PURPOSE: Abdominal wall reconstruction (AWR) can lead to raised intra-abdominal pressure (IAP) in the postoperative setting. The term “quaternary abdominal compartment syndrome” (QACS) was recently proposed as an abdominal compartment syndrome in the particular setting of AWR that reverts with medical treatment. The aim of this report is to determine the incidence of QACS in our series, potential risk factors and the outcome of these patients. METHODS: A retrospective study was conducted between 2010 and 2019 at our hospital, to identify patients with QACS after AWR and respective risk factors. RESULTS: From a total of 115 patients, five were diagnosed with QACS, all being hernias with Loss of Domain (LOD) ≥20% and showing major renal and pulmonary impairment. Four patients had predictable transitory QACS, yet one patient died despite damage control surgery. A total of 19 patients had LOD ≥20%, 14 without QACS development and 5 with this entity. The most important finding between the groups was a significant variation in the Peak Respiratory Pressure (PRP) (measured before incision and intraoperatively), being higher in the QACS group (7.40 ± 1.34 vs. 3.77 ± 1.59; P < 0.001). CONCLUSION: In this study, QACS was found to be a rare event, not always transitory. LOD ≥20% appeared as an important risk factor and PRP variations between 6 and 10 mmHg during fascial closure were a significant marker for adverse endpoints in AWR.

INTRODUCTION: Diastasis recti (DR) associated with midline hernias is common. Big size DR represents a clinical and cosmetic problem. Its repair is challenging, with intraoperative and postoperative risks. The adjuvant of botulinum toxin serotype A makes it possible to restoration of the linea alba by preaponeurotic endoscopic repair (REPA). METHODS: This was a retrospective study with prospective database. Between February 2019 and July 2020, six women were operated, with a mean age of 39 years and a diagnosis of DR >80 mm, with a body mass index of 27. All patients were infiltrated with 50 UR of botulinum toxin serotype A on each side, 30 days before the surgery. RESULTS: The intraoperative diagnosis of DR was 87.5 mm average, associated with midline hernias in 100%, with a mean transverse diameter of 24 mm (10–60 mm) Anatomical restoration of the linea alba was performed with a slow absorbable barbed suture. The wall was reinforced with 100% macroporous polypropylene mesh, with 83.3% atraumatic fixation and 16.6% absorbable traumatic fixation. The surgical time was 94 ± 15 min. Postoperative pain was 2/10 ± 1 according to the Visual Analog Scale, allowing a hospital stay of 18 ± 4 h. Return to work 18 ± 3 days. The mean follow-up was 9 (2–18) months by the clinical and ultrasound examination in 100%, without complications or recurrences. CONCLUSIONS: The application of botulinum toxin serotype A associated with endoscopic repair (REPA) allowed solving the big size DR and midline hernias with suture of the rectus sheath with less tension, associated with a reinforcement prosthesis, allowing a reduced hospitalization with a low level of postoperative pain, avoiding muscle release incisions, which are irreversible and not exempt from morbidity, added to the proven benefits of endoscopic access.

PURPOSE: Our initial publication on Stapled Mesh stomA Reinforcement Technique (SMART) for the prevention of parastomal hernias (PSH) demonstrated promising results. The aim of this study is to evaluate the long-term PSH occurrence rate with SMART and its associated complications and to radiologically measure the progression of trephine diameters. MATERIALS AND METHODS: All SMART cases from November 2013 to July 2016 were reviewed. Demographics, peri-operative details, and long-term mesh-related complications were collected. Serial computed tomography (CT) scans during follow-up were used to identify PSH and measure the progression of axial and sagittal trephine diameters and trephine area. RESULTS: 15 patients (M:F = 10:5) underwent an elective stoma formation with SMART. Nine died during the study period. Two patients died before any CT scan with no clinical evidence of PSH. All except one of the remaining 13 patients developed radiological PSH. There were no long-term mesh-related complications. Only one patient required the relocation of stoma due to the incarceration of small bowel in the PSH in an emergency setting. The median follow-up was 28 months (3–77 months). CONCLUSION: Prophylactic mesh placement by SMART did not prevent the occurrence of PSH in the long-term despite only a minority of patients required surgical intervention for PSH.

INTRODUCTION: Lichtenstein hernia repair is a clean surgical intervention and one of the most frequently applied operation worldwide. Despite guidelines, benefit of antibiotic prophylaxis in hernia surgery has been considered questionable and prophylaxis usage is not infrequent. Here, in this clinical randomized trial, we aimed to compare three different prophylaxis regimens to find out which one is more effective. METHODS: In this prospective study, patients were divided into three groups. First group (G1) received cefazoline, second group (G2) received topical gentamicin, and third group (G3) received combination of cefazoline and topical gentamicin. On 1^st, 7^th, and 30^th postoperative days, surgical sites were examined for the signs of infection according to the definitions of Centers for Disease Control. Furthermore, effectiveness of infection prevention in patients with comorbid diseases was also analyzed. RESULTS: Totally 276 patients were analyzed. In G1 three, in G2 two, and in G3 0 infections were recorded. Total, infection rate was 1.8%. There was no any difference in infection rates between three groups (P = 0.285). Comorbidities did not rise infection rates under prophylaxis coverage (P > 0.05). CONCLUSION: All three methods are equally effective in surgical site infection, but combination method seems better with “0” ratio. Prophlaxy coverage also prevents surgical site infection even in the presence of risk (comorbidities).

PURPOSE: Inguinal hernia repair is the most commonly performed surgery worldwide with surgical approaches being open and endoscopic hernioplasty. Mesh fixation in endoscopic hernia repair still remains a topic of debate. Moreover, a paucity of literature is present with regard to the quality of life (QOL) outcomes after mesh fixation in endoscopic hernia repair. MATERIALS AND METHODS: This prospective nonrandomized study was done on patients operated by totally extraperitoneal (TEP) hernioplasty. Primary outcome parameters included any complications, postoperative pain, and hernia-related QOL by Carolina's Comfort Scale among two different types of mesh fixation techniques (Group I - intracorporeal Suture fixation and Group II - tack fixation). RESULTS: TEP repair was done on 74 patients with suture fixation of the mesh by intracorporeal knotting (Group I; n = 30) and tack fixation of mesh (Group II; n = 44). There was no significant difference in the time to return to routine work, sensation of mesh, and pain, but time to return to office work was significantly lower in the patients of Group I (4.29 ± 0.99) compared to Group II (4.75 ± 0.96) and there was a significant difference in movement limitation from postoperative to subsequent time period in all groups except for after 3 months to 6 months in Group II. CONCLUSION: Intracorporeal suture fixation of mesh in TEP can be used as an alternate technique for mesh fixation with comparable perioperative and QOL outcomes.

Groin hernia is one of the most common surgical conditions worldwide. Clinical examination can reveal the majority of inguinal hernias. Small inguinal and femoral hernias (in women) may be missed. Dynamic inguinal ultrasound (DIUS) can fill this diagnostic gap. A standardized technique of DIUS is, therefore, important and will be described. The results show high specificity (0.9980) and sensitivity (0.9758), demonstrating the value of the method (which is known to be highly examiner dependent).

Clinically, significant perineal hernias are rare, occurring in <1% of all hernias. They may be congenital but are most commonly acquired and secondary to abdominoperineal resection (APR) or pelvic exenteration as treatments for cancer. We report a novel case of a combined perineal hernia and abdominal parastomal hernia and our approach for repair with mesh. The perineal hernia repair utilized a composite mesh implant, which was anchored to Cooper's ligament and the anterior longitudinal ligament. The parastomal hernia required component separation and re-siting of the stoma. This case describes a unique method for repairing the uncommon sequelae of concurrent perineal and parastomal hernias after an APR for rectal cancer.

Obturator hernia (OH) is a rare condition in all abdominal wall hernias, which usually presents with the symptoms of bowel obstruction caused by incarcerated intestinal segment, generally the ileum. We report a clinical case of an 81-year-old thin woman with 8-day history of nausea, vomiting, abdominal pain, and distension that aggravated for 1 day. A computed tomography scan showed an intestinal segment herniated into the obturator foramen in the left pelvic floor. A diagnosis of a left ileal, strangulated OH was made. A protective reduction management, air replacement method, was used to reduce the incarcerated ileum. Nonspecific symptoms of OH add difficulty in making diagnosis. Symptoms of bowel obstruction in patients with OH indicate incarceration. It is commonly seen in thin, elderly, multiparous women. Several ways for the reduction in patients with strangulated OH are described. Surgical approaches are the only choice for treatment. OH, a rare type in all hernias, is difficult to be diagnosed because of nonspecific symptoms. Air replacement method can reduce the incarcerated ileum successfully without unintentional injury.