Pain during sexual activity and ejaculation following hernia repair: A retrospective comparison of transabdominal preperitoneal versus Lichtenstein repair.

Pain during sexual activity and ejaculation are the unspoken long-term complications of groin hernia repair. Laparoscopic surgical techniques are associated with decreased post-operative pain and earlier return to daily activities, but its effect on these complications is unclear. This study aims to investigate the effect of transabdominal preperitoneal repair (TAPP) on de-novo pain during sexual intercourse and ejaculation and to compare with open repair. For this reason, two groups were determined according to the surgical technique: the Lichtenstein repair and the TAPP groups and a questionnaire was sent to the patients a minimum of 6 months following the surgery. A total of 317 patients included, as 115 in TAPP and 202 in Lichtenstein repair group. No significant difference was observed concerning pre-operative pain during sexual activity and ejaculation in both groups (p = .75, p = .56). Following the surgery, the number of patients experiencing painful sexual activity was significantly higher in the Lichtenstein repair group compared to the TAPP group (19.3% vs. 11.3%, respectively, p = .03). The post-operative painful ejaculation rate was also significantly lower for the TAPP group (p = .04). The lower rates of post-operative dysejaculation and pain during sexual activity can be achieved with the advantage of laparoscopic surgery.

The Effects of Platelet-Rich Plasma to Decrease the Risk of Seroma Formation After Mastectomy and Axillary Dissection.

BACKGROUND: Seroma, which is the most common complication after mastectomy and axillary dissection, is the leakage of the lymphovascular fluid into the dead space. It can cause local complications varying from delayed wound healing to infection and skin flap necrosis. The aim of this study was to evaluate whether platelet-rich plasma (PRP) reduces the risk of seroma formation. MATERIALS AND METHODS: A total of 24 Wistar albino rats were randomly divided into three groups of eight rats in each. For the rats in group 1, no additional procedures were carried out. The rats in groups 2 and 3 were applied with 0.25 and 0.5 mL/cm2 PRP, respectively, to the operation site. The groups were compared in respect of adhesion scores, histopathologic examination, and tissue seroma volume. RESULTS: The mean seroma volume was 2.19 ± 0.78 mL in group 1, 1.43 ± 0.35 mL in group 2, and 0.96 ± 0.24 mL in group 3. The seroma volumes of groups 3 and 2 were significantly lower than those in group 1. In the macroscopic assessment the mean general adhesion score was 6 ± 0.75 in group 3. The other general adhesion scores were 5.25 ± 0.70 and 2.12 ± 0.64 in groups 2 and 1, respectively. The adhesion scores of groups 3 and 2 were significantly higher than those of group 1. The mean inflammatory cell score was 0.87 ± 0.83 in group 3, 2.0 ± 0.92 in group 2, and 3.0 ± 0.53 in group 1. There were significantly lower levels of inflammatory cells in group 3 than in the other groups and the group 2 inflammatory cell count was lower than that of group 1. Fibroblast density score was significantly higher in group 3 (2.50 ± 1.06) compared with the other groups. Neovascularization was significantly higher in groups 3 and 2 compared with group 1. The mean neovascularization score was 2.25 ± 1.16 and 2.12 ± 1.12 in groups 2 and 3, respectively. There were no statistically significant differences between the groups in respect of collagen levels. CONCLUSIONS: Local application of PRP in rats after experimental mastectomy and axillary dissection was observed to decrease seroma formation and to increase neovascularization and fibroblast density.

Clinical outcomes of single incision laparoscopic surgery and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair.

BACKGROUND: Laparoscopic surgery has been a frequently performed method for inguinal hernia repair. Studies have demonstrated that the laparoscopic transabdominal preperitoneal (TAPP) approach is an appropriate choice for inguinal hernia repair. Single-incision laparoscopic surgery (SILS) was developed to improve the cosmetic effects of conventional laparoscopy. The aim of this study was to evaluate the safety and feasibility of SILS-TAPP compared with TAPP technique. MATERIALS AND METHODS: A total of 148 patients who underwent TAPP or SILS-TAPP in our surgery clinic between December 2012 and January 2015 were enrolled. Data including patient demographics, hernia characteristics, operative time, intraoperative and postoperative complications, length of hospital stay and recurrence rate were retrospectively collected. RESULTS: In total, 60 SILS-TAPP and 88 TAPP procedures were performed in the study period. The two groups were similar in terms of gender, type of hernia, and American Society of Anesthesiologists (ASA) classification score. The patients in the SILS-TAPP group were younger when compared the TAPP group. Port site hernia (PSH) rate was significantly high in the SILS-TAPP group, and all PSHs were recorded in patients with severe comorbidities. The mean operative time has no significant difference in two groups. All SILS procedures were completed successfully without conversion to conventional laparoscopy or open repair. No intraoperative complication was recorded. There was no recurrence during the mean follow-up period of 15.2 ± 3.8 months. CONCLUSION: SILS TAPP for inguinal hernia repair seems to be a feasible, safe method, and is comparable with TAPP technique. However, randomized trials are required to evaluate long-term clinical outcomes.

Comparison of mid-term clinical outcomes of laparoscopic partial cystectomy versus conventional partial cystectomy for the treatment of hepatic hydatid cyst.

BACKGROUND: The aim of this study was to compare the mid-term outcomes of open and laparoscopic partial cystectomy (LPC). METHODS: The medical records of patients who underwent conventional partial cystectomy (CPC) and LPC for liver hydatid cyst from May 2010 to February 2015 were retrospectively reviewed. Operative time, blood loss, length of hospital stay, post-operative morbidity, mortality and mid-term follow-up outcomes were evaluated. RESULTS: Amongst 130 patients, 38 patients were underwent LPC and 92 underwent CPC. Blood loss and post-operative complications were similar in both groups. The mean operative time in the LPC and the CPC groups was, respectively, 95.4 ± 13.1 and 63.5 ± 15.6 min, which showed a significant difference between the both groups. The mean length of hospital stay in CPC group was significantly longer when compared the LPC group. The mean diameter of cyst in LPC group was 6.1 ± 1.1 cm and 7.8 ± 2.1 cm in CPC group with a significant difference. The overall complication rates were 13.1% in LPC group and 17.3% in CPC group without significant difference. The most common complication was biliary leakage and surgical site infection. CONCLUSION: LPC for the surgical treatment of liver hydatid cyst appears to be safe and effective method with low morbidity rates in selected patients.

Migration of mesh into gastric lumen: A rare complication of vertical banded gastroplasty.

The problem of revision of failed vertical banded gastroplasty (VBG) has become a common situation in bariatric surgery. Sleeve gastrectomy (SG) has been recently used to revise failed restrictive procedures. This study presents a patient that is treated with Roux-n-Y gastric bypass because of mesh migration after SG for revision of failed VBG.

A New Approach to the Complicated Liver Hydatid Cyst--Laparoscopic Roux-en-Y Cystojejunostomy.

Surgery is still the gold standard in the treatment of hepatic hydatid disease. One of the major problems associated with hydatid cyst surgery is biliary fistula. In this report, we aimed to describe a laparoscopic internal drainage method for the treatment of complicated hepatic hydatid cyst in order to prevent long-term biliary fistulas. A 44-year-old female was referred to our clinic with the complaints of flank pain. On computerized tomography of the abdomen, an 8-cm hydatid cyst was detected on the right lob of the liver. Laparoscopic exploration demonstrated a cysto-biliary communication, and laparoscopic cystojejunostomy was performed to prevent long-term bile leakage. The patient was discharged on postoperative day 5 without any problems. In 45th days, nearly complete obliteration of the cavity was observed. Laparoscopic cystojejunostomy can be an effective and safe surgical approach for the treatment of complicated hepatic hydatid cysts.

Minimally invasive management of anastomotic leak after bariatric Roux-en-Y gastric bypass.

The aim of this retrospective study was to examine the anastomotic erosion due to drain and success of fibrin sealant in its management. Between 2013 and 2014, 102 patients underwent LRYGB and gastrojejunal anastomotic leak occurred due to drain erosion in 2 of them. The diagnosis was established with saliva drainage and was confirmed by upper gastrointestinal series. The absence of hemodynamic instability was directed us to conservative treatment. During the endoscopy, dehiscence was assessed and fibrin sealant was applied. The leaks healed progressively in a few days, and the drains removed within 6 days. Seven and 9 days later, the patients were discharged without any problem. Anastomotic leaks after bariatric surgery can cause severe morbidity, cost, and effects quality of life. Hemodynamically stable and drained patients are candidates for conservative methods. Endoscopic injection of fibrin sealant has been successful in closing gastric leaks.

Gallbladder paraganglioma.

Gallbladder paraganglioma is a very rare tumor, and only a few cases have been reported. Most of these cases were asymptomatic and found incidentally during operation. Our case involved a 57-year-old female patient complaining of intermittent right upper quadrant pain. Preoperative imaging demonstrated a mass in the neck of the gallbladder. Laparoscopic cholecystectomy was performed, and a frozen section of the gallbladder demonstrated a benign mass. The postoperative pathologic examination reported gallbladder paraganglioma and chronic cholecystitis. Immunohistochemically, the chief cells and sustentacular cells showed diffuse positivity with vimentin, synaptophysin, and S-100.

Assessment of the Quality and Reliability of Intragastric Balloon Videos on YouTube.

PURPOSE: There is no mechanism to control the accuracy and quality of videos on YouTube. However, it is essential to evaluate the quality of videos on YouTube to prevent patients from accessing misleading information. The aim of this study was to assess the quality and reliability of the videos available on YouTube concerning intragastric balloon. MATERIALS AND METHODS: YouTube was searched using the keywords "intragastric balloon" and "gastric balloon." A total of 158 videos were independently analyzed by two bariatric surgeons-endoscopists and were classified as reliable or non-reliable. Video demographics (view, view per day, like, dislike, comment) were analyzed according to the quality and source of the video. The video power index (VPI) was calculated for each video. The modified DISCERN and global quality scores (GQS) were used to rate the reliability and overall quality of the videos. RESULTS: Of the included videos, 63.9% were described reliable and 36.1% as non-reliable. The median number of dislikes, comments, views, views per day, and video duration on YouTube did not significantly differ between the two reliability groups. The mean length of the videos, GQS and DISCERN scores, and the median number of likes were significantly higher in the reliable group. The highest median VPI value was determined for the videos uploaded by TV programs. CONCLUSION: The number of reliable videos is higher than non-reliable about intragastric balloon on YouTube. However, the reliability and quality of the videos are generally low. The videos uploaded by TV programs are significantly more popular.

Comparison of Collagen Granule Dressing Versus Conventional Dressing in Patients With Diabetic Foot Ulcer.

Background. Diabetic foot ulcer (DFU) is a difficult, chronic wound with a significant long-term influence on the morbidity, mortality, and quality of life of patients. There is much information about the biochemical features of collagen and its function in wound healing. The aim of this study was to compare the results of DFU patients treated with and without collagen. Methods. A retrospective evaluation was made of the data of patients with DFU who underwent collagen treatment and physiological serum (PS) treatment. The patients were followed-up for a minimum of 12 weeks, and all complications, healing process, and wound characteristics were recorded. Results. Of the total 64 DFU patients included in the study, 30 were treated with PS and 34 with collagen. Complete closure was achieved in 17 (56.6%) of the PS group patients after 12 weeks of treatment. The rate was 25 (73.5%) in the collagen group. The mean duration of treatment was 9.2 weeks (range = 6-12 weeks) in the PS group and 8.08 weeks (range = 5-12 weeks) in the collagen group. The recovery time and recovery rates were determined to be better in the collagen group than in the PS group. Conclusion. A significant reduction in wound size was seen in the collagen group compared with the PS group. The results of this study demonstrated that collagen dressings are better than conventional dressings with regard to early granulation tissue and shorter hospital stay.

Comparison of the Keystone flap and the Limberg flap technique in the surgical treatment of pilonidal sinus disease.

Pilonidal sinus (PS) disease is a chronic inflammatory disease of the sacrococcygeal region. Although various methods have been described for surgical treatment, there is no consensus on the best surgical technique. The aim of this study was to present the results of a new advancement flap technique named the "Keystone flap (KSF)" and compared with the Limberg flap (LF) technique in pilonidal sinus surgery. A retrospective review was made of 124 consecutive patients surgically treated for PS disease with KSF and LF procedures. Baseline characteristics, operation time, volume of excised specimen, duration of hospitalization, duration of drainage, duration of healing, time to return to work, local complications and recurrence were evaluated and compared between the two procedures. Operation time, healing time, and time to return to work were significantly shorter in the KSF group. Partial wound dehiscense and prolonged wound healing were more common in the LF group. An additional intervention in the operating room was required by 21.1% of the LF group and was a significantly lower rate in the KSF group at 7.5%. There was no significant difference between the groups in terms of recurrence. The KSF procedure seems promising for treating pilonidal sinus disease, with the advantages of shorter operation, healing, and return to work times. It also provides lower partial wound dehiscence and necrosis rates.

Can Intralesional Epidermal Growth Factor Reduce Skin Graft Applications in Patients with Diabetic Foot Ulcer?

BACKGROUND: Diabetic foot ulcer (DFU) is a serious health problem. Major amputation increases the risk of mortality in patients with DFU; therefore, treatment methods other than major amputation come to the fore for these patients. Graft applications create an appropriate environment for the reproduction of epithelial cells. Similarly, epidermal growth factor (EGF) also stimulates epithelization and increases epidermis formation. In this study, we aimed to compare patients with DFU treated with EGF and those treated with a split-thickness skin graft. METHODS: Patients who were treated for DFU in the general surgery clinic were included in the study. The patients were evaluated retrospectively according to their demographic characteristics, wound characteristics, duration of treatment, and treatment modalities. RESULTS: There were 26 patients in the EGF group and 21 patients in the graft group. The mean duration of treatment was 7 weeks (4-8 weeks) in the EGF group and 5.3 weeks (4-8 weeks) in the graft group (P < .05). In the EGF group, wound healing could not be achieved in one patient during the study period. In the graft group, no recovery was achieved in three patients (14.2%) in the donor site. Graft loss was detected in four patients (19%), and partial graft loss was observed in three patients (14.2%). The DFU of these patients were on the soles (85.7%). These patients have multiple comorbidities. CONCLUSIONS: EGF application may be preferred to avoid graft complications in the graft area and the donor site, especially in elderly patients with multiple comorbidities and wounds on the soles.

The Short-Term Effects of Transit Bipartition with Sleeve Gastrectomy and Distal-Roux-en-Y Gastric Bypass on Glycemic Control, Weight Loss, and Nutritional Status in Morbidly Obese and Type 2 Diabetes Mellitus Patients.

PURPOSE: The aim of this study was to compare the postoperative metabolic and nutritional outcomes after transit bipartition with sleeve gastrectomy (TB-SG) and distal-Roux-en-Y gastric bypass (D-RYGB). MATERIALS AND METHODS: A retrospective evaluation was made of 109 morbidly obese patients who underwent TB-SG or D-RYGB. Primary outcomes included metabolic variables such as glycemic control and serum lipid levels, and secondary outcomes consisted of nutritional deficiencies and weight loss after surgical procedures. RESULTS: During the study period, 83 and 26 patients underwent D-RYGB and TB-SG, respectively. The preoperative characteristics and nutritional status of the groups were similar. D-RYGB resulted in significantly higher weight loss rates in the first 3 months, but the percentage of excess weight loss (EWL %) was not different in the 12-month follow-up period. Although D-RYGB provided faster glycemic control due to early weight loss, there was no difference between the two groups. At the end of the follow-up period, the TB-SG was associated with significantly less deficiency of vitamin D, vitamin B12, iron, and folic acid. Anastomosis leakage was more common in the D-RYGB technique. The overall complication rates of the groups were similar. CONCLUSION: TB-SG is a safe and effective alternative to D-RYGB for the treatment of obesity-related metabolic disorders with fewer nutritional deficiencies.

The Mid-Term Effects of Transit Bipartition with Sleeve Gastrectomy on Glycemic Control, Weight Loss, and Nutritional Status in Patients with Type 2 Diabetes Mellitus: a Retrospective Analysis of a 3-Year Follow-up.

BACKGROUND: Metabolic surgery is an effective treatment method for glycemic control and weight loss in obese patients with type 2 diabetes mellitus (T2DM). This study aimed to present the mid-term metabolic effects and weight loss results of the patients with T2DM who underwent transit bipartition with sleeve gastrectomy (TB-SG). METHODS: A total of 32 obese patients with T2DM who underwent TB-SG were included in the study. The T2DM remission status after surgery was evaluated. The postoperative glycemic variables, weight loss, lipid profile, and nutritional profile were also compared with the baseline values. RESULTS: At 36 months after surgery, T2DM remission occurred in 27 patients (84.3%) and the mean BMI decreased from 44.70 ± 9.34 to 29.75 ± 2.19 kg/m2. The percentage of total weight loss (TWL) and excess weight loss (EWL) was 33.84% and 77.19%, respectively. The mean LDL values significantly decreased compared to baseline; however, the mean HDL did not significantly differ. No significant difference was observed regarding the mean albumin, vitamin B12, and folic acid levels. CONCLUSION: TB-SG procedure seems promising in terms of T2DM remission and weight loss with less malnutrition and vitamin deficiency in treating obese patients with T2DM.

Comparison of the effects of cilostazol and aspirin on wound healing in patients with diabetic foot ulcer and peripheral artery disease.

Diabetic foot ulcer (DFU) is one of the most feared complications of diabetes mellitus. Studies report that the lifetimerate of developing DFU is 25% for patients with diabetes mellitus. In addition, peripheral artery disease (PAD) is seen in approximately 50% of patients with DFU. PAD increases the risk of amputation in patients with DFU and complicates treatment. This study aimed to compare the effects of cilostazol and aspirin on wound healing in patients with DFU and PAD. In the study, DFU patients with PAD were retrospectively reviewed. They were divided into two groups. One group was administeredcilostazoland the other was administeredaspirin. Patients were evaluated according to their demographic characteristics, wound characteristics, PAD symptoms, duration of treatment, and treatment grades. There were 30 patients in the cilostazol group and 20 patients in the aspirin group. Of the patients in the cilostazol group, seven(23.3%) had Wagner's grade 2, 16 (53.3%) had grade 3, and seven (23.3%) had grade 4 DFU. In the aspirin group this rate was 25%, 55%, and 20%, respectively. The mean size of the wound in the cilostazol group was 8.1 cm (2-25 cm), whereas it was 7.6 cm (5-25 cm) in the aspirin group. The mean ankle-brachial index (ABI) of the patients was 0.90 in the cilostazol group and 0.96 in the aspirin group. Five (23.3%) of the patients in the cilostazol group had triphasic, 19 (63.3%) biphasic, and six(20%) monophasic currents in the distal popliteal vein. In the aspirin group, these rates were 35%, 50%, and 20%, respectively. Of the patients in the cilostazol group, according to the Fontaine classification, six(20%) had stage 2A, 11 (36.7%) had stage 2B, 10 (33.3%) had stage 3, and three(10%) had stage 4 symptoms. In the aspirin group, these rates were 45%, 40%, 15%, and 0%, respectively. There was a complete response to treatment in 27 patients (90%) in the cilostazol group and 11 patients (55%) in the aspirin group. Partial response was present in the other patients. The mean duration of treatment was 1.31 months (1-2 months) in the cilostazol group and 1.82 months (1-2.5 months) in the aspirin group. In this study, it was observed that wound healing was faster in the cilostazol group, complete response to treatment was higher, and improvement in PAD symptoms was better compared to the aspirin group. KEY WORDS: Aspirin, Cilostazol, Diabetic foot ulcer.

The effects of chrysin in an experimental model of acute pancreatitis.

PURPOSE: This experimental study was conducted to evaluate the possible effects of orally administered chrysin on acute pancreatitis. MATERIAL AND METHOD: Twenty four rats were procured. The animals were randomly divided into four groups. In Group I, only vehicle solution (5% dimethylsulfoksid) was administered, and in Group II, chrysin dissolved in the vehicle solution was administered for six days. In Group III and Group IV cerulein was administered to induce acute pancreatitis. In Group III, only vehicle solution was administered, and in Group IV, chrysin dissolved in the vehicle solution was administered orally for six days. Blood samples were analyzed and the pancreatic tissue specimens were evaluated for histopathological examination. RESULTS: Group III and Group IV, exhibited markedly higher levels of serum WBC, amylase, and lipase, compared with Groups I and II. In the pancreatitis induced groups, CRP and TOS values were found to be significantly higher. In Group II and Group IV, TAS values were significantly higher. The highest calculated OSI values were observed in Group III. Group IV OSI values were significantly lower than those in Group III and even in Group I. Noticeable histopathological changes were identified in the pancreatitis induced Groups III and IV. Compared with Group III, the extent and severity of pancreatic injuries were markedly lower in Group IV. CONCLUSION: Chrysin application reduced oxidative stress and histopathological parameters. The present study shows that chrysin can be used to treat pancreatic diseases. KEY WORDS: Acute pancreatitis, Cerulein, Chrysin.

An overlooked complication of the inguinal hernia repair: Dysejaculation.

The objective of this study was to investigate the rate of post-herniorrhaphy dysejaculation in the current literature. A comprehensive search of PubMed, Medline, Google Scholar, and Google databases was performed using the keywords "groin hernia and chronic pain," "inguinal hernia and chronic pain," "dysejaculation," and "ejaculatory pain." The eligible studies were evaluated in terms of ejaculatory pain and surgical technique used. Ten studies with 122 patients were eligible for the analysis. The rate of ejaculatory pain for a total of 5521 patients was found to be 2.2%. The incidence of postoperative ejaculatory pain was found to be 2.1% following laparoscopic techniques and 1.1 % following open repair. Open techniques were not related to the increased frequency of dysejaculation. Sufficient data could not be obtained from the studies for the ejaculatory pain, and thus, no statistical evaluation was performed. Dysejaculation is a common cause of postoperative morbidity after inguinal hernia repair. Attention to technical details of the primary operation may reduce the incidence of dysejaculation.

Laparoscopic Ileal Interposition with Diverted Sleeve Gastrectomy Versus Laparoscopic Transit Bipartition with Sleeve Gastrectomy for Better Glycemic Outcomes in T2DM Patients.

BACKGROUND: Metabolic procedures provide better outcomes for obese patients with type 2 diabetes mellitus. Our aim was to compare the glycemic regulation in patients that have undergone the laparoscopic ileal interposition with diverted sleeve gastrectomy (II-DSG), laparoscopic transit bipartition with sleeve gastrectomy (TB-SG), and laparoscopic sleeve gastrectomy (LSG) throughout a 12-month follow-up period retrospectively. METHODS: This study considered patients with T2DM who underwent metabolic procedures. The postoperative changes in the glucose, C-peptide, HbA1c, HOMA-IR, insulin, cholesterol, body mass index, and total weight loss (TWL) were compared retrospectively. The intended outcome was to reach a long lasting fasting blood glucose (FBG) <126 mg/dl. A multivariate regression analysis was applied to define the predictive markers in glucose regulation. RESULTS: Present study consisted of 83 patients with a mean age of 47.25 ± 6.58 years, mean preoperative BMI of 37.36 ± 2.71 kg/m2, and mean outcomes in the HbA1C and FBG of 9.05 ± 1.33% and 237 ± 15 mg/dl, respectively. There were similar correlations in BMI and total weight loss (TWL). At 12-month follow up period, compared to LSG group, TB-SG and II-DSG groups have higher remission proportions (35.3, 67.9, 54.7, respectively, p < 0.05) with similar TWL% (22.35, 27.14, 23.16%) outcomes. The II-DSG and TB-SG results drew closer together toward the end of this study interval unlike the LSG group. CONCLUSION: Our results showed that II-DSG and TB-SG ensured significant regression rates during the follow-up period. Since the TB-SG achieved these outcomes by finite anastomoses and intervening segments, it was considered to be a superior procedure compared to II-DSG and LSG procedures.

Port site hernia after laparoscopic sleeve gastrectomy: a retrospective cohort study of 352 patients.

Port site hernia (PSH) following laparoscopic procedures is a rare but serious complication. The aim of this study was to evaluate the rate of PSH after laparoscopic sleeve gastrectomy (LSG), and the efficacy of closure of the port site as a means of preventing PSH. A retrospective analysis was performed on 386 patients who underwent LSG between December 2009 and January 2015. 352 (91.2%) of the patient were followed up for at least 24 months. In the first 206 patients, the fascial layers of the trocar incisions were not closed, while in the next 146 cases, routine closure of the trocar sites was performed. The patients were reviewed in relation to demographics, comorbidities, complications, percentage of excess weight loss, and rates of PSH. The total cohort consisted of 220 female and 132 male patients with a mean age of 36.2 ± 12.3 years. Demographic data, initial BMI, and comorbidities were similar for the patients in both groups. The closure of the fascia was caused by the prolonged duration of the operation with no significant difference. The unclosed fascial defects were associated with a significantly increased incidence of PSH (1.3 vs. 3.9%, p < 0.05). All of the patients who experienced PSH had at least one comorbidity, and no complication was noted in the fascial closure cases. It was found that the rate of PSH after LSG is not as low as previously thought, and that routine closure of fascial defects at port sites may result in a decreased PSH rate.