Laparoscopic ventral hernia repair using only 5-mm ports is a safe, effective technique with no extra risk of infection.

Background: Trends in the quality and quantity of surgical research in Australia have recently experienced considerable growth, stemming from the adoption of the "evidence-based practise" framework. The aim of this 30-year retrospective epidemiological study is to identify and analyse trends in publication of clinical otorhinolaryngology research in Australia from 1989 to 2018. Methods: The 24 highest ranked otorhinolaryngology journals worldwide were identified based on their respective impact factor (IF). Using OVID MEDLINE/PubMed, each Journal was searched for publications with an Australian affiliation for the last 30 years. One investigator screened and analysed results, collecting relevant data for all articles meeting inclusion criteria. Results: A total of 1,095 articles were identified from the period between 1989-2018. There has been an exponential increase in the total number of publications throughout this time. Randomised controlled trials (RCTs) accounted for 36 publications, whilst systematic reviews were tallied at 53 publications; with a trend towards publication of higher (level 1 & 2) levels of evidence. Level 4 evidence (prospective or retrospective case series), accounted for the largest quota of study designs, at 535 articles (48.9%). Furthermore, there has been a statistically significant increase in both multi-institutional and multinational collaborative research. Conclusions: There has been a considerable increase in the quantity and quality of otorhinolaryngology research within Australia in the last three decades. This is largely due to a strong impetus from the Royal Australasian College of Surgeon (RACS) on a developing academic surgical culture in concordance with financial support from bequeathing otorhinolaryngology foundations and a trend towards more multiinstitutional and multinational collaboration.

Background: Ventral hernias are increasingly managed with minimally invasive laparoscopic surgery. Invasive open surgery is typically used for the repair of large-sized hernias (>10 cm diameter). The two methods are often considered mutually exclusive. We report a hybrid technique for repair of medium to large-sized hernias. Methods: Data was collected prospectively from 44 hernias repaired using the hybrid technique from 2012 to 2020. Operative data was examined and follow-up conducted by both clinical and phone review. As for surgical technique, laparoscopic access was established via a 5 mm optical port and two (or more) 5 mm ports were added under vision. Hernia contents were reduced and extraperitoneal fat excised around the defect. Hernias with diameters ranging from 5 to 10 cm were fixed using the hybrid technique. A small incision was made directly over the hernia and polyester mesh was placed intraabdominally before defect closure with a transfascial suture. Pneumoperitoneum was re-established and mesh fixation achieved using absorbable tacks and/or fixation sutures. Results: Of the 44 ventral hernias repaired with the hybrid technique, 43 were secondary hernias from incisional defects. Average hernia diameter was 6.6 cm. 86% of patients were discharged within the first 48 h. Four patients (9%) had recurrences during the study period. Minor complications occurred in 8 patients (18%): 3 (7%) had post-operative wound infection, 3 patients (7%) developed post-operative seroma. Two patients (5%) had clinically significant wound haematoma. Conclusion: Laparoscopic hybrid ventral hernia repair can be safely performed by a combination of laparoscopic and open techniques, offering an alternative method in the management of medium-sized ventral hernias.