Most complications of ERCP in patients with previous Billroth II gastrectomy were caused by bowel perforation while the endoscope was being manipulated through the afferent limb. Such perforations are intraperitoneal and require surgical intervention.

Parastomal hernia is the most frequent problem encountered after an enterostomy procedure. Even with advances in colorectal surgery, the creation of a stoma will probably not disappear in the near future. There are varying incidences of parastomal hernia formation depending on the type of colostomy or enterostomy done with the end colostomy having the highest in terms of parastomal hernia formation. Even the type of repair for this type of hernia is plagued with challenges due to its high recurrence rate.We at the Asia Pacific Hernia Society would like to congratulate the European Hernia Society for coming up with these guidelines on the prevention and management of parastomal hernias. Though the study revealed a lot of questions that need to be answered, this opens up a lot of avenue for our institutions to do more research in response to the unanswered questions by these guidelines. One particular interesting recommendation of this guideline is the use of prophylactic mesh in the prevention of parastomal hernias. This particular recommendation entails more studies in the future to address its effectiveness for this problem.These guidelines will be of great use to general surgeons, and we at the Asia Pacific Hernia Society appreciate the opportunity to review these guidelines and would like to endorse this to our members as a guide in the management of this problem. We hope that this collaboration opens more future collaboration between the EHS and us.

The management of ventral hernia is continuously evolving as it responds to new demands and new technology in surgery.

Groin hernias are very common, and surgical treatment is usually recommended. In fact, hernia repair is the most common surgical procedure performed worldwide. In countries such as the USA, China, and India, there may easily be over 1 million repairs every year. The need for this surgery has become an important socioeconomic problem and may affect health-care providers, especially in aging societies. Surgical repair using mesh is recommended and widely employed in Western countries, but in many developing countries, tissue-to-tissue repair is still the preferred surgical procedure due to economic constraints. For these reason, the development and implementation of guidelines, consensus, or recommendations may aim to clarify issues related to best practices in inguinal hernia repair in Asia. A group of Asian experts in hernia repair gathered together to debate inguinal hernia treatments in Asia in an attempt to reach some consensus or develop recommendations on best practices in the region. The need for recommendations or guidelines was unanimously confirmed to help overcome the discrepancy in clinical practice between countries; the experts decided to focus mainly on the technical aspects of open repair, which is the most common surgery for hernia in our region. After the identification of 12 main topics for discussion (indication, age, and sex; symptomatic and asymptomatic hernia: type of hernia; type of treatment; hospital admission; preoperative care; anesthesia; surgical technique; perioperative care; postoperative care; early complications; and long-term complications), a search of the literature was carried out according to the five levels of the Oxford Classification of Evidence and the four grades of recommendation.

BackgroundInguinal hernia is a common condition and its repair (herniorrhaphy) is one of the most commonly performed procedures in general surgery. The Lichtenstein herniorrhaphy technique is a widely used and effective surgery that uses mesh to reinforce the area of weakness. Although a wide range of mesh sizes are available for use in hernia repair, in low-resource health care settings the provision of multiple products may not be supportable and it may be necessary for the provision and use of a single mesh size. This study aimed to determine whether the recommended 7.0 cm x 15.0 cm size is an appropriate single mesh size.MethodsIn order to determine the optimal mesh size according to recommended surgical practices, in vivo measurements of key dimensions of the inguinal floor were taken in patients undergoing herniorrhaphy.ResultsMeasurements were taken in 43 patients: 40 men and 3 women, mean age 43 years (SD 13.6); 39 with indirect hernias, 4 with direct. Allowing for recommended mesh overlaps, the optimal mesh size for provision to be appropriate for the majority of patients was determined to be 8.5 cm x 14.0 cm, 21% wider than the mesh size currently recommended for use in Lichtenstein herniorrhaphy.ConclusionsAn appropriate size for routine provision in low-resource settings, or other settings where the provision of several mesh sizes is not supportable, may be 8.5 cm x 14.0 cm.