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Background: In the Netherlands, limited variability exists in the performance of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) among centers treating colorectal peritoneal metastases (PM), except for the intraperitoneal drug administration. This study offers a unique opportunity to investigate any disparities in survival between the two most frequently used HIPEC regimens worldwide: mitomycin C (MMC) and oxaliplatin.

Introduction: Surgical planning for repair of giant hernias with loss of domain needs to consider patient comorbidities, potential risks and possible postoperative complications. Some postoperative complications are related to the increase in intra-abdominal pressure caused by the reintroduction of abdominal contents into the peritoneal space. Preoperative progressive pneumoperitoneum (PPP) increases the capacity of abdominal cavity prior to hernia repair and allows for better physiological postoperative adaptation. The aim of this study is to analyze perioperative and intraoperative characteristics as well as outcomes of a cohort of patients treated with PPP prior to giant hernia repair at a single, high volume center.Methods: Prospective, descriptive, observational single-center study including 50 patients undergoing PPP prior to hernia with loss of domain repair between January 2005 and June 2022. We analysed epidemiological, surgical and safety variables.Results: Fifty patients were included: 43 incisional hernias, 6 inguinal hernias and 1 umbilical hernia. Mean age was 66 years (36–85). Median insufflation time was 12 days (4–20) and median insufflated volume of ambient air was 10,036 cc. There were complications during PPP in nine patients: 2 decompensation of chronic respiratory disease and 7 subcutaneous emphysema. PPP was prematurely suspended in patients with respiratory decompensation. All patients with incisional and umbilical hernias underwent open repair with mesh placement. Preperitoneal repair was performed in inguinal hernias. Three cases of hernia recurrence were reported during the follow up.Conclusion: PPP is a safe and effective tool in the preoperative management of patients with giant hernias. It helps to achieve the decrease or absence of abdominal wall tension and can favour the results of complex eventroplasty techniques.

Aim We present a case of a recurrent parastomal hernia with enterocutaneous fistula and subcutaneous abscesses and their management. Material & Methods 79-year-old patient with history of pT4b low rectal cancer treated with an abdominoperineal resection with adjuvant chemo-radiotherapy in 2000. Parastomal hernia repair was performed in 2016 with PTFEe mesh according to the Sugarbaker technique and closing midline with double-sided inlay mesh. A plastic peritonitis was found at this moment In July 2021 presented episodes of fever with spontaneous parastomal purulent drainage, deciding initially conservative treatment. Due to persistence of soft tissue infection local surgical drainage was performed in September 2021, removing previous parastomal PTFEe mesh. The patient presented multiple infectious relapses from January to March 2022, debridement was carried out combined with negative pressure therapy. During follow-up intestinal fluid was seen through the negative therapy what put on show an enterocutaneous fistula. Finally, we decided radical surgery in May 2022 performing an in-block resection of end colostomy, 30 cm of ileum and abdominal wall area affected of chronic infection and previous meshes. A 20×20cm defect was left. Reconstruction with double-sided inlay mesh and new colostomy in the right iliac fossa was performed. Skin closure required cutaneous plastia. Conclusions The use of suitable prosthetic material for the repair of parastomal hernia doesn't exclude the developing of severe complications. An early and decisive surgical approach is recommended in cases of chronic prosthetic material infection to avoid redundant and non-cost-effective treatments.

Aim Report an unusual late complication after laparoscopic IPOM Material & Methods Description of a clinical case Results An 84 years old patient who had previously undergone laparoscopic IPOM with ePTFE mesh in 2012 for supraumbilical primary hernia, arrived to the emergency room in March 2022 with a small bowel obstruction due to an intraluminal foreign body impacted at the distal jejunum. In the computerized tomography scan (CT) there was no evidence in the abdominal wall of the intraperitoneal mesh present in a previous CT from 2019. An exploratory laparotomy was warranted. A resection the affected jejunal loops was performed, without evident perforation and clear palpation of an intraluminal foreign body. When the piece was opened, the mesh was found intraluminally, causing the patient's bowel obstruction. Conclusions Intra-abdominal foreign bodies usually cause a chronic inflammatory process that isolate them from neighboring structures by a fibrous capsule. In this case, however, after detaching it from the abdominal wall, the mesh migrated into the intestinal lumen, probably through slow erosion by decubitus. Despite it being an unusual complication, its incidence could increase as the use of intra-abdominal mesh has multiplied in recent years. Given the appearance of non-specific abdominal pain in patients with intra-abdominal mesh, it may be advisable to perform a CT scan to rule out this or other complications associated with the mesh, even many years after the initial surgery.