Hybrid Technique for Abdominal Wall Hernia Repair: Description and Early Results.

Objective Ventral hernia repair is a widely practiced surgical procedure worldwide. The objective of this paper is to evaluate and analyze the results of a hybrid approach for treating ventral hernias. Methods All patients with clinically and radiologically proven ventral hernia underwent hybrid laparoscopic ventral hernia repair at Princess Royal University Hospital, London, United Kingdom using a retrospective approach with the same surgical team. Large defects >10 cm, inguinal hernia, para-stomal hernia, incarcerated patients, and spigelian hernia were excluded. We utilized the laparoscopic approach for the dissection and isolation of the sac and used the port site for the delivery of mesh into the abdominal cavity. Results Our study comprises 67 patients, with 39 males (58.2%) and 28 females (41.8%). The median age in our study group was 41 years (range: 18-65 years). The median BMI was 38 kg/m2 (range: 24-52 kg/m2). The majority of the cases were umbilical or paraumbilical hernias (n = 46). The median defect size in our study was 5.4 cm (range: 2-10 cm). The median operative time was 67 minutes. We have not encountered any recurrences in this group. Conclusion This hybrid approach combines the advantages of both the open and laparoscopic approaches.

Suturing Versus Adhesion for Mesh Fixation in Ventral Hernia Repair and Abdominal Wall Reconstruction: A Systematic Review and Network Meta-Analysis.

Abdominal wall reconstruction (AWR) is a surgical procedure performed to address various conditions such as hernias, incisional hernias, and complex abdominal wall defects. Mesh fixation plays a crucial role in providing mechanical reinforcement to the weakened abdominal wall during AWR. Traditionally, suturing has been the preferred method for mesh fixation; however, adhesion techniques using tissue adhesives or glues have gained attention as an alternative approach. This systematic review aims to compare suturing and adhesion techniques for mesh fixation in AWR and assess their effectiveness in preventing hernia recurrence. A comprehensive literature search was conducted across relevant databases, including PubMed, MEDLINE, Embase, and the Cochrane Library. Studies that fulfilled the predetermined eligibility criteria were included. The primary outcome measure of interest was hernia recurrence rates. Secondary outcomes included mesh-related complications, surgical site infections, patient-reported outcomes, and functional outcomes. A risk of bias assessment was performed for the included studies, and data were synthesized qualitatively. Overall, the results of the included studies suggest that atraumatic mesh fixation with glue may have the potential to reduce chronic groin pain (CGP). However, there were significant variations in patient selection criteria, glue administration techniques, and hernia repair methods among the trials, which limited the ability to draw definitive conclusions. Additionally, the definitions of CGP and measurement scales for postoperative pain varied across studies, making it challenging to compare outcomes. The limitations of the review include the small sample sizes in some trials, relatively short follow-up durations, and the lack of standardized criteria for assessing variables such as foreign body sensation and groin compliance. Furthermore, the economic implications of using glue fixation compared to traditional suture fixation need to be considered.

Percutaneous Cholecystostomy to Manage a Hot Gallbladder: A Single Center Experience.

Objective A percutaneous cholecystostomy (PC) is a suitable option for treating acutely inflamed gallbladders. Its use has been postulated before for treating acute cholecystitis (AC), especially in elderly populations. The primary aim of our study is to analyze and present the positive results of PC as a bridge to laparoscopic cholecystectomy. Methods All patients who underwent PC at our hospital, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR, from October 2020 were reviewed using a retrospective approach. Results Our study comprises 123 patients, with 72 females (58.5%) and 51 males (41.4%). In our study, many patients had significant comorbidities, and some of them were categorized as high-risk due to their frailty and medical conditions. The majority of the patients were in American Society of Anaesthesiologists' (ASA) groups II and III (45, 61), respectively. Though hospital stays can depend on variable factors, in our experience, the mean hospital length of stay was 12.7 days. In our study, 119 patients (96.8%) had the procedure through the interventional radiological approach, while only four patients had it through the laparoscopic approach. The transhepatic route for drainage was more commonly practiced at our center and was used in 108 patients. At the time of writing this article, 54 patients have already had a laparoscopic cholecystectomy (LC) done as an interval procedure after surpassing the acute attack of cholecystitis, while 42 patients are still awaiting their surgical procedure. Conclusion Our results show that PC is a viable option, especially in cases of AC that are not responding to conservative treatments. Our study has shown low complications and conversion rates after PC. We believe PC is a safe and effective tool for managing severe and refractory cases of AC.

Technical Tips Following 850 Consecutive One Anastomosis Gastric Bypass (OAGB) Patients.

Background: The surgical procedure One Anastomosis Gastric Bypass (OAGB) has become widely used worldwide. Since its inception, many modifications have been introduced to improve results. Objectives: The primary aim of this study was to share the modifications that we have introduced to our OAGB technique after reflecting on the problems and complications we have faced during the evolution of this procedure in our unit. Method: A total of 850 patients who underwent OAGB under the same surgical team at two different hospitals in the United Kingdom were displayed according to demography and comorbidities. All complications were reviewed and analysed to instigate the changes in our technique. Results: There were 756 (89%) primary and 94 (11%) revisional procedures. There were 596 females (70.11%) and 254 males (29.89%) in our study group. The body mass index range was 32-84 and the mean was 45. The pre-operative weight range was 89-274 kg and the mean was 126.4 kg. Conclusions: With experience and reflecting on our complications we have modified our surgical approach, and these alterations have helped us to adopt OAGB as the mainstream bariatric procedure. We want to share our experience with the bariatric community for the benefit of patient care.