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Introduction and importance Ventral hernial repair extensively requires the use of surgical meshes to cover the abdominal wall. Patients with a history of laparoscopic ventral hernial repair are predisposed to secondary mesh infections. However, strategies to avoid these mesh infections have not yet been reported. Herein, we report the safety of laparoscopic cholecystectomy in a patient with cholecystitis following extended totally extraperitoneal repair of a ventral hernia. Case presentation A 69-year-old man presented with a five-day history of right hypochondrial pain and severe epigastric pain since the previous day. He had undergone ventral hernial repair. With a diagnosis of acute cholecystitis, laparoscopic cholecystectomy was performed. During laparoscopic cholecystectomy, we inserted the first trocar from the right lower quadrant of the abdomen. Subsequently, we completed the surgery without penetrating the mesh by the ports and observing the other ports in the abdominal cavity. The patient recovered without any complications or short-term mesh infections. Clinical discussion When performing abdominal surgery in a patient after ventral hernial repair, the presence of the mesh limits the approachability of the abdominal cavity without mesh penetration. Although it remains unclear whether mesh damage during abdominal surgery causes secondary mesh infection, avoiding any damage to the mesh may be recommended, especially in patients who are highly susceptible to intra-abdominal infection. Conclusion We concluded that if the surgery is completed without damaging the mesh site, mesh infection after abdominal contamination surgery may be avoided., Highlights • Strategies to avoid mesh infections after surgery have not yet been reported. • Surgery without mesh infection following extended totally extraperitoneal repair. • Mesh infection after surgery may be avoided by avoiding damage to the mesh.

Introduction Low and mid rectal cancer cells have the tendency to spread in the lateral pelvic lymph node (LPLN). The Japanese guidelines recommend systematic lymph node dissection when a positive LPLN is suspected or in stages II–III rectal cancer. However, laparoscopic lymph node dissection is complex and challenging. We introduce transanal LPLN dissection using an abdominal approach. Presentation of case A 78-year-old man was diagnosed with advanced rectal cancer. Computed tomography and magnetic resonance imaging showed lower rectal wall thickening and bilateral lateral lymph node swelling. We performed laparoscopic abdominal peritoneal resection with combined bilateral LPLN dissection using abdominal and transanal approaches. He had an uneventful postoperative course with no signs of recurrence at the 5-month follow-up. Discussion LPLN metastases for low rectal cancer especially occur at the bottom of the deep pelvic spaces. As laparoscopic LPLND for low rectal cancer can be complicated, we adopted abdominal and transanal approaches, which provide the advantage of an anatomical view. This procedure may improve lateral pelvic anatomical structure viewing, and may offer advantages over laparoscopic abdominal approaches for visualizing and dissecting LPLNs. Conclusion Curative resection has become available for rectal cancer with transanal LPLN dissection. LPLN dissection with combined abdominal and transanal approaches is a feasible treatment for advanced rectal cancer., Highlights • Laparoscopic lymph node dissection for low rectal cancer is complex and challenging. • The surgical view around the distal internal lymph node (#263d) and the Alcock duct improved with the transanal approach. • Ta-LPLND combined with abdominal dissection is feasible and effective for rectal cancer.

Introduction Dysfunctions such as mucosal prolapse occur after intersphincteric resection (ISR) to treat lower rectal cancer, even when it is possible to preserve the anus. Method We analyzed the data of 12 patients with rectal or colonic prolapse who underwent the Gant-Miwa-Thiersch procedure between March 2017 and May 2021. Result There were no severe postoperative complications or recurrences. Case presentation A 75-year-old Japanese man initially underwent ISR and had mucosal prolapse nine months after his initial operation. We performed the Gant-Miwa-Thiersch procedure for colonic mucosal prolapse after ISR. Surgical procedure Our procedure is a perineal plication method of prolapsed colonic mucosa with nylon wiring (The Gant-Miwa procedure), using a 1-nylon wire encircled three times to straighten the anal canal, with a cord inserted above the internal sphincter muscle (Thiersch procedure). Discussion Mucosal plication is performed via the Gant-Mowa or Delorme procedure to reduce the risk of recurrence. However, mucosal plication can be performed many times. Our Thiersch procedure involves encircling and straightening the anal canal with a 1-nylon wire to fix the new internal anal sphincter. In conclusion, the Gant-Miwa-Thiersch procedure for rectal and colonic mucosal prolapse, especially after ISR, is a viable treatment option., Highlights • Our procedure is The Gant-Miwa procedure, using a 1-nylon wire encircled three times (Thiersch procedure). • Mucosal plication is performed via the Gant-Mowa or Delorme procedure to reduce the risk of recurrence. • The Gant-Miwa-Thiersch procedure for rectal and colonic mucosal prolapse, especially after ISR, is a viable treatment option.