efficacy will be published after the study patients have completed the 10 months' follow-up., (© 2023. The Author(s).)

Internal hernias are protrusions of viscera that can cause obstructions such as small bowel obstruction (SBO). Diagnosis can be challenging, as they usually come with an atypical presentation. We report on a case of a woman in her early 40s, with no history of surgery or chronic illnesses, which came with abdominal pain associated with vomiting. CT scan revealed obstructed small bowel. On exploratory laparoscopy, an internal hernia through a peritoneal defect in the vesicouterine space was found, entrapping a limb of the jejunum. The entrapped loop of the small bowel was freed, the ischaemic part was resected, and the defect was closed. Our case presents the second reported case of a congenital vesicouterine defect causing SBO. It is important to consider patients presenting with SBO as a case of congenital peritoneal defect if they had no previous surgeries., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Small bowel obstruction (SBO) due to internal herniation (IH) is a well-known complication of laparoscopic Roux-en-Y gastric bypass (LRYGBP). The objective of this study is to evaluate different types of non-absorbable sutures used for closure of the defects regarding the incidence of SBO due to IH/adhesions, adhesion formation in general, or reopening of the defects., Methods: A single-center retrospective study was performed. Patients who underwent LRYGBP were divided in 3 groups: group A closure of the defects with monofilament Polypropylene suture (Prolene®), group B with braided polyester suture (Ethibond®), group C with barbed knotless Polybutester suture (V-Loc®). Descriptive statistics were performed regarding SBO due to IH/adhesions, adhesion formation, and reopening of closed defects., Results: From 5145 patients, 224 patients underwent exploratory laparoscopy for suspicion of SBO. Mean time interval was 28.4 months. IH or intermittent IH was found in 1.94% in group A, 1.78% in group B, and 1.40% in group C. Obstruction due to adhesions was found in 0.70%, 0.36%, and 0.42% per group, respectively. Adhesions in general were observed in 1.47% in group A, 1.43% in group B, and 1.06% in group C. The incidence of reopening was higher in group A (2.24%) in comparison with group B (1.13%, P = 0.041) and group C (1.05%, P = 0.001)., Conclusions: After descriptive analysis, these results can withhold no difference among the 3 non-absorbable sutures regarding incidence of SBO due to IH or SBO due to adhesions, yet tendency for higher reopening rates after closure with monofilament Polypropylene suture is observed., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The present case reports on a 53-year-old patient with severe chronic obstructive pulmonary disease (COPD) and acute pneumonia who complained of massive right-sided chest pain and hemoptysis after a severe coughing fit. To the authors' great surprise, further clinical and radiological investigations revealed a rupture of the right intercostal muscles caused by the coughing fit, with herniation of parts of the right lower lobe of the lung down to the subcutaneous and below the M. latissimus dorsi. The patient was presented to the colleagues in thoracic surgery and needed to be operated twice, finally with a mesh insert., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Acute epiploic appendagitis is a rare differential diagnosis of unclear or acute abdomen., Aim: To describe - by means of a scientific case report - the extraordinary diagnosis of acute epiploic appendagitis along with contained diverticulitis and incarcerated herniation of the greater omentum into the hernial sac of a former trocar site (medical history, significant for laparoscopic ovarian cyst removal) in a 29-year-old female based on experiences obtained in the successful clinical case management, and on selective references from medical scientific literature., Case Summary: Medical history: A 29-year-old female was admitted with abdominal pain in the lower left quadrant. She reported a laparoscopic ovarian cyst removal 3 years prior. Physical examination of the abdomen revealed tenderness in the lower left quadrant without a palpable mass.Leading diagnoses were found using transabdominal ultrasound and confirmed by an abdominal CT scan; namely, incarcerated trocar hernia, diverticulitis of sigmoid colon, and acute epiploic appendagitis. Therapeutic approach was comprised of an explorative laparoscopy (because of the incarcerated hernia), adhesiolysis, removal of a tip of the greater omentum out of the hernial sac, closure of the hernial orifice, and removal of an unclear, inflamed, and bloody fatty tissue from the wall of the descending colon ( histopathological investigation confirmed acute epiploic appendagitis). This was flanked by conservative treatment of diverticulitis of the sigmoid colon.Further clinical course was uneventful, with discharge on the 3 rd postoperative day with favorable long-term outcome, characterized by no further complaints for 15 months., Discussion: Acute epiploic appendagitis is an inflammatory, usually self-limiting condition of the epiploic appendages of the colon. It typically manifests with abdominal pain in the lower left quadrant. Imaging is an important diagnostic tool to determine whether the patient has, in fact, acute epiploic appendagitis, so recognizing the characteristic oval lesions with the surrounding inflammation and central fat attenuation on CT, as well as the hyperechoic oval lesions with a hypoechoic peripheral band on ultrasound images is crucial. Nevertheless, it is often overlooked in patients and confused with other differential diagnoses, such as appendicitis or diverticulitis. Although the condition appears infrequently, it is essential to be proficient in the diagnostic evaluation, as a misdiagnosis may lead to unnecessary treatment and even surgical intervention., In Conclusion: , the patient was initially diagnosed with an incarcerated abdominal hernia, and therefore subsequently underwent surgery. The inflamed epiploic appendage was discovered in laparoscopic exploration, removed, and confirmed through the histopathology report. This is an approach to be performed with great caution so as not to 1. : misinterpret an inflamed diverticula or covered perforation of it as well as not 2. : overlooking a peritoneal tumor lesion., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Introduction: Intussusceptions diagnosed on computed tomography (CT) scans in Roux-en-Y gastric bypass (RYGB) patients could cause serious small bowel obstruction (SBO) or be an incidental finding. The objective of this study was to correlate radiological findings with clinical outcomes to differentiate intussusceptions requiring emergent surgery for SBO., Methods: A search for acute abdominal CT scans reporting intussusceptions in RYGB patients between 2012 and 2019 at Skåne University Hospital, Malmö, Sweden, retrieved 35 scans. These were independently reevaluated by two radiologists for the length and location of the intussusception, whether oral contrast passed through, proximal bowel dilatation, and signs of internal herniation. Clinical outcome in terms of emergency surgery and the diagnosis was determined through chart review., Results: Out of 35 acute patients, 9 patients required emergency surgery within 24 h. Intussusception caused SBO in five patients, and one patient had an internal herniation, while three patients had unremarkable findings. Eight patients were evaluated for intermittent pain with five unremarkable laparoscopies, while 18 patients had intussusceptions as incidental findings. Intussusception length on CT as measured by radiologists O.E. and D.L. predicted acute bowel obstruction (p = .014 and p < .001). A 100 mm threshold predicted bowel obstruction with a sensitivity of 80% and 100% and a specificity of 93% and 86% by radiologists O.E. and D.L., respectively. Proximal bowel dilatation predicted SBOs of any cause as well as SBO caused by an intussusception (all p < .05)., Conclusion: Intussusception length > 100 mm on CT in RYGB patients is an easy and valuable sign indicating SBO that may require emergent surgery., (© 2022. The Author(s).)

BACKGROUND Tracheocele are rarely encountered air cysts formed due to tracheal wall outpouching through a weak vantage point. The majority are acquired in the adult population and are associated with conditions that weaken the tracheal wall. Most tracheoceles are diagnosed incidentally since many are asymptomatic or present with nonspecific symptoms. Multidetector computed tomography (MDCT) scans are the most common imaging modality for diagnosis of silent tracheal cysts. Tracheocele have been very rarely documented in the trauma setting; therefore, in the setting of multiple body trauma diagnosis can be challenging. CASE REPORT We report a case of an acquired tracheocele after a high-impact blunt thoracic trauma with an admission diagnosis of suspected tracheal perforation. MDCT of the neck and chest demonstrated an irregularly multicystic-shaped air collection at the right posterolateral trachea upon evaluation. Flexible laryngoscopy and bronchoscopy results were unremarkable. CONCLUSIONS Tracheocele are rare and asymptomatic pseudo-diverticulum of the tracheal wall. Many are diagnosed incidentally with imaging studies for other conditions. Nevertheless, in the trauma setting its diagnosis can be challenging and misleading. Consideration of conditions such as tracheocele is important to prevent any unwarranted treatment modalities.

A female patient in her 80s presented with a 2-day history of abdominal pain and absolute constipation, having previously undergone a robotic left distal ureterectomy with ureteric re-implantation. CT revealed a closed-loop small bowel obstruction with transition point adjacent to the left ureter and resultant upstream hydronephrosis. An emergency laparotomy revealed small bowel herniation into a paraureteric space created by her previous surgery and defined by the distal ureter medially, the common iliac vessels laterally and the mobilised bladder dome anteriorly. The viable small bowel was reduced, and the space was eliminated by omental flap transposition after omentoplasty. The patient made a full recovery. Preoperative diagnosis of such an unusual cause of internal herniation can be challenging. This very rarely reported case raises awareness of the condition and proposes a treatment strategy., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Left paraduodenal hernia is an internal herniation that develops due to anomalous fetal development. If incarcerated, it becomes an unusual cause of acute abdomen., Case Report: This case report presents an uncommon case of a 39-year-old man with acute abdominal pain with vomiting. The patients medical history included recurrent subileous events and Crohn´s disease in long-term remission. CT scan of abdominal cavity indicated a possible mechanical obstruction of small bowel loops in the upper left abdominal quadrant. Incarcerated left paraduodenal herniation was identified during surgery. Repositioned small bowel loops did not require resection and the entrance of Landzert´s fossa was sutured., Conclusion: Left paraduodenal hernia is the most common congenital internal herniation. Although rare, it should be considered in the differential diagnosis of acute abdomen.

Objective: To introduce a case of a uterus "hernia-like" myoma within the uterine cavity that was successfully treated with hysteroscopy., Design: Step-by-step explanation of the case and surgical procedure using a video and slides. The Medical Ethics Committee of Women and Children's Hospital of Chongqing Medical University approved the study and decided for this video to be exempt from formal approval, and informed consent was obtained from the patient., Setting: Hospital., Patient(s): A 37-year-old woman, gravida 1, para 1, with a history of secondary infertility for 2 years and heavy menstrual bleeding for 7 months, which eventually resulted in anemia, was diagnosed with a type 1 (International Federation of Gynecology and Obstetrics leiomyoma subclassification system) myoma approximately 4 cm in diameter using ultrasonography. Her hemoglobin level was 8.6 g/dL (11.5-15.0 g/dL), red blood cell count was 3.6 ×10-12/L (3.8-5.1 ×10-12/L), and hematocrit was 26.7% (35%-45%)., Intervention(s): Hysteroscopic myomectomy with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the hernia-like myoma. Blunt dissection combined with oxytocin (20 U I.V.) and uterine dilation pressure reduction was used to induce the hernial content (myoma) protrusion into the uterine cavity., Main Outcome Measure(s): The hernia-like myoma was completely resected by hysteroscopy, and all symptoms disappeared., Result(s): The hernia-like myoma was successfully and completely resected by hysteroscopy. The operative time was 37 minutes. No surgical-related or anesthesia-related complications occurred. During the follow-up period, the patient had regular menstrual cycles without hypermenorrhea, and her anemia had improved. The 5-month follow-up ultrasound examination and hysteroscopy revealed that the uterine cavity had recovered well. The patient conceived 7 months after the procedure and delivered at term (39 weeks 1 day) via cesarean section., Conclusion(s): A hernia-like myoma covered with endometrium is a degenerative myoma that herniates into the myometrium and forms a hernia sac-like defect. Hysteroscopy is an effective and feasible method for treating hernia-like myoma., (Copyright © 2022 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Repeat abdominal surgery in the bariatric surgery patient population may be challenging for non-bariatric-accredited institutions. The impact of regionalized bariatric care on clinical outcomes for bariatric surgery patients requiring repeat abdominal surgery is currently unknown. This study aims to investigate the association between bariatric center designation and clinical outcomes following hepatobiliary, hernia, and upper and lower gastrointestinal operations among patients with prior bariatric surgery., Methods: This is a cohort study of a large sample of Ontario residents who underwent primary bariatric surgery between 2010 and 2017. A comprehensive list of eligible abdominal operations was captured using administrative data. The primary outcome was 30-d complications. Secondary outcomes included 30-d mortality, readmission, and length of stay., Results: Among the 3301 study patients, 1305 (40%) received their first abdominal reoperation following bariatric surgery at a designated bariatric center. Nonbariatric center designation was not associated with significantly higher rates of 30-d complications (5.73% versus 5.72%), mortality (0.80% versus 0.77%), readmissions (1.11% versus 1.85%), or median postoperative length of stay (4 versus 4 d). After grouping the category of reoperations, upper gastrointestinal (odds ratio [OR] 0.66, confidence interval [CI] 0.39-1.11) and abdominal wall hernia surgery (OR 0.52, CI 0.27-0.99) showed a lower adjusted OR for complications among bariatric centers., Conclusions: Our study demonstrates that after adjustment for case-mix and patient characteristics, bariatric surgery patients undergoing repeat abdominal surgery at nonbariatric centers is not associated with higher proportion of complications or mortality. Complex hernia surgery may be considered the most appropriate for referral., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Purpose: Hernia management in patients with cirrhosis is a challenging problem, where indication, timing and type of surgery have been a subject of debate. Given the high risk of morbidity and mortality following surgery, together with increased risk of recurrence, a wait and see approach was often advocated in the past., Methods: The purpose of this review was to provide an overview of crucial elements in the treatment of patients with cirrhosis and umbilical hernia., Results: Perioperative ascites control is regarded as the major factor in timing of hernia repair and is considered the most important factor governing outcome. This can be accomplished by either medical treatment, ascites drainage prior to surgery or reduction of portal hypertension by means of a transjugular intrahepatic portosystemic shunt (TIPS). The high incidence of perioperative complications and inferior outcomes of emergency surgery strongly favor elective surgery, instead of a "wait and see" approach, allowing for adequate patient selection, scheduled timing of elective surgery and dedicated perioperative care. The Child-Pugh-Turcotte and MELD score remain strong prognostic parameters and furthermore aid in identifying patients who fulfill criteria for liver transplantation. Such patients should be evaluated for early listing as potential candidates for transplantation and simultaneous hernia repair, especially in case of umbilical vein recanalization and uncontrolled refractory preoperative ascites. Considering surgical techniques, low-quality evidence suggests mesh implantation might reduce hernia recurrence without dramatically increasing morbidity, at least in elective circumstances., Conclusion: Preventing emergency surgery and optimizing perioperative care are crucial factors in reducing morbidity and mortality in patients with umbilical hernia and cirrhosis., (© 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Skin closure following abdominal wall reconstruction (AWR) has received little attention, even though these patients have demonstrated insufficient wound healing. This study assessed the postoperative wound-related complications and patient-reported outcomes after skin closure using single- or triple layer closure following AWR. This was a retrospective study at a University Hospital from 2016 to 2018. Patients were grouped into a single-layer cohort (SLC) and a triple-layer cohort (TLC). Skin incisions closed with either technique were compared. Postoperative complications were registered from chart review (SLC: n  = 48, TLC: n  = 40). Patient reported-outcomes were assessed through the Patient Scar Assessment Questionnaire (PSAQ) and the Hernia Related Quality of Life survey. A total of 51 patients were included (SLC: n  = 26, TLC: n  = 25). There was no difference in wound complications after single- or triple-layer skin closure; seroma (SLC: 16.7% vs. TLC: 15%, p  = 1.00), surgical site infection (SLC: 4.2% vs. TLC: 7.5%, p = .834), hematoma (SLC: 6.2% vs. TLC: 2.5%, p = .744) and wound rupture (SLC: 2.1% vs. TLC: 2.5%, p  = 1.00). Patients who had incisions closed using single-layer closure were more satisfied; PSAQ satisfaction with scar symptoms (SLC: 6.7 points (IQR 0.0-18.3) vs. TLC: 26.7 points (IQR 0.0-33.3), p = .039) and scar aesthetics (SLC 25.9 points (IQR 18.5-33.3) vs. TLC: 37.0 (IQR 29.6-44.4), p = .013). There was no difference in 30-day wound complications after either skin closure technique. The results favoured the single-layer closure technique regarding the cosmetic outcome. Abbreviations: AWR: abdominal wall reconstruction; SLC: single-layer cohort; TLC: triple-layer cohort; PSAQ: patient scar assessment questionnaire; IH: incisional hernia; QOL: quality of life; BMI: body mass index; HerQLes: hernia-related quality of life; ASA: American Society of Anesthesiologists; SSO: surgical site occurence; SSI: surgical site infection; LOS: length of stay; RCT: randomized controlled trial.

Patients with liver cirrhosis are at increased risk of various visceral hernia because of persistent ascites and tissue fragility. Here we report successful treatment in a patient with pararectal hernia due to liver cirrhosis by a less invasive approach via para-anal region. The patient was a 73-year-old woman with a history of chronic hepatitis B that had been untreated for at least 20 years. At the age of 68 years, she was referred to our hospital for treatment of persistent ascites and thrombocytopenia due to advanced liver cirrhosis. Neither diuretics nor cell-free and concentrated ascites reinfusion therapy could decrease the ascites. She needed repeated paracentesis. She was referred to the surgical department due to the painful swelling of the left buttock which was diagnosed as the pararectal hernia. The welling was huge enough with the erosion of the covering skin. Surgery was planned in view of concern about the possible rupture of the hernia. Due to the massive ascites with the advanced liver cirrhosis, we were reluctant to do the laparotomic approach, and simple closure of the hernial orifice via direct approach from the cutaneous side was planned and performed. The patient was fortunately discharged seven days after the operation without any complications. One year later, there has been no recurrence of the hernia. Even in cases with massive ascites, direct simple closure of the hernia by percutaneous approach may be one of the options for the treatment of the pararectal hernia in case of urgent situation.

A 50-year-old man was referred to our hospital with myelitis associated with a 10-months history of progressive muscle weakness in the left leg. Neurological examinations demonstrated diffuse muscle weakness of the left leg, touch hypoesthesia of the right leg, reduced pain sensation below the right nipple, left pyramidal sign, and urinary incontinence. On the basis of thoracic spinal MRI and thoracic CT myelography, revealing anterior displacement of the spinal cord and enlargement of the posterior subarachnoid space at the Th4 vertebral level, we diagnosed the patient as having idiopathic spinal cord herniation with incomplete Brown-Séquard syndrome. After microsurgical release of the spinal cord and subsequent covering of the anterior dural defect with an artificial dura mater, the symptoms improved without progression. Clinicians should consider spinal cord herniation as a cause of slowly progressive thoracic myelopathy with Brown-Séquard syndrome.