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Backgrounds Ventral hernia repair with a preformed device is a frequent intervention, but few reports exist with Parietex™ Composite Ventral Patch. The aim was to evaluate the results of this mesh with the open intraperitoneal onlay mesh (open IPOM) technique. Methods Observational retrospective single institution study of all consecutive patients intervened for ventral or incisional hernia with a diameter inferior to 4 cm, from January 2013 to June 2020. The surgical repair was performed according to the open IPOM technique with Parietex™ Composite Ventral Patch. Results A total of 146 patients were intervened: 61.6% with umbilical hernias, 8.2% with epigastric hernias, 26.7% with trocar incisional hernias, and 3.4% with other incisional hernias. The global recurrence rate was 7.5% (11/146). Specifically, it was 7.8% in umbilical hernias, 0% in epigastric hernias, 7.7% in trocar incisional hernias and 20% (1/5) in other incisional hernias. The median time for recurrence was 14 months (IQR: 4.4–18.7). The median indirect follow‐up was 36.9 months (IQR: 27.2–49.6), and the median presential follow‐up was 17.4 months (IQR: 6.5–27.3). Conclusion The open IPOM technique with a preformed patch offered satisfactory results for the treatment of ventral and incisional hernias.

Introducción: La hospitalización a domicilio para pacientes quirúrgicos (HaDQ) es una alternativa a la hospitalización convencional para pacientes quirúrgicos estables clínicamente, que precisen procedimientos de enfermería complejos por intensidad, frecuencia o características, y control por especialista quirúrgico en el domicilio. Método: Estudio transversal, descriptivo y retrospectivo de la actividad de la HADQ de nuestro hospital durante los primeros seis meses del 2020, para analizar la repercusión de la pandemia por SARS-CoV-2 en la unidad. Se distinguen tres periodos: prepandemia (enero-febreo), confinamiento (marzo-abril), posconfinamiento (mayo-junio). Se diferencian dos grupos: A (HaD convencional) y B (despistaje preoperatorio COVID19). Se recogieron diversas variables: mes, tipo, estancia (HaD y hospital), procedimientos, reingresos, domicilio, tipo visitas, COVID+. Se realizó un análisis estadístico descriptivo cuantitativo y cualitativo de los resultados obtenidos Resultados: Ingresaron 345 pacientes, 225 en el grupo A (fase Pre (34%), fase C (40%), y fase Pos (25%)), y 120 en el B (fase C (75%), fase Pos (25%)). El confinamiento (fase C) fue el período más activo de la HADQ, tanto por número de ingresos (53%), como por la complejidad del grupo A que requería más procedimientos (71%) y más visitas domiciliarias (52%). También aumentaron los pacientes de zona de no cobertura (42%), que implicaron visitas médicas y de enfermería en Hospital de Día (HD) (21%), y aumento de consultas telefónicas médicas (36%). En la fase Pos disminuyeron un 37% los ingresos del grupo A. Conclusiones: La HaDQ se reorganizó por la pandemia para atender a más pacientes quirúrgicos, siendo un recurso asistencial esencial, especialmente durante el confinamiento.

Aim Complex hernias with loss of domain are a challenge for the surgeon, especially when presenting with complications in the emergency room. The emergency treatment differs from definitive surgery, as the patient's scenario is very different and they often present hemodynamic instability, intestinal perforation, etc.. Clinical Case 58-year-old male patient who underwent emergency surgery for septic shock due to intestinal perforation secondary to intestinal occlusion from a primary umbilical hernia, with loss of domain. Through a median laparotomy on the hernia, intestinal resection was performed. Abdominal wall closure wasperformed directly with the hernia sac, without abdominal wall repair. The patient was discharged for outpatient follow up. We planned the definitive surgery. Prehabilitation of the patient begins with botulinum toxin infiltration one month prior to surgery and by creating a progressive pneumoperitoneum. The definitive surgical procedure consists in performing retromuscular umbilical hernioplasty with a posterior component separation technique with placement of four 30×30 cm polypropylene meshes in the retromuscular space and closure of the anterior wall, associated with dermolipectomy. The patient evolved favorably and was discharged. Conclusions The treatment of this type of hernia in the emergency room must be personalized in each case, prioritizing damage control, and followed up by a definitive repair of the hernia. For this repair, it is advisable to perform prehabilitation with botulinum toxin, associated or not, with progressive pneumoperitoneum depending on the characteristics of the patient and the hernia, to avoid an increase in intra-abdominal pressure and the consequent compartment syndrome.

Introduction One of the limitations in extraperitoneal abdominal wall surgery is the reduced range of movements of conventional instruments. The aim of this video was to show the advantages of articulated instruments. Case presentation The first case was a laparoscopic totally extraperitoneal (TEP) inguinal hernia repair of a direct bilateral hernia in a male patient. In this intervention the articulated grasper assisted with the isolation of the hernia sac and allowed to modify the direction of the traction during the dissection. The second case was an extended totally extraperitoneal (eTEP) repair of a M3W2 incisional hernia associated to rectus diastasis in a female patient. The articulated instrument gave an increased traction adapted to the surface of the posterior rectus sheath and marked the limits for the section with the scissors. Conclusion The articulated instruments allowed an increased mobility in the extraperitoneal field. Note: the articulated instruments were manufactured by IMM, Mannheim, Germany.