Abstract Background Inguinal hernia surgery is a common surgical procedure worldwide, with over twenty million surgeries being performed annually. However, healthcare delivery contributes significantly to pollution, accounting for 5 to 8% of greenhouse gas emissions in developed countries. This project aims to evaluate the environmental effects of inguinal hernia surgery throughout the patient's journey and identify opportunities for optimization. Method This study involves a process-based, multicenter evaluation of ten consecutive patients undergoing inguinal hernia surgery. It examines three key phases: preoperative, intraoperative, and postoperative. Critical variables for each phase were identified and measured according to established guidelines. Boundaries were set to include all relevant and achievable information. Results A structured form was developed with specific fields and detailed instructions for each phase. Preoperative data includes the number of consultations, commutes, and exams. Intraoperative data encompasses the number of personnel involved, the volume of anaesthetic gas used, and the quantification of surgical waste. Postoperative data includes the number of wound care treatments, consultations, and commutes. Direct emissions and primary and secondary process activity data will be measured, such as waste management, energy consumption, and commute estimation. Conclusion Environmental sustainability is increasingly recognized as crucial across all human activities, including healthcare. With the global population exceeding 8 billion, prioritizing health without considering environmental impact is no longer acceptable, especially if it does not provide significant value. Abdominal wall surgery, given its prevalence, offers an opportunity to optimize resources and reduce the environmental impact of healthcare.

Abstract Introduction Interstitial or intraparietal hernias are those placed between the two layers of the abdominal wall. They are rare and can be congenital or acquired. One of the presentations can be as bowel obstruction. Material and Method We present a case of a 71 caucasian male with primary ventral hernias and diastasis recti operated by laparoscopy performing a total extraperitoneal e-TEP with a retromuscular polipropilene mesh. The 4th postoperative day he complained with nausea and vomiting. CT scan demonstrated a bowel obstruction with a small bowell loop adherent to the abdominal wall, but no hernia was demonstrated. Conservative treatment was tried without result. He was operated again 7 days after the first surgery by laparoscopy approach. An interstitial hernia with intestinal obstruction was confirmed with 1,4 m of small bowel in the abdominal wall. The hernia was reduced, and a suture was performed to close the defect. We present the video of both surgeries, the e-TEP and the interstitial hernia repair. Conclusion Even when the repair is extraperitoneal, the tension created with the closure of the posterior fascia can lead to a small hole where a loop of small intestine can pass creating the interstitial hernia. This is a diagnostic we need to have in mind and, when a postoperative obstruction is not rapidly solved, we have to re-operate the patient.

Abstract Introduction Congenital diaphragmatic hernias have an incidence of 1 in 2000 to 1 in 3000 births. Of them, about 70% are postero-lateral defects (Bochdalek hernias BH). Most of them are symptomatic in newborns with respiratory complaints. In adults, they can produce vague or nonspecific gastrointestinal complaints. When a BH is diagnosed in adult patients, surgery is recommended when it is symptomatic or even asymptomatic, when the patient is fit for surgery. Material and method We present the case of a 53 African male with the incidental diagnosis of a BH in a thoracic CT scan with fat and splenic colon in the hernia. A laparoscopic approach was performed. The hernia was dissected with the reduction of the viscera and the visualization of the diaphragm. We performed a suture of the diaphragmatic edges, and a coated mesh was used to reinforce the diaphragm. The mesh was fixed with resorbable tuckers in the lower part and with barbed suture in the upper part. The patient was discharged 24 hours after surgery. Discussion BH has risk of growing because of the negative pressure of the thorax. The risk of an incarceration of a viscera in the thorax can develop serious complications. Laparoscopic approach is a minimally invasive access that allows a good repair of diaphragmatic hernias with a fast recovery. For theses reasons we recommend laparoscopic repair of BH.

Abstract Aim Lateral incisional hernias with denervation of the muscles of the abdominal wall are a problem difficult to solve. The repair of the defect does not guarantee a functionality of the abdominal muscles if the lack of force of the abdominal wall is not solved. With the technique we present there is a minimally invasive reinforcement of the mid lateral wall affected. Material and Method 54 yo female. Previous surgeries: biliary cystadenoma 2014 by Makuuchi laparotomy (2 surgeries), Ooforectomy 2011, Hysterectomy 2013, Mamoplasty 2001, 3 vertebral surgeries. Six months after the surgery she felt a growing lump in the right side of the incision. Physical exam: right lateral incisional hernia and small umbilical hernia. Asymmetry of the abdominal wall because of flaccidity of the right abdominal muscles. Ultrasound Voluminous incisional hernia in the right flank dependent of the right transverse sub-costal incision with a hernia ring of 20mm and hernia sac 60mm of diameter increasing with Vasalva maneuvers. Surgical technique Hybrid approach laparoscopic and lateral by e-TEP to dissect the retrorectal bilateral space and lateral preperitoneal approach with reverse TAR. A macroporous polipropilene preperitoneal mesh is placed from the right psoas to left semilunar line and from top to bottom of the abdominal wall. Result Discharged 2nd po. day without complications. 5 months after surgery she has a symmetric abdominal wall without recurrence. Conclusion Hybrid technique to repair lateral hernias with denervation allows a wide repair with low morbidity and good tolerance with excellent result in abdominal functionality.

Postoperative rectovesical fistulas require surgical intervention for their treatment. We present a case treated by placement of a silicone self-expanding prosthesis in the rectum and vesical drainage and give technical details of the procedure.