BACKGROUND: Literature on a potential relationship between surgeon case volume and intra- or postoperative complications after ventral hernia repair remains scarce.
METHODS: Patients who underwent ventral hernia repair between 2011 and 2023 were selected from the prospectively maintained French Hernia-Club Registry. Outcome variables were: intraoperative events, postoperative general complications, surgical site occurrences, surgical site infections, length of intensive care unit (ICU), and patient-reported scar bulging during follow-up. Surgeons\' annual case volume was categorized as 1-5, 6-50, 51-100, 101-125, and > 125 cases, and its association with outcome volume was evaluated using uni- and multivariable analyses.
RESULTS: Over the study period, 199 titular or temporary members registered 15,332 ventral hernia repairs, including 7869 primary, 6173 incisional, and 212 parastomal hernia repairs. In univariate analysis, surgeons\' annual case volume was significantly related with all the postoperative studied outcomes. After multivariate regression analysis, annual case volume remained significantly associated with intra-operative complications, postoperative general complications and length of ICU stay. A primary repair was independently associated with fewer intra- and post-operative complications.
CONCLUSIONS: In the present multivariable analysis of a large registry on ventral hernia repairs, higher surgeon annual case volume was significantly related with fewer postoperative general complications and a shorter length of stay, but not with fewer surgical site occurrences, nor with less patient-reported scar bulging. Factors in the surgeons\' case mix such as the type of hernia have significant impact on complication rates.

Cholecystic parastomal herniation is a rare condition that has only been documented 16 times in the literature. We present a case report and literature review of cholecystic parastomal herniation managed with diagnostic laparoscopy without cholecystectomy or hernia repair. Furthermore, we assess the demographics, presentation, stoma types, and management of cholecystic parastomal hernias across all documented cases.

BACKGROUND: In recent years, mesh has become a standard repair method for parastomal hernia surgery due to its low recurrence rate and low postoperative pain. However, using mesh to repair parastomal hernias also carries potential dangers. One of these dangers is mesh erosion, a rare but serious complication following hernia surgery, particularly parastomal hernia surgery, and has attracted the attention of surgeons in recent years.
METHODS: Herein, we report the case of a 67-year-old woman with mesh erosion after parastomal hernia surgery. The patient, who underwent parastomal hernia repair surgery 3 years prior, presented to the surgery clinic with a complaint of chronic abdominal pain upon resuming defecation through the anus. Three months later, a portion of the mesh was excreted from the patient\'s anus and was removed by a doctor. Imaging revealed that the patient\'s colon had formed a t-branch tube structure, which was formed by the mesh erosion. The surgery reconstructed the structure of the colon and eliminated potential bowel perforation.
CONCLUSIONS: Surgeons should consider mesh erosion since it has an insidious development and is difficult to diagnose at the early stage.

A 75-year-old woman underwent sigmoid colon resection and transverse colostomy for perforation of the diverticulum of the sigmoid colon at 70 years of age at another hospital. She was referred to our hospital with complaints of abdominal discomfort 3 months prior to presentation. Abdominal computed tomography revealed a parastomal hernia (PSH). We performed laparoscopic repair using the Sugarbaker approach with a Symbotex Composite Mesh™ and laparoscopic adhesive intestinal repair. The patient\'s post-operative course was unremarkable, and she was transferred to the Department of Internal Medicine after 10 days. There was no recurrence 6 months after surgery. Tension-free surgery using a mesh has been reported to be effective in preventing the recurrence of PSH. We performed a laparoscopic modified Sugarbaker mesh method using the Symbotex Composite Mesh™ with collagen film to repair an abdominal hernia.

A 79-year-old man underwent sigmoid colostomy about 50 years previously and sought surgical reconstruction of the colostomy. He presented with 30 cm of prolapsed stoma accompanying an intrastomal hernia which contained ileum. The prolapsed stoma which led to the intrastomal hernia was made from the distal sigmoid colon, and the everted colon wall constituted the hernia sac. A computed tomography scan was useful to demonstrate the contents of the intrastomal hernia. Reconstruction with relocation of the colostomy was considered appropriate for the presented patient. The thickened and stretched distal sigmoid colon was resected with the stoma. A new end colostomy using the descending colon was seated in the left upper quadrant. The lateral pararectus muscles which formed the 8-cm hernia orifice were closed using tension-reducing incisions. The postoperative course was uneventful.

Parastomal hernia (PH) is an abnormal herniation of tissue or intra-abdominal organ through the fascial defect created at the ostomy site. It is a common complication of stoma creation and usually contains bowel, intra-abdominal fat, or omentum. Herniation of a fixed organ like the stomach is very rare and can lead to significant morbidity and mortality. Here, we present a case of an 83-year-old female with a history of sigmoidectomy and subsequent development of parastomal hernia who presented with abdominal pain, nausea, and vomiting and was found to have stomach herniation into the parastomal hernia sac. She was managed conservatively with intravenous (IV) fluids, electrolyte replacement, and decompression with a nasogastric (NG) tube. In this article, we have discussed the incidence, clinical presentation, diagnosis, and management of gastric involvement in the parastomal hernia that can help clinicians identify and treat it early at the time of presentation.

Parastomal hernia is the most common complication after surgical procedures that lead to the creation of a stoma. Most commonly in the hernia sac, there is omentum or small intestine or colon. The presence of the stomach as hernia\'s content is a rare event. Herein, we present the case of a 68-year-old woman, who was hospitalized in our surgical unit with incomplete gastric obstruction due to herniation of the stomach into a parastomal hernia and who was managed conservatively.

OBJECTIVE: The closure of a stoma is frequently associated with an acceptable morbidity and mortality. One of the most frequent complications is incisional hernia at the stoma site, which occurs in 20%-40% of cases, higher than incisions in other parts of the abdomen. The objective of this study was to identify the risk factors associated with the presentation of incisional hernia after stoma closure, this in order to select patients who are candidates for prophylactic mesh placement during closure.
METHODS: An unpaired case-control study was conducted. This study involved 164 patients who underwent a stoma closure between January 2014 and December 2019. Associated factors for the development of incisional hernia at the site of the stoma after closure were identified, for which it was performed a logistic regression analysis.
RESULTS: 41 cases and 123 controls were analyzed, with a mean follow-up of 35.21 ± 18.42 months, the mean age for performing the stoma closure was 65.28 ± 14.07 years, the most frequent cause for performing the stoma was malignant disease (65.85%). Risk factor for the development of incisional hernia at the stoma site after its closure was identified as a history of parastomal hernia (OR 5.90, CI95% 1.97-17.68).
CONCLUSIONS: The use of prophylactic mesh at stoma closure should be considered in patients with a history of parastomal hernia since these patients present a significantly higher risk of developing a hernia.

An intestinal knot is a rare cause of intestinal obstruction. We report a rare case of strangulating bowel obstruction due to a small intestinal knot. A 69-year-old man who had an end colostomy was admitted with severe abdominal pain and vomiting. Contrast enhancement computed tomography showed dilated intestinal loops with decreased contrast enhancement in the parastomal hernia sac. Emergent laparotomy revealed a dilated and congested intestinal loop strangulated by a small intestinal knot. The knot was carefully untied, and the color of the intestinal loop improved subsequently. Intestinal resection was not performed. Immediate diagnosis and prompt surgical treatment are crucial for strangulating small bowel obstruction due to an intestinal knot. A high degree of clinical suspicion of an intestinal knot is needed in patients with a large extra-abdominal cavity.

A parastomal hernia is a type of incisional hernia that occurs in abdominal integuments in the proximity of a stoma. It is a frequent late complication following colostomy. Surgical repair is currently the only treatment option for parastomal hernia. Here we present the case of a 74-year-old patient with parastomal hernia and a history of open surgery treated with a totally extraperitoneal (TEP) endoscopic approach. There was no recurrence of the hernia at the 3-month follow-up. We discuss the feasibility and possible operative approaches for endoscopic repair of parastomal hernia with the TEP technique.