BACKGROUND: Over the past two decades, minimally invasive techniques for ventral hernia repair have evolved significantly. Among these, the enhanced view totally extraperitoneal approach has gained popularity in recent years. This study presents our early experience with the enhanced-view totally extraperitoneal (eTEP) technique for ventral hernia repairs.

MATERIALS AND METHODS: This prospective observational study was conducted from January 2022 to April 2025. A total of 72 patients who underwent eTEP repair for midline ventral hernias were included. Patient demographics, hernia characteristics, operative details, and postoperative outcomes were also recorded. The early outcomes in terms of complications, postoperative pain, recurrence, and cosmetic satisfaction were analyzed.

RESULTS: eTEP was successfully performed in 68 (94.4%) of 72 patients in whom eTEP was attempted, while in four patients, it was converted to an open or hybrid procedure. Seroma was observed in 5.9% of patients at the first week and month, and in 2.9% of patients at 3 months of follow-up. The mean visual analog scale scores showed progressive improvement, and cosmetic outcomes were excellent at 3 months (mean Likert score: 4.35/5). Two patients had recurrence, while there were no cases of surgical site infection or posterior rectus sheath rupture.

CONCLUSION: The eTEP approach is feasible, safe, and cost-efficient for ventral hernia repair. Careful patient selection and proper surgical techniques are associated with favorable early outcomes, minimal complications, and high patient satisfaction. However, comparative trials and further studies with long-term follow-up are required to confirm its long-term efficacy.

BACKGROUND: To investigate the effect of laparoscopic herniorrhaphy on the treatment of unilateral Gilbert type-III inguinal hernia.

METHODS: This study retrospectively reviewed medical records of 325 individuals who underwent minimally invasive laparoscopic surgery for unilateral Gilbert type-III inguinal hernias at the Ninth People’s Hospital affiliated with Shanghai Jiaotong University Medical College, with data collection occurring between January 2021 and May 2024. The cohort was stratified into two surgical groups: Partial resection (n = 180) receiving transection procedures versus radical resection (n = 145) undergoing complete sac dissection, determined by intraoperative decision-making. The ages, body mass index values, operation modes, operation times, intraoperative bleeding levels, postoperative pain scores, postoperative hospital stays, postoperative seroma rates, postoperative chronic pain levels, postoperative hematoma rates, incision infection rates, and hernia recurrence rates of the patients in the two groups were analyzed and compared.

RESULTS: The transection group demonstrated a marked reduction in postoperative seroma occurrence relative to the complete dissection cohort, with statistical significance confirmed (P < 0.05). There were no significant differences between the two groups in intraoperative bleeding, operation times, postoperative hospital stays, postoperative pain scores, postoperative chronic pain levels, postoperative hematoma rates, or incision infection rates (P > 0.05). Continuous surveillance spanning 12 months revealed equivalent therapeutic durability across both treatment arms, with no hernia reappearance detected.

CONCLUSION: For patients requiring laparoscopic repair of unilateral Gilbert type-III inguinal hernias, intraoperative sac transection is an effective strategy, particularly in cases where the hernia sac is long and complete dissection is difficult, as it may be the preferable option and can significantly reduce the risk of postoperative seroma formation.

BACKGROUND: Intestinal stomas remain an essential aspect of surgical practice despite medical technology advances. This study aimed to evaluate the early postoperative morbidity associated with diversion stomas in both elective and emergency settings.

MATERIALS AND METHODS: A prospective observational study was conducted over 3 years (June 2020 to May 2023) in the Department of General and Minimal Invasive Surgery. All patients aged >18 years undergoing intestinal stoma formation for benign and malignant conditions were included. Early postoperative complications were recorded and analyzed.

RESULTS: A total of 148 patients were included, with 102 (69%) males. The most common procedure was loop ileostomy (105, 71%). Early postoperative complications occurred in 101 (68%) patients, with skin excoriation (53, 36%), mucosal necrosis (31, 21%), and retraction (21, 14%) being the most frequent. Multivariate logistic regression analysis identified emergency surgery (odds ratio [OR]: 2.6, 95% confidence interval [CI]: 1.4-4.9, P = 0.002), low serum albumin (<3 g/dL) (OR: 3.1, 95% CI: 1.5-6.3, P = 0.001), and ileostomy formation (OR: 2.8, 95% CI: 1.3-5.7, P = 0.003) as independent predictors of early postoperative complications. Trainee-led surgeries (OR: 2.4, 95% CI: 1.2-4.8, P = 0.009) and malignancy (OR: 2.2, 95% CI: 1.1-4.5, P = 0.025) were also significantly associated with increased morbidity.

CONCLUSION: Early postoperative complications following stoma formation remain significant. Ileostomies were associated with higher complication rates than colostomies. Patient factors, surgical expertise, and operative conditions significantly influence outcomes. The development of specialized stoma care teams and early involvement of enterostomal therapists may help in early detection and management of complications. Regular audit of outcomes and complications can identify areas for improvement in surgical technique and perioperative care.

BACKGROUND: Abdominal surgery is a common procedure for treating infections, obstructions, tumors, or inflammatory bowel disease. Postoperative complications can include pain, muscle weakness, incisional hernias, and reduced quality of life (QOL). This study assessed the effects of respiratory exercises and abdominal strength training on pain and QOL in 183 patients (aged 18-65) after open abdominal surgery.

MATERIALS AND METHODS: Patients were divided into two groups: one received respiratory exercises plus abdominal strength training, while the other did only respiratory exercises (3×/week for 4 weeks). Pain (visual analog scale), abdominal strength (pressure biofeedback), and QOL (WHOQOL) were measured at baseline, 15 days, and one month post-surgery.

RESULTS: Results showed significant within-group improvements in pain, strength, and QOL (P < 0.001). However, between-group comparisons found no significant differences in pain or QOL (P > 0.05), except for greater abdominal strength improvement in the intervention group (P < 0.001).

CONCLUSION: Combining respiratory exercises with abdominal strength training enhances muscle recovery post-surgery but does not significantly reduce pain compared to respiratory exercises alone. Integrating these exercises into rehabilitation may improve strength and overall recovery.

Radical surgery for abdominal wall incisional hernia with loss of domain (LOD) has a high incidence of postoperative complications and recurrence, and there is no consistent consensus on the surgical approach. This article reports the surgical management of an incisional hernia with LOD complicated by morbid obesity. A 70-year-old female with a body mass index of 40.4 kg/m² was admitted to our hospital owing to severe abdominal pain. She had an adult-head-sized incisional hernia in the lower abdomen and an incarcerated intestine extending from the ileum to the transverse and sigmoid colons in the hernial sac. After 1 month of diet and exercise therapy prior to surgery, elective herniorrhaphy was performed. Intraperitoneal onlay mesh repair was used, and postoperative intensive care was provided to manage subsequent abdominal compartment syndrome (ACS). She was discharged on postoperative day 22 without morbidity. Three years postoperatively, no recurrence was observed. Careful perioperative strategies of surgical procedure and intensive management to prevent the progression of ACS are essential for optimal outcomes in LOD hernia complicated by morbid obesity.

We present the case of a 50-year-old male patient with a subxiphoidal painful induration six months after endoscopic retromuscular mesh repair by means of an endoscopic mini- or less-open sublay operation. Investigations revealed a heterotopic ossification (HO) with dimensions 46 mm×85 mm deep to the anterior fascia. After the failure of conservative treatment, a surgical excision was performed. The postoperative course was uneventful. In this article, we discuss the existing literature on HOs of the abdominal wall and provide an overview of therapeutic options.

Iliac crest bone grafts are a cornerstone in reconstructive and orthopedic surgery due to their superior biological properties. Yet they carry a risk of rare complications, such as herniation at the donor site, with an incidence of 5%-9%. This report highlights an uncommon case of herniation through a bone graft donor site in a 67-year-old male, focusing on its clinical and surgical management. The patient presented with progressively enlarging, reducible lumbar swelling following two iliac crest bone grafts performed during revision surgeries for total hip replacement complications. Imaging revealed a posterior abdominal wall defect with herniation of abdominal contents. The surgical intervention involved an open hernioplasty with mesh repair, leading to an uneventful recovery and no recurrence. This case underscores the importance of meticulous surgical technique and early recognition of donor site complications. Tension-free hernioplasty is effective in managing such cases, while preventive measures, including preserving the iliac crest structure and considering alternative grafting materials, may mitigate risk.

We present a unique case of a Spigelian hernia and its laparoscopic pre-peritoneal mesh herniorrhaphy. A Spigelian hernia is the only known interparietal hernia of the abdominal wall and its clinical diagnosis and management remain elusive. Various attempts at surgical repair have included open, laparoscopic and robotic techniques. The mesh placement has varied between an on lay, underlay, or pre-peritoneal fixation. Current hernia guidelines remain nebulous as to the correct technique and mesh placement. Our case remains unique because the peritoneum was quite emaciated and could not be used for a proper mesh reperitonealization. We, therefore, used the hernia sac to cover our non-absorbable nylon mesh. We believe this adds to the rarity of this case report. The patient`s recovery was uneventful. She has no hernia recurrence at six months post-surgical herniorrhaphy. A surgical follow-up of at least five years is required to determine the feasibility of our technique.

Mesh infections have been described as “a surgeon’s biggest nightmare.” Infection with non-tuberculous mycobacteria (NTM) is often associated with the presence of a foreign substance, such as a catheter or mesh. Poorly sterilized laparoscopic instruments can also serve as a source of infection with NTM. Here, we report three cases of hernial mesh infections that followed laparoscopic surgery, caused by Mycolicibacterium fortuitum. NTM isolated in culture, from the samples were identified using 16s rRNA sequencing or Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI TOF MS). The patients presented with slowly progressive swelling at the surgical site over 1-2 months. The lesions healed following extensive surgical debridement and long-term antibiotics: fluoroquinolone with doxycycline/trimethoprim-sulfamethoxazole (6-10 months). Accurate diagnosis and prompt aggressive treatment are needed to cure NTM infections and prevent the development of complications, that can lead to prolonged recovery, multiple hospitalizations, and numerous antibiotic courses.

INTRODUCTION: The development of post-operative abdominal compartment syndrome is one of the major risks associated with the repair of massive parastomal hernias. Minimizing the occurrence of such post-operative complications is imperative but challenging. Plastic surgery techniques in complex hernia repairs can offer significant advantages in such complex surgeries.

CASE PRESENTATION: We present a case of a 26-year-old, obese, non-smoking male with a massive left-sided parastomal hernia extending below the inguinal region. The hernia was confirmed on a pre-operative computed tomography (CT) and seen to include most of the remaining bowel area. Pre-operative optimization of the abdominal wall was performed by ultrasound-guided botulinum toxin injections to all three abdominal wall muscles bilaterally. The surgery was performed in three steps involving the reduction of the hernia, abdominal wall component separation, closure of the abdominal wall with dual mesh placement, de-epithelization and folding of excess abdominal skin, and repositioning of the stoma. Post-operatively, the patient was followed-up for pain, ventilatory problems, and increasing abdominal pressures.

CONCLUSION: Massive parastomal hernia repair avoiding post-operative abdominal compartment syndrome can be achieved by application of a multi-dimensional surgical approach. The use of pre-operative Botox represents an innovative approach that may reduce the risk of post-operative complications.

Large ventral hernias, often with significant defects and loss of domain, present a challenge even for experienced surgeons. Traditionally, surgical management of large incisional hernias involves tension-free mesh repair, either via open or laparoscopic methods. Bridging these defects has involved artificial prostheses. However, failure to close the midline can lead to adverse effects on posture, respiration, micturition, defecation, and overall biomechanical function, severely affecting the patient’s quality of life. Albanese et al. first proposed a model for abdominal wall component separation in 1951, which was later refined by Ramirez et al. in 1990 through a cadaveric study. This technique offers a novel approach to closing midline defects by utilizing native, vascularized tissue—either alone or in combination with prosthetic materials. Over time, this technique has evolved, incorporating various modifications, including anterior and posterior component separation. Component separation has become more widely used, with ongoing modifications aimed at addressing the key challenges of the technique. Hence, here we present a case of a 42-year-old male with a large ventral hernia at the site of midline abdominal surgery performed a decade earlier. The hernia was successfully repaired using a combination of anterior and posterior (dual) component separation techniques, complemented by mesh reinforcement, resulting in a satisfactory outcome and restoring the patient’s functional capacity and quality of life. In conclusion, for complex cases, dual component separation techniques may be used to facilitate defect closure, ensuring abdominal wall integrity and promoting recovery while minimizing complications and recurrence.

Ventriculoperitoneal (VP) shunting is the gold-standard treatment for hydrocephalus; however, it can lead to numerous complications. VP shunt malfunction from occlusion secondary to a ventral wall hernia is rare and poorly described. Herein, we present the case of a VP shunt occlusion complicated by a strangulated ventral wall hernia. A 39-year-old male with a past medical history of hydrocephalus and multiple previous abdominal surgeries presented with headache, abdominal pain, and erythema along with a non-reducible ventral hernia. Computed tomography (CT) scan of the head demonstrated interval ventriculomegaly when compared to prior imaging of the head. CT abdominal scan revealed a strangulated ventral hernia containing omental fat as well as a section of the peritoneal portion of the patient’s VP shunt. The patient would ultimately undergo peritoneal catheter re-positioning and ventral hernia repair without mesh placement. Despite utilizing an open technique to repair the patient’s hernia, the VP shunt was successfully re-positioned, and the feared complication of a shunt infection was nullified.

Femoral hernia (FH) is a rare condition in children, characterized by the protrusion of abdominal organs through the femoral canal. The localization of FHs is classified into typical and atypical variants. This report presents two clinical cases of FH treatment in children. In the first case, following an examination and identification of a typical FH in an 8-year-old boy, open FH repair using Lockwood’s technique was performed. In the second case, an atypical FH (Laugier’s hernia) was diagnosed in a 7-year-old girl during diagnostic laparoscopy. The child underwent video-assisted percutaneous extraperitoneal FH repair. The article discusses the challenges of the differential diagnosis of FHs and the methods of their treatment.

This case is of a 63-year-old male with a history of renal transplant for IgA nephropathy (June 1, 2009) who presented to the renal unit with an acute kidney injury related to an unusual complication-an indirect ipsilateral inguinal hernia causing obstructive hydroureteronephrosis of the transplanted kidney. Successful open surgical repair resolved the obstruction and restored renal function. This is a case demonstrating the importance of timely intervention in high-risk hernias while balancing the need for specialist input in complicated cases.

Hernias present a significant surgical challenge, with the extended totally extraperitoneal (eTEP) approach, modified with the Rives-Stoppa (RS) technique, emerging as a preferred minimally invasive strategy for incisional hernia repair. This technique creates a retrorectus space without breaching the peritoneal cavity, allowing laparoscopic defect closure and extensive mesh placement. Despite its advantages, including lower recurrence rates and reduced morbidity, recurrences have been reported. We present a case of a 52-year-old female with a recurrent ventral hernia following eTEP RS repair, managed with open onlay meshplasty. Contributory factors such as obesity, surgical technique, and mesh coverage were considered. Minimally invasive procedures like eTEP RS or endoscopic mini or less open sublay or intraperitoneal onlay mesh remain the gold standard for ventral hernia repair, and recurrence management requires a measured approach. A patient-centric approach, thorough evaluation, and optimization of surgical techniques are essential to minimize recurrence. This case highlights the need for further studies to establish best practices for recurrent hernias post-eTEP RS.