Ventral Hernia Repair and Drainage - A Prospective, Observational, and Comparative Study of Outcomes.

Background: While ventral hernia repair is a frequent surgical intervention, the possibility of complications remains present. The use of drains to mitigate complications is a topic of debate, with conflicting evidence. This study aimed to evaluate the association between drain usage and postoperative complications in ventral hernia repair. Materials and Methods: A single-center prospective study included patients undergoing ventral hernia repair from 2018 to 2022. Patient data and surgical techniques were recorded. Statistical analysis was performed to assess risk factors for drain insertion and complications. Results: Of the 216 patients included, 19.44% had diabetes, and 20% had cancer. Postoperative complications (Clavien Dindo grade IIIB) occurred in 9.3% of cases, resulting in a 3.7% mortality. Decision factors for drain insertion included older age, larger hernia size, bowel resection with anastomosis, emergency setting and the need for adhesiolysis. No differences were found between the two groups regarding seroma and hematoma formation and mesh infection. Patients with drains had a longer hospital stay and higher costs. Conclusion: The decision to use drains in ventral hernia repair was influenced by surgical complexity factors rather than patient characteristics. While drain usage did not correlate with postoperative morbidities, it was associated with longer hospitalization and higher costs. Individualized decision-making is crucial to balance complications and resource utilization in ventral hernia repair.

Risk Factors for the Development of Parastomal Hernia: A Narrative Review.

Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.

Histology of Male Breast Lesions. Series of Cases and Literature Review.

BACKGROUND: Breast carcinoma is the most important cause of death in women's oncologic pathology worldwide. Due to its high frequency, important advances in diagnostic and management of this entity were made. Because of its rarity (only 0.5-1% in all breast cancers), little is known about male breast cancer, and no specific male standardised protocol was made, treatment and follow-up being adopted from women breast cancer guidelines. We consider that this entity, with its hormone specific profile, is worth being considered for further studies, taking into account that male breast cancer has a far worse prognostic than female breast cancer. METHODS: We present our four-year experience with male breast lesions in a retrospective review study, including gynecomastia and breast carcinoma cases. RESULTS: We identified 17 male breast lesions, 11 of them with a diagnosis of gynaecomastia, the rest being breast carcinomas. Four malignant lesions were encountered in the 5th, 6th and 7th decade, with two of them in young adults (35 and 40 years old). In a single case, two different histotypes of breast carcinoma were found. All of them were G2, with tumoral stages varying between IB to IV. Androgen receptors were expressed in each case, in different percentages. CONCLUSION: Male breast carcinoma is a rare entity with a poor prognosis, a diffuse and profound invasion of adjacent structures, and a high expression of hormone receptors, and with no histologic relation to gynaecomastia, considering that no associated benign lesions were found.