The incidence of IH is high in patients undergoing elective or emergency surgery for colorectal diseases. The addition of a prophylactic large-pore polypropylene mesh on the overlay position decreases the incidence of IH without adding morbidity.

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Introduction Parastomal hernias (PH) can be a complex surgical problem. When there is a combination of midline and parastomal hernias, an option could be using both posterior component separation technique and an intraparietal Sugarbaker as described by Pauli. We present a case with the combination of midline and parastomal hernias. The aim of this video is to offer the most relevant steps that should be followed for a Pauli repair. Methods This is a 75 years-old man,, that underwent abdominoperineal resection for rectal cancer T3N2 in 2018. He developed a very symptomatic incisional hernia + parastomal and repaired was offered. After adhesiolysis, a retromuscular Rives dissection and a left posterior component separation were made. A Pauli was planned lateralizing the bowel in the retromuscular plane (like an intraparietal Sugarbaker repair) and a biosynthetic mesh was used in the retromuscular preperitoneal plane, making an inner stoma site with the mesh and bringing the colon trough the previous stoma site. Finally, anterior abdominal wall was closed Results The patient was discharged uneventfully on the 6th postoperative day. Discussion Pauli described 3 patients in similar circumstances but leaving the new posterior ostomy site lateral to the mesh. This technique that we describe in this video could be particularly useful in patients in whom a simpler Sugarbaker laparoscopic repair is not adequate and in those cases with PH with concomitant midline defects.

PColorectal cancer is the third leading cause of death worldwide. Approximately 15-20 % of the patients present synchronic Colorectal Liver Metastases (CRLM) and 60 % will develop them metachronicaly. Surgical treatment is the only therapy that gives these patients the option of long-term survival. In the 1980s surgical treatment offered a 5-year survival rate of approximately 20 % for patients undergoing liver resection. Recent studies show 5-year overall survival rates ranging between 42 and 58 %. Systemic chemotherapy regimens are based on fluoropirimidines. These regimes include neoadjuvant, adjuvant or both depending on the disease stage. Adjuvant chemotherapy has shown better overall survival and progression free survival in patients treated surgically for CRLM. Surgical approach to CRLM has changed dramatically in the last years. There are hardly any contraindications for treating surgically CRLM, as long as the liver remnant is at least 30 % of the total volume for non-cirrhotic non-chemotherapy treated livers. In cirrhotic or chemotherapy-treated livers this amount should reach 40 %. Aspects concerning synchronic CRLM and irresectable metastases have shown greater advances. The reverse approach or liver-first approach has offered patients with advanced disease a better option for completing total resection. Portal vein embolization, two-stage hepatectomy or ALPPS procedure (associating liver partition and portal vein ligation) are the top developments in this field showing promising results. These developments are widening surgical indications in CRLM. Surgical and systemic treatment, as well as a better understanding of molecular alterations has definitely improved the perspective for patients with CRLM. Keywords: Colorectallivermetastases; Irresectablemetastases; Synchronicmestastases