Introduction: Laparoscopic repair is now the treatment of choice for most cases of ventral/incisional hernia. Although the technique has undergone many refinements, there is no standard technique for difficult or complicated hernias. Aim: The aim of this study was to show the different innovative methods used to treat difficult ventral hernia through hybrid techniques. Materials and Methods: A total of 75 ( n = 75) patients underwent Laparoscopic Ventral Hernia Hybrid Mesh Repair (LVHHMR) by our surgical unit between January 2014 and December 2016. Three different techniques of repairing the defects were used. Mesh fixation time, post-operative pain score (visual analogue score) and follow-up for pain and recurrence (at 6 months, 12 months and 24 months) were recorded and analysed. Results: Out of 75 patients (20 men and 55 women), the median age was 45 years and body mass index of the patients was 25–35. Types of hernias operated were paraumbilical hernias, incisional and recurrent hernias. The techniques used were (1) laparoscopic adhesiolysis, open sac excision with closure of defect and laparoscopic mesh placement, (2) laparoscopic adhesiolysis, omphalectomy with closure of defect and laparoscopic mesh placement and (3) open adhesiolysis, sac excision with closure of defect and laparoscopic mesh placement. Five patients required analgesics for 48 h. No patients complained of pain at follow-ups (1 month, 6 months, 12 months and 24 months). Mean hospital stay postoperatively was 2–3 days. Conclusion: LVHHMR is safe and feasible approach for complicated/difficult ventral hernias. However, further larger studies are required to establish these methods as gold standard.

An intramural venous leiomyosarcoma is a rare, malignant tumour arising from the smooth muscle cells of the vessel wall and the inferior vena cava (IVC) is the most common location. The middle part of IVC is most often affected, often involving the kidneys. There is a strong prediction for women. Clinical symptoms depend upon the size and location of the tumour. Diagnosis is often not made until advanced stage, as the symptoms are non-specific and they present late in the disease course. (Ind J Thorac Cardiovasc Surg 2008; 24: 261-263)

Background: Repair of the abdominal wall defects can be quite challenging even for most experienced surgeon under best of conditions. In the laparoscopic method there have been many modifications with regard to the type of mesh and methods of fixation. The aim of this study was to identify immediate post-operative pain and the long-term outcomes of laparoscopic ventral hernia mesh repair without the use of transfascial sutures to fix the mesh.Methods: A total of hundred (n=100) patients underwent Laparoscopic Ventral Hernia Mesh Repair by our surgical unit between January 2011 and December 2015. All patients underwent standardized Laparoscopic mesh repair with light weight composite meshes and without the use of transfascial sutures. Only absorbable tackers were used to anchor the mesh. Analgesics stopped after 24 hours or given only on demand. Mesh fixation time, post-operative pain score (visual analogue score), and follow up for pain and recurrence (at 6 months, 12 months and 24 months) were recorded and analyzed.Results: Out of 100 patients (42 men and 58 women), the mean age was 48 years and BMI of the patients was 20-35. Types of hernias operated were 63 para umbilical hernias, 32 incisional and 5 recurrent hernias. The median defect size was 5 cm (Range 3-8 cm) and the mesh sizes used were15 x 15 cm circular (87) and 15 x 20 rectangular (13). The median mesh fixation time with only absorbable tackers was 15 mins (range 15-20 mins). Visual analog scale for pain (VAS) was of median 1 (Range 0-2) at 24 hours. Five patients required analgesics for 48 hours. No patients complained of pain at follow ups (1 month, 6 months, 12 months and 24 months). Mean hospital stay post operatively was 2-3 days. Only one patient had recurrence of hernia within 6 monthsConclusions: Laparoscopic Ventral Hernia Mesh Repair without the use of transfascial sutures is an easy and feasible approach. The use of only absorbable tacks to fix the mesh is time saving and gives less post-operative pain. However, randomized controlled trials are required to compare transfascial sutures with absorbable tacks for fixing the mesh in separate cases to reach a standardized method.

The aims of this review are to ascertain the true prevalence of venous thromboembolism (VTE) in critically ill COVID 19 patients, to explore the strategy regarding prophylaxis and whether intensified prophylaxis is required for critically ill patients and to review the published guidelines to identify areas where clarity is required. An electronic search of the literature on VTE in COVID patients with reference to prevalence and prophylaxis was made using PubMed as the main search engine. A snowball search was followed to retrieve additional relevant data. The database consisted of prospective and retrospective studies and systematic reviews. The results showed that the reported incidence of VTE varies from <10% to more than 60%. Majority of studies reported a higher incidence of VTE in critically ill COVID 19 patients. Few authors, therefore, suggested a higher dose of low molecular weight heparin (LMWH), but this approach has not been validated. There is also a suggestion to extend the prophylaxis postdischarge. There are also reports of thromboprophylaxis with LMWH improves outcome in critically ill patients. This review confirms the generally held view that the incidence of VTE is higher in COVID 19 patients who are critically ill. However, whether they will benefit from a higher or intensified dose of Heparin is not fully assessed, with opinion equally divided among researchers there are few other grey areas like prophylaxis post discharge and in ambulatory patients.