Laparoscopic management of non-midline incisional hernia: A multicentric study.

BACKGROUND: The laparoscopic repair of non-midline ventral hernia (LNM) has been debated. The aim of this study is to analyze our experience performing the laparoscopic approach to non-midline ventral hernias (NMVHs) in Northwest Italy for 6 years. METHODS: A total of 78 patients who underwent LNM between March 2008 and March 2014 in the selected institutions were analyzed. We retrospectively analyzed the peri- and postoperative data and the recurrence rate of four subgroups of NMVHs: subcostal, suprapubic, lumbar, and epigastric. We also conducted a literature review. RESULTS: No difference was found between the four subgroups in terms of demographic data, defect characteristics, admission data, and complications. Subcostal defects required a shorter operating time. Obesity was found to be a risk factor for recurrence. CONCLUSIONS: In our experience, subcostal defects were easier to perform, with a lower recurrence rate, lesser chronic pain, and faster surgical performance. A more specific prospective randomized trial with a larger sample is awaited. Based on our experience, however, the laparoscopic approach is a safe treatment for NMVHs in specialized centers.

A new method of jejunal reconstruction after pancreaticoduodenectomy.

Although advances in pancreatic surgery have reduced mortality rates, post-operative morbidity remains a frequent problem in patients undergoing pancreaticoduodenectomy. The single most significant cause of morbidity in these patients is the development of pancreatic fistula. In this study, we assessed the occurrence of pancreatic fistula after isolated Roux loop pancreaticojejunostomy with the use of a haemostatic collagen-fibrin patch (TachoSil) to prevent pancreatic leakage. A total of 27 patients (15 men and 12 women, mean age 59 years, range 19-74 years) underwent proximal Whipple-type resection. Ten patients underwent a classical pancreaticoduodenectomy while a pylorus-preserving pancreaticoduodenectomy was performed in the other 17 patients. Reconstruction was done using three-jejunal anastomosis, with TachoSil applied at the end of the pancreatic jejunal anastomosis, along the entire anastomotic circumference. None of the 27 patients who underwent pancreaticoduodenectomy developed pancreatic fistula. One patient had bleeding from the gastro-jejunal anastomoses, five patients had infections of surgical sites, and three patients developed bacterial pneumonia. There were no significant differences in duration of surgery or intra-operative blood loss between patients with soft or hard pancreatic tissue. The reconstruction technique described here with three independent jejunal loops appears to offer good protection against pancreatic leakage.