The case is a woman in her 60s. She had been aware of lower abdominal distention and pain for six months but was under observation. Gradually, the patient experienced worsening pain during distention and became aware of distention, especially before urination. She visited our clinic. Ultrasound (US) and computed tomography (CT) revealed an abdominal incisional hernia. The hernia was in the bladder. We decided on surgical treatment and made a skin incision of about 3 cm just above the hernia portal. Since the size of the hernia portal was approximately 1.3 cm, the patient underwent direct suture closure to repair the hernia portal, and the surgery was completed. The postoperative course was good. The patient was discharged on the second postoperative day. Four months have passed since the surgery, and the patient is under observation without recurrence.

Background: In this study, a new composite biological mesh named SFP was prepared by combining silk fibroin with polypropylene mesh. The mechanism and clinical application value of the SFP composite mesh were explored. Methods: The fibrous membrane was prepared by electrospinning of silk fibroin. The silk fibrous membrane was adhered to the polypropylene mesh by fibrin hydrogel to make a new composite mesh. The characterizations were verified by structural analysis and in vitro cell experiments. A total of 40 Sprague-Dawley rats were randomly divided into two groups, and 20 rats in each group were implanted with the SFP mesh and pure polypropylene mesh, respectively. The rats were sacrificed in batches on the 3rd, 7th, 14th, and 90th days after surgery. The adhesion degree and adhesion area on the mesh surface were compared, and a histopathological examination was carried out. Results: In vitro cell function experiments confirmed that the SFP mesh had good cell viability. The control group had different degrees of adhesion on the 3rd, 7th, 14th, and 90th days after surgery. However, there was almost no intraperitoneal adhesions on the 3rd and 7th days after surgery, and some rats only had mild adhesions on the 14th and 90th days after surgery in the SFP group. There were statistically significant differences in the postoperative intraperitoneal adhesion area and adhesion degree between the two groups (p < 0.05). Histopathological examination confirmed that the mesenchymal cells were well arranged and continuous, and there were more new capillaries and adipocyte proliferation under the mesenchymal cells in the SFP group. Conclusion: The SFP mesh shows good biocompatibility and biofunction in vitro and in vivo. It can promote the growth of peritoneal mesenchymal cells. The formation of a new mesenchymal cell layer can effectively reduce the extent and scope of adhesion between the mesh and abdominal organs. The SFP mesh will have a good application prospect in the field of abdominal wall hernia repair.

The use of laparoscopic surgery has become widespread in recent years. One of its complications is port site hernia (PHS). It can be difficult to close the fascia at the time of laparoscopy, especially in obese patients, and there is a risk of herniation through a fascial defect with incomplete closure. It is important to ascertain closure of the defect when repairing PHS to prevent recurrence. We report a 47-year-old woman who developed a PHS at the superior aspect of the umbilicus. We repaired the defect using the VersaOneTM Fascial Closure System with laparoscopic guidance. This system allows the port site to be reliably closed while observing the suture from the abdominal cavity. The incision is the same size as a port site. If the abdominal wall is thick and the PHS has a diameter of ~10 mm, this method is considered to be indicated, regardless of the site.

UNASSIGNED: We present an open retromuscular mesh technique for incisional hernia repair, the modified peritoneal flap hernioplasty, where the fascia is sutured to the mesh and the hernia sac utilized for anterior mesh coverage. The aim was to describe the modified peritoneal flap hernioplasty technique and to compare it to a retromuscular repair, without component separation, regarding short-term complications, patient satisfaction, abdominal wall complaints, and recurrent incisional hernia.
UNASSIGNED: Consecutive patients operated electively with modified peritoneal flap hernioplasty technique (December 2012-December 2015) or retromuscular technique (Jan 2011-Oct 2014) were included in a retrospective single-center cohort study. Outcomes were evaluated from the Swedish Ventral Hernia Registry, by chart review, physical examination, and an abdominal wall complaints questionnaire.
UNASSIGNED: The modified peritoneal flap hernioplasty group (n = 78) had larger hernias (mean width 10.4 vs 8.5 cm, p = 0.005), more advanced Centers for Disease Control classification (p = 0.009), and more simultaneous gastrointestinal-tract surgery (23.1% vs 11.5%, p = 0.041) than the retromuscular group (n = 96). No difference in short-term complications was seen. Incisional hernia recurrence was lower in the modified peritoneal flap hernioplasty group (1.4% vs 10.3%, p = 0.023), and patients were more satisfied (93.8% vs 81.7%, p = 0.032). Follow-up time was shorter in the modified peritoneal flap hernioplasty group (614 vs 1171 days, p < 0.001).
UNASSIGNED: This retrospective study showed similar rates of short-term complications, despite more complex hernias in the modified peritoneal flap hernioplasty group. Furthermore, a lower incisional hernia recurrence rate for the modified peritoneal flap hernioplasty technique compared with the retromuscular technique used in our department was found. If this holds true with equally long follow-up remains to be proven.

BACKGROUND: Bochdalek hernia (BH) is a congenital diaphragmatic hernia that generally occurs in infants and is rarely seen in adults. Surgical repair of BH is recommended, but the approach for repairing BH should be selected carefully in individual cases. It is well known that hand-assisted laparoscopic surgery (HALS) has the advantage of preserving tactile sensation compared with standard laparoscopic surgery. We describe an adult patient with a history of abdominal incisional hernia who developed BH that was treated safely by HALS.
METHODS: An 87-year-old woman was admitted to our hospital with nausea. She had a history of right hemicolectomy and repair of an abdominal incisional hernia using mesh at 5 years after hemicolectomy. Chest and abdominal computed tomography revealed herniation of the gastric corpus through the left posterior diaphragm. BH was diagnosed and hernia repair by HALS was selected as the approach because dense adhesions were expected in the abdominal cavity. The operation was performed safely and her postoperative course was uneventful.
CONCLUSIONS: HALS was useful, especially when removing adhesions around the hernial orifice. HALS is a feasible approach for BH and should be considered as one of the options in patients with a history of previous abdominal surgery.

The objective of this study was to investigate the long-term outcome of incisional hernias treated with the Erlangen Inlay Onlay Mesh (EIOM) repair technique, taking into account recurrence, complications, and patient satisfaction.
A total of 163 patients treated in the surgical department of Erlangen university hospital with the EIOM repair between the years 1996 and 2009 were evaluated retrospectively.
The collected data revealed a mean follow-up period of 70 (18-190) months. Incisional hernia recurrence after EIOM repair was observed in 6 (3.7%) patients after a mean observation period of 70 mo (18-190) postoperatively. The recurrence rate increased significantly when the body mass index (BMI) was higher than 32 kg/m2. Here, a recurrence rate of 10.5% for BMI> 32 versus 1.7% with BMI ≤32 was reported. There were no significant differences in hernia recurrence if haven been operated by an assistant under supervision or by a consultant. In regard to patient satisfaction, 91% of patients included in this study were satisfied with the surgical outcome.
The EIOM procedure is a safe surgical technique that can be used for the treatment of all, also for giant incisional abdominal wall hernias regardless of the size, BMI, or position of the incisional hernia.

Fifty patients (5 men and 45 women) in the age group of 25 to 65 years with abdominal incisional hernia were studied. The most common antecedent cause (in 86 per cent patients) was found to be a gynaecological operative procedure done earlier through a lower midline incision. All patients underwent anatomical repair and were followed-up after repair for an average of 18 months (range 6-32 months). The results were reviewed and it was seen that there was evidence of recurrence in 3 patients only.

BACKGROUND: Development of an incisional hernia after abdominal surgery is a common complication following laparotomy. Following recent advancements in laparoscopic and open repair a literature review has demonstrated no difference in the short term outcomes between open and laparoscopic repair, concluding there was no favourable method of repair over the other and that both techniques are appropriate methods of surgical repair. However, long term outcomes in the available literature between these two approaches were not clearly analysed or described. The objective of this study is to assess the effectiveness and safety of laparoscopic versus open abdominal incisional hernia repair, and to evaluate the short and long term outcomes in regards to hernia recurrence using meta-analysis of all randomised controlled trials from 2008 to end of 2013.
UNASSIGNED:
METHODS: Patients who developed an abdominal hernia or abdominal incisional hernia following a laparotomy.
METHODS: Two methods of surgical repair, laparoscopic and open abdominal wall hernia repair. Comparison: To compare between laparoscopic and open repair in abdominal wall incisional hernia.
RESULTS: length of hospital stay, operation time, wound infection and hernia recurrence rate.
METHODS: This study is a systematic review on all randomized controlled trials of laparoscopic versus open abdominal wall and incisional hernia repair. Medline, Pubmed, Cochrane library, Cinahl and Embase were the databases interrogated. Inclusion & exclusion criteria had been defined. The relevant studies identified from January 2008 to December 2013, are included in the analysis. The primary end point can be described as hernia recurrence, and secondary outcomes can be described as length of hospital stay post operatively, operation time and wound infection.
RESULTS: Five randomized controlled trials (RCTs) were identified and included in the final analysis with a total number of 611 patients randomized. Three hundreds and six patients were in the laparoscopic group and 305 patients in the open repair group. The range of follow up in the studies was two months to 35 months. The recurrence rate was similar (P = 0.30), wound infection was higher in the open repair group (P < 0.001), length of hospital stay was not statistically different (P = 0.92), and finally the operation time was longer in the laparoscopic group but did not reach statistical significance (P = 0.05) CONCLUSION: The short and long-term outcomes of laparoscopic and open abdominal wall hernia repairs are equivalent; both techniques are safe and credible and the outcomes are very comparable.

BACKGROUND: In the present paper, we show a rare case of the large abdominal wall defect and enterocutaneous fistulas after the tension free repair using prostheses for incisional hernia.
METHODS: The patient, a 70-year-old man, had a history of a hemicolectomy for a perforating colon cancer, complicated by a large incisional hernia that was closed primarily but recurred. Three years later, the hernia was repaired at the time of a second colectomy using a Composix Kugel Patch. His course was complicated by a chronic postoperative wound infection with eventual development of enterocutaneous fistulas. The patient was successfully treated with extirpation of the prosthesis, resection of the fistulized bowel, and placement of a tensor fasciae latae myocutaneous flap.
CONCLUSIONS: Enterocutaneous fistulas are a known complication of incisional hernia repairs using prostheses. Additional clinical data are required to confirm the safety and efficacy of this procedure as it becomes more widely adopted.
CONCLUSIONS: Extirpation of the prosthesis should be performed without delay to prevent serious complications. Reconstruction with a tensor fasciae latae myocutaneous flap was useful for the large abdominal wall defect.

BACKGROUND: In 1990, Ramirez introduced a new procedure to close abdominal wall hernia (AWH), called \"components separation technique (CST)\". Thanks to endoscopy, surgical repair possibilities have risen, reducing the operative trauma and preserving vascular and neuronal anatomical structures. This report aims to describe a single port endoscopic approach for CST to repair the abdominal wall of a patient undergoing surgery for abdominal aneurysm and already subject to placement of a mesh for AWH.
METHODS: We performed endoscopic-assisted CST, using a single-port access with a gasless technique.
CONCLUSIONS: CST is a useful procedure to close large abdominal wall incisional hernia avoiding the use of mesh, notably under contamination, when prosthetic material use is contraindicated. The endoscopic-assisted CST produces same results than the conventional open separation technique and also minimised tissue trauma that ensures blood supply and prevents postoperative wounds complications. The described single port method was found to be safe and effective to close large midline abdominal hernias when a primary open or laparoscopic closure is not feasible or when patients have been previously treated with abdominal meshes.