AIM: Cirrhotic patients with ascites have a high incidence of abdominal wall hernias and carry an elevated perioperative morbidity and mortality. The optimal surgical treatment as well as timing of inguinal hernia repair in this situation remains controversial. In the present study, we aim to address the safe and risk profile of inguinal hernia repair in cirrhotic patients with ascites. MATERIALS AND METHODS: Major databases (PubMed, Embase, Springer, and Cochrane Library) were searched, and all studies published through October 2019 were identified, using the keywords: “inguinal hernia,” “liver cirrhosis,” “ascites,” “hernia repair,” including various combinations of the terms, all relevant articles and reference lists in these original studies were also obtained from the above databases. RESULTS: Nine articles were identified on inguinal hernia repair in cirrhotic patients with ascites. Various anesthetic methods and repair techniques were used to repair inguinal hernia in this situation. The frequent postoperative complications were minor-wound complications, with an overall incidence of 15.4% in elective surgery, which could be managed with conservative treatment. While, emergent surgery was associated with increased wound complications. The recurrence rate was 2.0%, the average of postoperative 30-day mortality was 1.0%, and none of the death was attributable to the complications of inguinal hernia repair and their treatment. CONCLUSION: Elective inguinal hernia repair in cirrhotic ascites is safe and should be advocated. Emergent surgery is associated with increased wound complications. Although the data are insufficient to support a specific technique, mesh repair has advantages with regard to long-term recurrence rate.

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INTRODUCTION: Transversus abdominis release (TAR) is the new revolution in hernia surgery and hernia surgeons are passionately doing it all over the world. With the increase in the popularity of TAR technique, there seems a decrease in anterior component separation technique (ACST) popularity. ACST despite gone modification such as endoscopic and perforator preserving method is seen as an inferior procedure to TAR. Is TAR better than ACST? What are its theoretical limitations? We have done a literature review to compare the postoperative outcomes and technicality of open ACST and open TAR procedure. METHODS: We performed a search in the database of PubMed, EMBASE, and Cochrane library for articles that have compared ACST with TAR procedure for postoperative outcomes and technical superiority. The search was limited to human studies and in the English language with cadaveric studies included. RESULTS: We found seven studies that have compared ACST and TAR for various outcomes. They are three systemic reviews with meta-analysis, one multicentric prospective randomized controlled trial, one prospective study, and two cadaveric studies. They have compared the surgical site infection and surgical site occurrence rates, recurrence rate, quality of life (QOL), and extent of mobilization of the rectus muscle. Most of the studies found no significant difference between ACST and TAR; however, the overall quality of the studies may be limited. CONCLUSION: Open ACST is comparable to open TAR procedure and has equally acceptable outcomes. In ACST, it seems to be essential to preserve the perforator vessels; however, altogether further studies are needed to gain more clarity in the daily decision-making process in the repair of complex ventral hernias.

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PURPOSE: The surgical technique for inguinal hernia repair is well established. However, the safety of this procedure in young children still remains under debate because of risks of general anesthesia in young children. We assessed the indications for inguinal hernia repair in neonates and infants. PATIENTS AND METHODS: Between 2007 and 2017, laparoscopic hernia repair was performed in 408 patients at our institution. We reviewed the data from their medical records, including their sex, age at surgery, and incidence of asymptomatic patent processus vaginalis (PPV) during the surgery. RESULTS: The incidence of asymptomatic contralateral PPV in the female neonates/infants in whom the original hernia was on the left side was 75% and higher as compared to the frequency in other subpopulations. The incidence of bilateral inguinal hernia repair in female neonates/infants was 68.8% and higher as compared to that in other subpopulations. CONCLUSION: The incidence of an asymptomatic contralateral PPV and of a bilateral inguinal hernia repair was higher in female neonates/infants as compared to the corresponding frequencies in other subpopulations. In some infants of this group, the PPV on the contralateral side could potentially close as the children grew older. Therefore, girls with inguinal hernia under 1 year of age should be treated by elective surgery after they become at least 1 year old.

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Spigelian hernia is a rare entity, with an incidence of approximately 2% of all hernias. Adriann Spieghel first described it in 1645. It is a congenital or acquired defect in the Spigelian aponeurosis - an area between the semilunar line and lateral border of the rectus muscle. It is challenging to diagnose Spigelian hernia preoperatively as the sac is usually located between the muscle layers of the abdominal wall. Computed tomography or ultrasound of the abdomen is often the preferred diagnostic modality for confirming the diagnosis. Surgery should be performed immediately after the diagnosis, either by open or laparoscopic repair because the rate of incarceration is very high in the case of Spigelian hernia. We report a female patient presenting with pain in the right lower abdomen and a palpable swelling, and later diagnosed as a case of Spigelian hernia. The patient underwent open-mesh repair and recovered well without any complication or recurrence at a 6-month follow-up.

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Tension-free vaginal tape (TVT) is often placed for stress urinary incontinence. A number of gastrointestinal complications following TVT placement have been previously described. Internal herniation through this pelvic mesh, however, has not yet been documented. Herein, we describe the presenting symptoms and operative management strategies of this rare complication. Two patients who presented to our institution were ultimately found to have internal herniation through TVT mesh and managed differently. Both patients presented complaining of unilateral sharp flank pain and were initially worked up for renal colic; computed tomography of the kidney, ureters, and bladder raised suspicion for small bowel obstruction. Both were taken to the theater. In one case, exploratory laparotomy revealed necrotic strangulated small bowel herniating through a defect in the TVT mesh. We performed small bowel resection and mesh explantation with postoperative return of urinary incontinence. In the other case, the hernia was reduced laparoscopically revealing noninfracted small bowel. The mesh defect was obliterated with interrupted sutures. Flank pain and symptoms of bowel obstruction with a history of TVT placement should prompt surgeons to consider internal herniation. The extent of ischemia and the need for small bowel resection are factors that should be considered when deciding whether to manage open or laparoscopically and whether to preserve or remove the mesh.

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Inguinal hernia repair is one of the most common surgeries performed in the department of general surgery throughout the world. However, the presence of a vermiform appendix in the hernial sac, also known as Amyand's hernia, along with a perforated cecum is very rare. We report the case of an elderly male presenting to the surgery emergency with a strangulated, large, right-sided inguinal hernia containing perforated cecum and vermiform appendix as contents in the sac. Resection of the ileocecal segment and side-to-side ileocolic anastomosis of the bowel was performed. Anatomical repair of the hernia was done without the use of mesh.

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BACKGROUND AND AIMS: The eventration involves a highly variable surgical entity with a wide range of possible surgical techniques for its repair, without having found a “Gold Standard” technique. With these animal study, we propose a possible and useful surgical procedure for hernia repair. MATERIALS AND METHODS: We present a modified technique of the anterior component separation (ACS) based on a release of the external oblique muscle from a posterior anatomical approach, accessing the space from the retrofascial space of the anterior sheath of the rectus abdominis muscle. The technique was performed in an experimental animal model with pigs of the “Large White” breed of 20-25 kg since the pig is a good representative model of human anatomy and its abdominal wall. RESULTS: The technique was performed in an experimental animal model with pigs of the “Large White” breed. The procedure through the anterior retrofascial space of the rectus abdominal muscle was easily done, allowing the access to the inter-oblique space and facilitating the release of the external oblique muscle. CONCLUSION: Waiting for its clinical application, the ACS by its external retrofascial space approach could be an interesting surgical resource for incisional hernia repair.

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The iliac crest is the most common donor site for autologous bone grafting. Complications can vary from simple hematoma to significant injuries to the iliac vessels, nerves, or ureter as well as pelvic instability; the occurrence of incisional hernia is rare.

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