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The Kugel patch inguinal hernia repair is a relatively new, open, minimally invasive procedure using a preperitoneal approach. Prospective multicentre case series of 450 consecutive Kugel patch repairs. Recurrence rates and persistent inguinal pain after at least 1 year as well as short-term outcomes were studied. After a follow-up of 18 months, eight recurrences (1.9%) were found, and persisting inguinal pain was reported in 15 patients (3.5%). The mean operation time and hospital stay were 20 ± 9 min and 19 ± 1.3 h respectively. Less than 1% of patients planned for an ambulatory treatment needed prolonged hospitalisation. Analgesics were used for 3 ± 2 days. Paracetamol was the only painkiller used in 69% of patients, and 13% did not take any painkiller at all. Half of all patients returned to their daily activities after 9 days and half of the employed patients returned to work after 14 days. The Kugel patch repair is a quick technique with a low recurrence rate and good patient comfort. It offers the advantages of a preperitoneal inguinal hernia repair without the need for general anaesthesia or expensive laparoscopic equipment. [ABSTRACT FROM AUTHOR]

We describe a case of a young woman with acute epigastric pain. Extensive diagnostic workup suggested a hernia through the foramen of Winslow. A laparoscopic exploration of the abdomen revealed an internal herniation of the cecum and ascending colon behind the hepatoduodenal ligament into the lesser sac. Successful management requires prompt diagnosis and surgical treatment. In our case the internal herniation was uncomplicated and could be reduced laparoscopically. To our knowledge, this is the first documented case of a laparoscopiccally treated Winslow hernia. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of incisional hernias (IHs) after open repair of an abdominal aortic aneurysm (AAA) is high. Several randomized controlled trials have reported favorable results with the use of prophylactic mesh to prevent IHs, without increasing complications. In this analysis, we report on the results of the 60-month follow-up of the PRIMAAT trial., Methods: In a prospective, multicenter, open-label, randomized design, patients were randomized between prophylactic retrorectus mesh reinforcement (mesh group), and primary closure of their midline laparotomy after open AAA repair (no-mesh group). This article reports on the results of clinical follow-up after 60 months. If performed, ultrasonography or computed tomography were used for the diagnosis of IHs., Results: Of the 120 randomized patients, 114 were included in the intention-to-treat analysis. Thirty-three patients in the no-mesh group (33/58-56.9%) and 34 patients in the mesh group (34/56-60.7%) were evaluated after 5 years. In each treatment arm, 10 patients died between the 24-month and 60-month follow-up. The cumulative incidence of IHs in the no-mesh group was 32.9% after 24 months and 49.2% after 60 months. No IHs were diagnosed in the mesh group. In the no-mesh group, 21.7% (5/23) underwent reoperation within 5 years due to an IH., Conclusions: Prophylactic retrorectus mesh reinforcement after midline laparotomy for the treatment of AAAs safely and effectively decreases the rate of IHs. The cumulative incidence of IHs after open AAA repair, when no mesh is used, continues to increase during the first 5 years after surgery, which leads to a substantial rate of hernia repairs., Competing Interests: M.M. reports having received research grants from Johnson and Johnson, FEG Textiltechnik, and Medtronic, speakers honorarium from Bard-Davol and Medtronic, and consultancy fees from Lifebond. T.T. reports having received research grants from Johnson and Johnson and Medtronic, speakers honorarium from Bard-Davol, and consultancy fees from Bard-Davol. F.B. reports having received research grants from Johnson and Johnson, speakers honorarium from Medtronic and Bard-Davol, and consultancy fees from Medtronic. F.M. reports having received research grants from Intuitive, Medtronic, and Dynamesh, speaker’s honorarium from Medtronic, Bard-Davol, Dynamesh, Intuitive, and WL Gore, and consultancy fees from Medtronic, Intuitive, and CMR Surgical. The remaining authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The incidence of incisional hernias after abdominal aortic aneurysm repair is high. Prophylactic mesh-augmented reinforcement during laparotomy closure has been proposed in patients at high risk of incisional hernia., Methods: A multicenter randomized trial was conducted on patients undergoing elective abdominal aortic aneurysm repair through a midline laparotomy (Clinical.Trials.gov: NCT00757133). In the study group, retromuscular mesh-augmented reinforcement was performed with a large-pore polypropylene mesh (Ultrapro, width 7.5 cm). The primary endpoint was the incidence of incisional hernias at 2-year follow-up., Results: Between February 2009 and January 2013, 120 patients were recruited at 8 Belgian centers. Patients' characteristics at baseline were similar between groups. Operative and postoperative characteristics showed no difference in morbidity or mortality. The cumulative incidence of incisional hernias at 2-year follow-up after conventional closure was 28% (95% confidence interval [CI], 17%-41%) versus 0% (95% CI, 0%-6%) after mesh-augmented reinforcement (P < 0.0001; Fisher exact test). The estimated "freedom of incisional hernia" curves (Kaplan-Meier estimate) were significantly different across study arms (χ = 19.5, P < 0.0001; Mantel-Cox test). No adverse effect related to mesh-augmented reinforcement was observed, apart from an increased mean time to close the abdominal wall for mesh-augmented reinforcement compared with the control group: 46 minutes (SD, 18.6) versus 30 minutes (SD, 18.5), respectively (P < 0.001; Mann-Whitney U test)., Conclusions: Prophylactic retromuscular mesh-augmented reinforcement of a midline laparotomy in patients with abdominal aortic aneurysm is safe and effectively prevents the development of incisional hernia during 2 years, with an additional mean operative time of 16 minutes.

The reliability of auscultation, continuous wave (CW) Doppler imaging, and intravenous digital subtraction angiography (IV DSA) in the assessment of carotid artery disease has been evaluated in comparison with conventional angiography in 30 patients. With auscultation, specificity and sensitivity for internal carotid artery (ICA) stenosis of 50% or more were 81% and 67% respectively. CW Doppler imaging detected ICA stenosis of 50% or more with a sensitivity of 83% and a specificity of 92% and ICA occlusion with a sensitivity of 60%. The specificity of IV DSA was 95% and the sensitivity for ICA stenosis of 50% or more and ICA occlusion were 75% and 100% respectively. Combining CW Doppler and IV DSA findings raised sensitivity for ICA stenosis of 50% or more and ICA occlusion to 89% and 100% respectively and specificity to 95%. The combination of CW Doppler and IV DSA is a safe and accurate test battery in the detection and categorization of carotid disease.

A case of recurrent bleeding from gastric varices due to isolated splenic vein thrombosis is reported. There was no evidence of pancreatic, retroperitoneal or infectious disease. The final diagnosis was made by intraoperative ultrasonography during an emergency laparotomy for massive bleeding from a ruptured gastric vein. Splenectomy is the treatment of choice in this case. The patient was cured after splenectomy.

Primary aortocolic fistulas are a rare but lethal complication of aortic or iliac aneurysms. A case of fistula between a nonaneurysmal aortic bifurcation and sigmoid colon caused by an ingested chicken bone is presented. This cause of rectal bleeding, which has never been described, might have been suspected after careful examination of abdominal x-ray films. Surgical management included removal of the foreign body and primary repair of the colonic and aortic rent and appeared to be adequate.

Left ventricular-right atrial communication is a relatively rare surgically corrigible congenital heart defect. We report a case with review of the literature.