PURPOSE: Stoma reversal sites are a common location for incisional hernias. We aim to evaluate fascial defects at previous stoma sites in patients with a history of colorectal cancer. METHODS: This was a retrospective cohort study from a single center. We included adult patients diagnosed with colorectal cancer, who underwent stoma reversal from 2011 to 2018 with at least one postoperative computed tomography scan. RESULTS: Of 92 patients, 40 (43%) were female, with a mean age of 58 years. Fascial defects were noted in 45 (49%) patients, with stoma-site hernias present in 24 (26%) patients. Posterior sheath defects were not associated with subsequent hernia development, and most hernias occurred within 2 years. Body mass index >30 was associated with increased risk of stoma-site hernia (odds ratio 11.9, P = 0.002), but smoking, hypertension, stoma type, pathologic stage, and chemotherapy within 90 days were not found to be significant. CONCLUSIONS: The incidence of stoma-site hernias is high. Obesity appears to be a significant risk factor for the development of these hernias and most hernias occur quickly following surgery.

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Reconstruction of full-thickness abdominal wall defect is difficult and is usually done by regional flaps or free tissue transfers. This creates additional donor site morbidity. A 20 cm × 15 cm full-thickness defect in the right iliac fossa of a woman after tumor excision was reconstructed successfully with right-sided external oblique muscle flap and abdominoplasty in a hitherto undescribed fashion. External oblique muscle flap with abdominoplasty can be used for reconstruction of abdominal wall defects with minimum morbidity and satisfactory esthetic appearance.

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BACKGROUND: The method of mesh fixation in Lichtenstein hernia repair may have an impact on the incidence of chronic groin pain (CGP) after surgery. This study aimed to compare fixation of mesh with N-butyl 2-cyanoacrylate and with sutures in open inguinal hernia repair in terms of CGP, postoperative complications, operation time, and hernia recurrence. PATIENTS AND METHODS: Adult patients with unilateral uncomplicated inguinal hernia were randomly assigned to one of two equal groups. Group I underwent mesh fixation with cyanoacrylate glue and Group II underwent mesh fixation with polypropylene sutures. The main outcome measures were pain scores at 1, 6, and 12 months of follow-up, hernia recurrence, postoperative complications, and operation time. RESULTS: Forty patients (39 male) of an average age of 48.2 years were included in the study. Patients in Group I had significantly lower pain scores at 1 week and 6 and 12 months after surgery than Group II. The operation time in Group I was significantly shorter than Group II (51.7 vs. 58.7 min, P = 0.007). No recurrence of hernia was recorded in either group at 12 months. Four patients in Group I experienced complications as compared to two patients in Group II with no significant difference (P = 0.66). CONCLUSIONS: Fixation of mesh in Lichtenstein repair with cyanoacrylate glue conferred significantly lower pain scores in the early postoperative period and at 6 and 12 months of follow-up than the classical suture fixation. No difference in the hernia recurrence and postoperative complication rates between cyanoacrylate and suture mesh fixation groups was observed.

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Retroperitoneal liposarcoma presenting as an inguinal hernia is extremely rare without specific clinical findings and laboratory abnormalities; it might mislead the surgeon for the diagnosis and the following decision. This study is to report our experience of a large retroperitoneal liposarcoma presenting as an irreducible inguinal hernia. A 56-year-old male presented with a painless irreducible right inguinal scrotal mass without other abnormal physical examination. Preoperative computed tomography scan revealed a huge retroperitoneal mass protruding through the inguinal canal. During the operation, the tumor was en bloc removed together with the involved right testis and spermatic cord. The histopathological diagnosis was dedifferentiated liposarcoma originated from the retroperitoneum. For the patients presenting painless, slow-growing and irreducible inguinal mass, a thorough preoperative workup is crucial to rule out other likely pathologies, particularly large retroperitoneal tumor.

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AIM AND PERSPECTIVE: Obturator hernia is an uncommon surgical disease, a condition predominantly affected the elderly, emaciated, female patients. Various surgical procedures have been used to treat this disease, including open and laparoscopic approaches; however, in some special conditions, the technique is still challenging. METHODS: The technique details of total extraperitoneal (TEP) repair in the treatment of obturator hernia in critical challenging conditions were described. RESULTS: The challenging obturator patients had high risk of comorbidities, including massive ascites, partial intestinal obstruction, malnutrition, and previous abdominal surgeries. All the procedures were successful; patients had no modality and recurrences and chronic pain. One patient developed wound dehiscence and healed with bedside suture. CONCLUSION: The present report justifies the feasibility of TEP obturator hernia repair in challenging conditions.

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PURPOSE: The aim of this study was to compare the effects of self-gripping mesh and prolene mesh fixed with staples on postoperative pain in patients undergoing videolaparoscopic inguinal herniorrhaphy by the transabdominal preperitoneal (TAPP) technique. MATERIALS AND METHODS: The study analyzed data from 52 patients (46 males, mean age 54.9 years, 51.9% right-sided hernias) who underwent TAPP. They were operated on consecutively and randomly in two groups of 26 patients each: Group 1 with self-gripping mesh and Group 2 with endoscopic tacker-fixed prolene mesh. Each patient's postoperative pain was recorded twice using a visual analog scale (VAS) at 6 and 24 h after the surgery. Patients were followed up to 10 months after the surgery. RESULTS: The median VAS score at 6 h for all patients was 3. The median score at 24 h was 1. The median VAS scores of the two groups were different at 6 h: In Group 1, the median score was 2, whereas in Group 2, it was 3 (P = 0.053). At 24 h, there was no difference between the groups, with a median score of 1 in both (P = 0.277). CONCLUSION: There was no statistically significant difference between groups according to postoperative pain (after 6 h and after 24 h). Studies with larger samples are needed to compare self-gripping mesh with tacker fixation in laparoscopic inguinal hernia repairs. The technique performed was safe and reproducible, with a low complication rate, early patient discharge, and good postoperative recovery.

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AIMS: The external oblique release (EOR) is a well-described technique for myofascial advancement during hernia repair. One of the reported drawbacks of an open approach is the high wound morbidity associated with this procedure. One proposed technique to reduce wound morbidity is the endoscopic EOR. The purpose of this study was to compare the outcomes of the open and endoscopic EOR. METHODS: Data from the Americas Hernia Society Quality Collaborative were queried on May 10, 2017. All patients undergoing open or endoscopic incisional hernia repair with an EOR were evaluated with comparative outcomes including hernia recurrence, quality of life, and 30-day wound complications. RESULTS: Four hundred and eighty-five patients met inclusion criteria of undergoing open or endoscopic EOR. Surgical site infections (SSIs) occurred in 6% of the patients undergoing open EOR and 14% undergoing endoscopic EOR. There were no differences in outcomes comparing open and endoscopic EOR for hernia recurrence, quality of life, or 30-day SSI rate (P > 0.05). Laparoscopic EOR had a significantly higher rate of surgical site occurrences (SSOs) compared with open EOR (P < 0.05); however, this did not result in an increase in procedure intervention for the SSOs (P > 0.05). CONCLUSIONS: Equivalent outcomes were achieved using the open or endoscopic EOR technique in open repair of incisional hernia. Both techniques offer good outcomes and are important adjuncts in the repair of complex incisional hernias.

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BACKGROUND: A new original laparoscopic operative technique was used to suture paraesophageal hernia (PEH) with the strips of mesh. METHODS: The Mercilen (Mercilen^TM) mesh suture was used to close large hiatal hernia. The strips of mesh, instead of normal thread, were applied to close the gap between diaphragm's crura in four patients with hernia defect more than 5 cm. Mesh suture were tighten as a simple laparoscopic intracorporeal knot. The surgical technique and surgical outcomes are presented. RESULTS: Four patients underwent a laparoscopic PEH suturing with Mercilen strips of mesh. We recorded no recurrence or dysphagia at 6 and 12 months follow-up. CONCLUSIONS: Mesh-sutured repairs of diaphragm's hernia support the concepts of force distribution and resistance to suture pull through. The new original technique avoids using the sheet of mesh and enables to reduce the amount of dangerous complications connected with mesh and its fixation. Mesh-sutured closures of hiatal hernias seem to be safe and effective in tension closure of large hiatal defects. Further investigations are needed to evaluate the results.

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