BACKGROUND: Complex inguinal hernia repairs (IHR) have been defined based on previous relative contraindications for their minimally invasive repair. In this study, we aim to describe outcomes after complex robotic IHR (rIHR) and the associated challenges. MATERIALS AND METHODS: A retrospective analysis was performed of patients who underwent complex rIHR in an elective setting between 2013 and 2020. Patients included into the study were those with a recurrence after posterior IHR, history of prostatectomy, large scrotal hernia, or irreducible hernia after anesthesia induction (incarcerated). Any patients with concomitant procedures or emergent repairs were excluded. Complications were assessed with the Clavien-Dindo (CD) and Comprehensive Complication Index (CCI^®) scoring systems. RESULTS: A total of 88 patients were identified. Accounting for bilateral IHRs, the total number of complex rIHRs was 110. Although there were no conversions to an open approach, one patient required a hybrid procedure. The average length of stay (LOS) and follow-up period were 0.2 days and 33 months, respectively. A total of four major complications (CD-Grade III/IV) were observed. These included three seromas requiring drainage, one of which necessitated readmission, and 1 postoperative intensive care unit admission. No chronic pain or recurrence was observed. The CCI^® scores were ranged between 0 and 42.4. In a univariate analysis, no statistically significant variable was found between patients with and without postoperative complications. CONCLUSION: Complex rIHR may be performed with minimal LOS, complications, and adverse long-term sequelae. A patient-tailored approach and adequate surgical training and knowledge are essential to attempt these procedures.

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Three cases of giant diaphragmatic hernia were reported in our study. Computed tomography (CT) scan showed multiple organ migration into the chest. The clinical presentation included bowel obstruction, dyspnea, or chest pain. The operations were performed initially by laparoscopy to reduce the hernia content. The defect was closed with a nonabsorbable suture and was reinforced with a synthetic mesh. All patients recovered well without any serious complications. The symptom improved significantly after surgery. Postoperative CT scan showed normal anatomy. There was no evidence of recurrence within 6 months after the operation.

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BACKGROUND: Minimally invasive techniques, such as robotic inguinal hernia repair (RIHR), have potential benefits for patients in various clinical scenarios. However, the value of RIHR in older age groups has not yet been established, as increased age may place patients at a higher risk of postoperative morbidity and mortality. The aim of the study is to evaluate the feasibility of RIHR in patients ≥80 years old. MATERIALS AND METHODS: Among patients who underwent RIHR between February 2013 and August 2020, patients ≥80 years old were included. Preoperative, intraoperative, and postoperative variables were reviewed. Postoperative complications were assessed according to the Clavien–Dindo (CD) classification and the Comprehensive Complication Index (CCI^®) scoring system. Univariate and multivariate analyses were used to identify the risk factors for patients with complications. RESULTS: A total of 51 patients were included in the study. The average operative time was 58.7 min. The average length of stay was 0.5 days. Urinary retention and seroma were the commonly encountered complications (CD Grades 1 and 2). A procedural intervention and overnight intensive care unit follow-up were needed in two patients for each (CD Grade-3a and-4a). The maximum morbidity CCI score was 43.3. There was no hernia recurrence or reoperation during the mean follow-up period of 42 months. No statistically significant difference was found between patients with and without complications. CONCLUSION: This is the first study to demonstrate the feasibility of RIHR in patients ≥ 80-year-old. Although advanced age is associated with increased comorbidities and physiological irregularities, RIHR may be performed with short operative time, length of hospital stay, and low rate of postoperative complications in these patients.

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BACKGROUND: An issue that has become apparent in using Progrip in ventral hernias is the restriction in the available sizes. The area of dissection for mesh placement can be variable. This report is based on a subgroup analysis of the cases in which a combination of Progrip meshes was used. MATERIALS AND METHODS: This was a retrospective review of our prospective database. Cases were identified of Progrip mesh used in ventral hernia repair from 2016 to 2020. Subgroup analysis was performed of cases which Progrip meshes were combined. Telephone follow-up was done in September 2020. RESULTS: Sixty-eight cases were identified. The mean age of patients was 63.13 (26–87). Thirty-three were female. The mean American Society of Anesthesiologists grade was 2 (range: 1–4). The procedure time was 164.35 min (45–490). The mean defect size was 7.23 (2–25 cm). The mean mesh size was a 20 cm × 15 cm mesh. Follow-up was achieved in 63/68 cases. Follow-up ranged from 1 to 4 years. Recurrence was found in 4 (6%). Nine had ongoing abdominal pain. Fifty-nine (93.65%) returned to normal activity. Three returned to theater for wound dehiscence and seromas. Twelve cases required 2 meshes to be combined. All cases involved a mesh size of 30 cm × 30 cm. The mean age was 64 (44–78 years). Six were male. The mean defect size was 9 cm. The operative time was 235 min (120–320). The mean postoperative stay was 5 days (4–60). Three cases required component separation (2 anterior component separation and 1 posterior component separation). There were no recurrences or further surgery. One had ongoing pain. Nine cases had full return to activity. CONCLUSION: Combining Progrip meshes in ventral hernia is an acceptable practice. Mesh may be sutured together or overlapped with equivalent results. Extending the product range to a 30 cm × 30 cm mesh would obviate the need for mesh overlap in our practice.

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BACKGROUND: Spiegel hernia (SH) is a rare type of primary ventral hernia. Surgery has been performed by open or minimally invasive means with no current gold standard due to a shortage of current evidence. We advocate for the transabdominal preperitoneal approach (TAPP) for its cost effective outcome. We present a series of 3 cases operated using the TAPP approach in the past 5 years, carried out by a single surgeon, and a review of the literature. METHODS: A retrospective analysis of a case series of 3 patients' operations between January 2015 and June 2020. TAPP repair was found to be a safe and effective anatomical repair with all the added benefits of laparoscopic surgery such as reduced hospital stay, quicker recovery, and fewer surgical site occurrences. CONCLUSIONS: Several operative techniques have been described to repair Spiegel hernia but in our particular practice we felt laparoscopic TAPP approach was the safest and with a more predictable outcome due to the authors familiarity with it.

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Inguinal hernia repair is one of the most common procedures done in the surgical discipline. The hernia sac commonly contains the omentum and small bowel as contents, but structures such as cecum, appendix, urinary bladder, Fallopian tubes, and ovary have been reported. We report an extremely rare presentation in our emergency of a right indirect irreducible inguinal hernia containing hemorrhagic ovarian cyst in an adolescent female. The inguinal region was explored, the cyst was excised, the contents were reduced, and a polypropylene mesh was laid. The preservation of reproductive organs and fertility with prompt surgical intervention is extremely important in such cases of inguinal hernia.

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Abdominal intercostal hernia (AIH) is a rare disease, may occur secondary to trauma or previous surgery, recently. There is no consensus on the best treatment of AIH. The aim of the present study is to report the repair of AIH in a male patient. The AIH in a 56-year-old male was repaired with the laparoscopic procedure; the patient characteristics and repair details were described. The computed tomography scan revealed an intercostal hernia containing omentum between the 9th rib and 10th rib. The laparoscopic repair with synthetic mesh was successfully performed, and the patients were absent of symptoms at 8-month follow-up. There is no consensus on the best treatment of AIH, tension-free prosthetic repair is recommended, and the laparoscopic approach has several advantages for AIH repair.

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PURPOSE: The purpose of this study is to compare the complication rates and recurrence rates of two types of incisional hernia repairs by a single surgeon. MATERIALS AND METHODS: The medical records of all patients undergoing incisional hernia repair by the senior author were reviewed. Patients who underwent the biologic mesh underlay/synthetic mesh overlay (BUSO) “sandwich” repair and separation of components with retrorectus mesh (SOCRM) repair were assessed. Only Grades I, II, and III incisional hernias were included. The two groups were matched for age, sex, hernia size, and body mass index. The groups were compared for any 30-day complication, any adverse event in the follow-up period, and any recurrence as determined by physical examination or imaging. RESULTS: Fifty-six patients were successfully matched. There were no differences in the type of suture used, skin closure, dressing, or drain use. There was no difference in 30-day postoperative complications or discharge status. The BUSO group had a 29% recurrence rate, compared to 4% in the SOCRM group (P = 0.0248). However, the follow-up was longer in the BUSO group. CONCLUSIONS: The results of this study suggest that for incisional hernias not amenable to primary closure, SOCRM repair may be superior to even a two-mesh layer bridging repair.

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