A new technique for tension-free reconstruction in large incisional hernia.

In the surgical management of large incisional hernias, the main target is the closure of the abdominal wall defect on the midline without a dangerous increase in the intraabdominal pressure. In this setting, new intraperitoneal prosthesis and components separation techniques were proposed to solve this problem. Both solutions present some critical issues. A new surgical approach with a free lateral double layer prosthesis totally in polypropylene both sides (FLaPp®) is proposed to overcome this problem. This is a retrospective cohort analysis study with a prospectively collected database from two different Italian hospitals. Twenty-nine patients operated from April 2010 to December 2015 were treated using the new prosthesis. Four patients developed postoperative complications: one (3.4%) presented wound infection, two (6.9%) experienced seroma, and one had a hematoma (3.4%). No deaths were recorded. At a median follow-up of 28.5 months (IQR 22-36), no hernia relapse occurred. The application of FLaPp® mesh is a safe and feasible option that can be employed to manage Rives repair in cases of abdominal wall defects with difficult closure of the posterior plan when the conventional prosthetic meshes could be unsuitable.

Late cutaneous fistulae after prosthetic hernia repair of the abdominal wall.

Late cutaneous fistulae, after a hernioplasty operation for a hernia in the abdominal wall, represent an unusual complication. They can appear a considerable time after a hernioplasty operation and feature the presence of a fistula between the prosthesis and the cutaneous wall. The Authors report the cases of five patients who developed late cutaneous fistulae after an operation for the repair of a hernia of the abdominal wall and the treatment established in the end to correct the existing complication. All five patients were subjected to a second operation to achieve recovery. In fact, conservative medical treatment, before the operation, using antibiotic-therapy for this purpose proved to be ineffective. Only one patient developed hernia recurrence after surgical treatment. Late cutaneous fistulae represent a complication that is difficult to deal with as their treatment has yet to be clearly identified.

[Acute abdomen due to a strangulated and perforated para-esophageal hernia. A case report]. / Addome acuto da ernia paraesofagea strozzata e perforata. Caso clinico.

Para-oesophageal hiatus hernia, a condition in which the fundus and part of the body of the stomach wrapped in a peritoneal sac herniate into the mediastinum, is a relatively uncommon entity. It tends to grow progressively and may become so large as to lead to symptoms of intrathoracic organ compression. In some exceptional cases, the entire stomach together with other abdominal viscera might herniate through the hiatus into the thorax. Paraesophageal hiatus hernias are characterised clinically by vague symptomatology, absent gastro-oesophageal reflux, and possible onset of gastric volvulus, generally without consequent incarceration of the portion of the herniated organ. Such an event is uncommon but dangerous and life-threatening. These cases often require resection of the incarcerated viscera, followed by hiatoplasty and Nissen fundoplication. The authors report on the case of a patient presenting with acute abdomen as a result of incarcerated and perforated para-oesophageal hiatus hernia.