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Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.

A 24-year-old man survived for 8 years after a vascular lesion of the pons and midbrain. During these years a subresponsive comatose state with neurological signs extending from the oculomotor nuclei to the trigeminal and facial nuclei levels was present. A decorticated type of rigidity, with bilateral paralysis of the limbs accompanied by pyramidal signs, was also present. The EEG during the first months showed slow activity which afterwards gradually changed towards fast and alpha activities, maintained in the course of the years. The pathological diagnosis was a fibrous endarteritis, mainly in the territory of the basilar and vertebral arteries. The pons and midbrain, presenting a large cystic infarct, were serially studied to determine the anatomical extent of the lesion. After reviewing other examples from the literature, the clinical features of our case are discussed. The evolution of the EEG is related to different structures of the ponto-mesencephalic region with different functional activities.

Resumen Presentamos un caso de un tumor embrionario con predominio de estructuras del seno endodermico, que consideramos encuadrable dentro del carcinoma embrionario. No hemos encontrado referido ningun otro caso en la literatura nacional. Esta localizado en mediastino anterior y lleva una supervivencia en la actualidad de 9 meses. La respuesta al tratamiento fue aceptable, aunque no lo suficientemente satisfactoria, y fue valorada segun criterios clinicos, radiologicos, broncoscopicos y analiticos, entre los que cabe destacar su control con la monitorizacion de las alfaproteinas, las cuales cursaron con niveles mucho mas altos que los descritos en la literatura, y sus niveles como respuesta al tratamiento han descendido de forma muy acentuada. Creemos por ello, que las determinaciones de alfa-fetoproteinas y gonadotropinas por radioinmunoensayo, asi como otros test de inmunidad celular, pueden servir de indice, lo suficientemente precoz, para poner en evidencia una mala respuesta a la terapeutica, o bien orientar unos criterios terapeuticos mas eficaces.