Aim To present hybrid approach with open/endoscopic extraperitoneal dissection for large lateral-inferior incisional hernias Material and Methods 64 years-old man who underwent left laparoscopic nephrectomy (2019) due to hypernephroma with specimen extraction by a left oblique iliac incision. He presents L3–4 W3 incisional hernia (14×10 cm) Technique description Results After 48 hours ICU admission patient was discharged to hospital ward. Drainages were removed at 2nd-4thpostoperative day and hospital stay was 5 days. Conclusion The hybrid approach to large lateral incisional hernias allowed us to use a large sublay mesh with an increased overlap beyond the hernia defect, trying to reduce hernia recurrence rate.

Aim The aim is to describe the laparoscopic surgical technique of eTEP with 3 trocars from the upper port in a 52-year-old male patient who presented 3 small ventral hernias Material & Methods Recently, the surgical technique of ventral hernia repair, Rives-Stoppa e-TEP eventroplasty (eTEP-RS) has been introduced. First, 2 subcostal incisions are made. By introducing the dissector balloon through both retromuscular spaces up to the linea arcuata, the retromuscular space is exposed. Great care must be taken to preserve the neurovascular bundles at semilunar line. A 5mm trocar is placed on the right flank to perfom the epigastric crossover maniobre by incising the medial aspect of rigth posterior sheath. The dissection of the left retromuscular space is performed. The midline dissection is progressed to the retzius, completing the Rives retromuscular space. The hernia sacs are dissected and reduced. Finally, posterior rectus sheaths and the linea alba are sutured with 2/0 absorbable self-locking continuous barb suture and a mesh is placed in the retromuscular space. Results The patient was discharged the next postoperative day with good pain control. To date, he does not present data on hernia recurrence. Conclusions The repair of abdominal wall defects via endoscopic eTEP Rives-Stoppa with three trocars is a feasible and reproducible technique that meets the criteria of ideal open surgery and is safe for the patient. In addition, it offers advantages such as less postoperative pain, less need for analgesia, favors rapid and safe recovery, added to an excellent aesthetic result.

Objective We aim to evaluate the outcomes and stoma complication in parastomal hernia repair (PHR) with Pauli procedure. Material and Methods 18 patients were recruited between 2015–2022 in 2 hospitals. Data were obtained from prospective clinical database. Surgical technique included: posterior component separation (TAR), bowel lateralization according to Pauli modified Sugarbaker and, if necessary, stoma relocation. Quantitative variables are shown as median [interquartile rank] and qualitative as percentage. Results 22.2% patients had recurrent PH with 2 [3] previous repair attempts. 22.2% underwent bilateral TAR and 11.1% required inlay mesh. Panniculectomy was performed in 17,8% of patients and stoma relocation in 44,4%; 17% required intestinal resection and 11,1% bowel suturing. Complications < 30days: 17% had surgical site infection (SSIs), 2 deep SSIs and one required surgical management. 22.2% had clinical seroma, one required percutaneous drainage and other surgical intervention. Postoperative complications were adynamic ileus (22,2%), bowel obstruction (5%) which was managed conservatively and anastomotic leakage (5%). No mortality was observed, and hospital-stay length was 8 [7.25] days. Complications > 30days: 5.5% chronic seroma (grade III), 5.5% PTE and 22.2% bowel obstruction of which one required adhesiolysis and another bowel resection. 27.8% had any stoma-related complication: partial ischemia (5.5%), retraction (11.1%), prolapse (5.5%) and obstruction (5.5%) managed conservatively. One patient required reoperation due to stoma perforation. We found 25% of clinical or radiological recurrence after 24 [20.1] months follow-up. Conclusion This technique provides acceptable recurrence rates of the PH, but is still high, with a non-negligible associated comorbidity.