Laparoscopic inguinal herniorrhaphy is an effective method to correct an inguinal hernia. It can be offered safely to patients undergoing other abdominal procedures. The TAPP, IPOM, and EXTRA procedures appear to be equally effective. A controlled randomized trial is needed to compare this procedure with conventional inguinal herniorrhaphy.

Abstract. This paper aims at presenting and comparing two methodologies adopted by the Emilia-Romagna region, northern Italy, to evaluate coastal vulnerability and to produce hazard and risk maps for coastal floods, in the framework of the EU Floods Directive. The first approach was adopted before the directive had been issued. Three scenarios of damage were designed (1-, 10-, 100-year return periods), produced by the concurrent occurrence of a storm, high surge levels and high-water spring tidal levels. Wave heights were used to calculate run-up values along 187 equally spaced profiles, and these were added to the tidal and atmospheric water level contributions. The result is a list of 10 vulnerability typologies. To satisfy the requirements of the directive, the Geological, Seismic and Soil Service (SGSS) recently implemented a different methodology that considers three scenarios (10-, 100-and > 100-year return periods) in terms of wave setup (not including run-up) plus the contribution of surge levels as well as the occurrence of high-water springs. The flooded area extension is determined by a series of computations that are part of a model built into ArcGIS ® . The model uses as input a high-resolution lidar DEM that is then processed using a least-path cost analysis. Inundation maps are then overlapped with land use maps to produce risk maps. The qualitative validation and the comparison between the two methods are also presented, showing a positive agreement.

ObjectiveThis study was done (1) to determine whether congenital indirect inguinal hernias in male pigs could be repaired by placing a polypropylene mesh prosthesis over the defect intra-abdominally, (2) to measure the incidence of adhesions between intra-abdominal viscera and the prosthesis with and without the adhesion barrier oxidized regenerated cellulose, (3) to determine the incidence of other complications, and (4) to assess the effect on fertility. Summary Background DataSeveral techniques for laparoscopic inguinal herniorrhaphy are currently being evaluated to determine whether there are advantages over conventional inguinal herniorrhaphy. Perhaps the most controversial is the intraperitoneal onlay mesh procedure (IPOM). Its advantage is its simplicity (in that the repair is accomplished by placing a prosthesis over the hernia defect intraabdominally, avoiding a groin dissection). Its disadvantage is the potential for complications because the prosthesis is in contact with the intra-abdominal viscera. MethodsIn male pigs, polypropylene mesh alone or polypropylene mesh plus the adhesion barrier oxidized regenerated cellulose (composite prosthesis) was fixed to the peritoneum surrounding the hernia defect. In phase 1 (6-week follow-up), two groups of 13 pigs each underwent herniorrhaphy at laparotomy or laparoscopy. In phase 2 (7.1-month follow-up), 21 pigs underwent laparoscopic herniorrhaphy. ResultsAll IPOM herniorrhaphies were successful. The prostheses adhered most frequently to the bladder, followed by small bowel, peritoneum, and cord structures. Prosthetic erosion into these organs was not observed. Laparoscopically placed prostheses in phases 1 and 2 had significantly less surface covered by adhesions (13% ± 13% and 19% ± 27%, respectively) and a lower adhesion tenacity grade (1.5 ± 0.9 and 1.3 ± 1.1, respectively) than those placed at laparotomy (44% ± 27% and 2.5 ± 0.7, respectively; p < 0.01). In phase 1, a histologic evaluation of laparoscopically placed specimens demonstrated significantly thinner above-mesh fibrotic tissue compared with the prostheses implanted at laparotomy (p < 0.04). In either phase, the use of the adhesion barrier did not produce any histologic difference between the polypropylene alone and the composite prosthesis. Fertility studies were performed in phase 2 and showed no adverse effects caused by either prosthesis. 144

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