Many techniques can reapproximate fascia during herniorrhaphy. Reports suggest utility of interrupted figure-of-eights for large defects less amenable to running suture closures. However, anecdotal concerns regarding 'ischemic' qualities of figure-of-eights may dissuade utilization, despite no substantiating evidence. This study compares wound morbidity for figure-of-eights vs running sutures for fascial closure during open ventral hernia repair (VHR). A prospectively maintained hernia-specific registry was queried for open VHRs from 1/1/2014 to 12/31/2023 with fascial closure, ≥ 10cm defect width, CDC Class 1 wound, fascial closure via figure-of-eights or running suture, and clinical follow-up at 30days. Cases featuring anterior myofascial or cutaneous flaps were excluded. Surgical site occurrence (SSO), surgical site infection (SSI), SSO/SSI requiring procedural intervention (SSO/I-PI), recurrence, and patient-reported quality-of-life (QoL) at 30-day and 1-yearintervals were considered. SSO at 30days was selected as the primary outcome to serve as a surrogate for suture line ischemia, and 1-year recurrence was a key secondary outcome of interest. Baseline factors including age, BMI, gender, race, ASA class, immunosuppressant use, smoking, diabetes, hernia width, and hernia length were controlled via multivariable regression. A total 4195 cases met criteria and 31% utilized figure-of-eights (n = 1317). Multivariable logistic regression found no increased risk of 30-day SSO or 1-year recurrence for figure-of-eight vs running suture closure. Adjusted odds of SSI (OR 1.47; 95% CI 1.11, 1.95) and SSO/I-PI (OR 1.31; 1.02, 1.70) were greater for figure-of-eight closures. No associations were identified regarding patient-reported QoL or 1-year outcomes. This retrospective analysis of wound morbidity in clean cases identified an increased risk of SSI and SSO/I-PI for figure-of-eight closures at 30days vs running closures. Though the association may relate to residual confounding from selective utilization in high complexity repairs rather than an ischemic nature, the results suggest figure-of-eights should perhaps be reserved for challenging or high-tension fascial reapproximation.

The use of abdominal supports after ventral hernia repair remains common practice despite inconsistent evidence and lack of clear recommendations. Concerns persist that more rigid devices may be poorly tolerated in the early postoperative period. To compare early postoperative patient-reported health state, functional outcomes, global preference, and willingness to recommend an elastic abdominal binder and a semi-rigid corset. In this prospective randomized within-subject cross-over study, 23 patients following open sublay repair of large ventral hernias were sequentially fitted with an elastic abdominal binder and a semi-rigid corset on postoperative day 2-3. Each device was worn for approximately three hours during routine postoperative activities. Patient-reported outcomes were assessed using VAS and EQ-5D-5L questionnaires. Global preference and willingness to recommend each device were recorded. VAS scores were comparable between devices (p = 0.36), indicating no deterioration in perceived health state with corset use. No EQ-5D-5L domain was rated worse with the corset. Significant improvements were observed for usual activities and anxiety/depression. A majority of patients preferred the corset (69.6%), and significantly more patients recommended it compared to the binder (95.7% vs. 65.2%, p = 0.039). Semi-rigid corsets were not associated with worse early postoperative tolerance and were more frequently preferred and recommended by patients. Early tolerance of semi-rigid supports may influence patient acceptance of postoperative abdominal support strategies, although long-term adherence was not assessed in the present study. These findings challenge the assumption that more rigid supports are poorly tolerated and support considering semi-rigid corsets as a viable option after open ventral hernia repair.

Asymptomatic contralateral patent processus vaginalis (CPPV) is commonly detected during the laparoscopic repair of inguinal hernias in children and is a risk factor for metachronous contralateral inguinal hernias (MCIHs). However, predicting CPPV preoperatively is challenging, and evidence on its clinical predictors is limited, particularly regarding sex-specific differences. We aimed to identify preoperative predictors of CPPV and to evaluate sex-specific risk factors. This retrospective observational study was conducted at a single tertiary-care university hospital and included children (aged < 16years) who underwent single-incision laparoscopic percutaneous extraperitoneal closure for a clinically unilateral inguinal hernia or hydrocele between 2013 and 2024. Those who underwent surgery for a recurrent inguinal hernia, MCIH, or bilateral presentation were excluded. The preoperative clinical characteristics were analyzed. Missing data were addressed using multiple imputation before conducting multivariable logistic regression analyses in the overall and sex-stratified cohorts to determine the independent predictors of CPPV. Overall, 1031 children (502 males, 529 females) were included. CPPV was identified in 511 (49.6%) patients. In the multivariable analysis of the overall cohort, left-sided presentation and history of incarceration were independently associated with CPPV, whereas sex was not. In sex-stratified analyses, hydrocele was independently associated with CPPV in males (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.06-2.45; P = 0.03). In females, left-sided presentation (OR, 2.80; 95% CI, 1.94-4.03; P < 0.001), incarceration history (OR, 5.19; 95% CI, 1.39-19.30; P = 0.014), and older age (OR, 1.01; 95% CI, 1.00-1.01; P = 0.046) were associated with CPPV. Preoperative predictors of CPPV showed sex-specific patterns. Sex was not an independent predictor; however, hydrocele was associated with CPPV in males, whereas, in females, left-sided presentation and incarceration history showed strong independent associations with CPPV. These findings may inform preoperative counseling, operative approach selection, and meticulous contralateral laparoscopic exploration, potentially reducing the risk of subsequent MCIH.

There is a complex relationship between gastroesophageal reflux disease (GORD), hiatus hernia, obesity, and metabolic bariatric surgery. We report the outcomes of laparoscopic hiatus hernia repair (HHR) with BIO-A® mesh in the management of GORD post LSG in patients who developed a hiatus hernia with migration of the proximal gastric sleeve. A retrospective review of 50 patients who previously underwent LSG and revisional surgery (HHR, n = 25; RYGB, n = 25) between 2011 and 2022. The modified DeMeester scoring system was used to assess the severity of the patient's GORD symptoms pre-HHR/pre-RYGB and 6 months post-op. Twenty-five patients underwent HHR with BIO-A® mesh following a previous LSG. The severity of GORD six months post-HHR was significantly lower (0.96 ± 0.84 vs. 2.60 ± 0.50, p = < 0.0001). After HHR, 3/25 (12%) patients had ongoing GORD symptoms that were not medically controlled and underwent conversion to RYGB. In contrast, 25 patients underwent direct conversion to RYGB following a previous LSG. The severity of GORD at 6 months post-RYBG was significantly lower (0.40 ± 0.50 vs. 2.36 ± 0.64, p = < 0.0001). At six months, there was no significant difference in GORD symptoms when HHR was compared with RYGB (3.32 ± 1.6 vs. 3.76 ± 1.54, p = 0.4296). In appropriately selected patients, HHR with BIO-A® mesh appears safe and effective in managing persistent GORD following LSG, within the limits of this study. However further research is needed to explore its role and the long-term outcomes.

Postsurgery recovery is a multifaceted and dynamic process. Recent reports recommend using condition-specific patient-reported outcome measures to evaluate surgical recovery. This study aimed to examine the psychometric properties of the Abdominal Surgery Impact Scale (ASIS) in the Turkish population. This methodological study included 181 patients who primarily underwent minor or intermediate abdominal procedures. The scale was applied twice: in the early postoperative period and one month postoperatively. Content validity, construct validity, item analysis, internal consistency, and responsiveness were evaluated. Most participants underwent hernia surgery (44.2%) or cholecystectomy (41.4%); only 7.7% had major surgery. Responsiveness analysis showed that mean total ASIS-TR scores increased significantly (p < 0.001) from the early postoperative period (77.71 ± 23.60) to one month postoperatively (116.08 ± 14.50). The ceiling effect of the one-month postoperative scale was 40.3%. Item-total correlations ranged from 0.33 to 0.75. Internal consistency was high (McDonald's ω = 0.91, Cronbach's α = 0.91), with domain ω values ranging from 0.51 for Visceral Function to 0.94 for Psychological Function. The fit indices at the two time points supported construct validity. Early fit index values were as follows: χ2/df = 2.08, RMSEA = 0.07, CFI = 0.93, IFI = 0.93, TLI = 0.91, GFI = 0.87. The ASIS-TR demonstrated acceptable to high reliability, validity, and responsiveness. However, these findings should be interpreted cautiously given the predominance of minor surgical procedures, the presence of a ceiling effect, and the low reliability of the Visceral Function domain. Future research involving multicentre recruitment should be conducted with patient populations undergoing major gastrointestinal surgeries, and convergent validity and test-retest reliability should be evaluated.

Umbilical hernia is a frequently encountered surgical condition. Its optimal repair method remains debatable. This retrospective study presents a novel technique for umbilical hernia repair, the single-incision laparoscopic (SIL) preperitoneal repair, and compares it with the currently most widely adopted technique, intraperitoneal onlay mesh (IPOM). We reviewed cases of umbilical hernias (> 1cm) treated with either SIL or IPOM at our center, detailing the SIL procedure and comparing demographics, complications, costs, and outcomes. In the study of 107 umbilical hernia patients, 61 underwent SIL repair and 46 underwent IPOM repair. Both groups had similar baseline characteristics. SIL had a shorter median operating time (57 vs. 64min, p = 0.030) and a shorter postoperative stay (2 vs. 2.7days, p = 0.019). SIL also had lower hospitalization costs (1709.7 ± 177.3 vs. (2545.4 ± 528.0 EUR, p < 0.001). No recurrences or mesh infections were observed during follow-up. Compared to the current laparoscopic IPOM plus standard, SIL preperitoneal repair demonstrates comparable safety and represents a feasible and reproducible minimally invasive alternative within the extraperitoneal spectrum. While this study observed shorter operative time and lower institutional costs, these findings should be interpreted with caution. No recurrences were observed during the short-term follow-up. This technique can be standardized, but further comparative studies are required to define its role relative to other established repairs.

Despite being one of the most common procedures worldwide, with over 20 million cases annually, hernia repair overall continues to pose persistent challenges to clinicians. Challenges such as recurrence, chronic pain, and surgical site infections. Aside from surgical technique, preoperative optimization and postoperative follow-up can influence patient outcomes. However, practices vary widely and are influenced by practice type and patient-level barriers. We conducted a cross-sectional survey of practicing surgeons worldwide through Facebook hernia and abdominal wall surgery groups. The anonymous survey assessed existing prehabilitation programs, follow-up, and perceived limitations to optimal care. A total of 145 surgeons from 22 countries participated. Of these, 58% were abdominal wall and hernia specialists and 44% practiced in dedicated hernia centers. Overall, 74% routinely recommended prehabilitation and 66% did so for all patients. The most common components were weight loss, smoking cessation, and glycemic control. Surgeons in hernia centers were more likely to recommend smoking cessation (p = 0.005), diabetes control (p = 0.04), and exercise (p = 0.03). Specialists more frequently recommended prehabilitation in more than 75% of ventral hernia cases (p = 0.001) and atypical hernias (p < 0.001). Hernia society membership was the only independent predictor of routine prehabilitation recommendation (OR 6.30; 95% CI 1.56-29.58; p = 0.01). Regarding postoperative follow up, 50% reported a standardized protocol for all hernias and 30% for high risk or complex cases only. Follow up was primarily in-person 77%. Hernia centers more frequently reported longer term follow up of 1-5years for inguinal (p = 0.02), umbilical (p = 0.03), and non-complex ventral hernias (p < 0.001), as well as life-long follow up across hernia types. Abdominal wall and hernia specialty was independently associated with standardized follow-up protocols (OR 4.74; 95% CI 1.36-18.1; p = 0.017). Prehabilitation and follow-up remain heterogeneous with adherence limited by the combination of patient, surgeon, and system-level barriers. Differences in practices between high- and low-volume surgeons suggest opportunities for society-driven guidance, extending standardized protocols, and deploying adherence tools to improve consistency and outcomes.

Minimally invasive surgery (MIS) for congenital diaphragmatic hernia (CDH) has previously been associated with higher recurrence rates and uncertain indications compared with open surgery. Since 2017, the Japanese Congenital Diaphragmatic Hernia Study Group (JCDHSG) has implemented a standardized national protocol, potentially improving perioperative management and surgical outcomes. This multicenter retrospective study analyzed 1,081 infants who underwent definitive CDH surgery at 15 tertiary centers in Japan between 2007 and 2023. Patients were categorized by surgical approach and period: early-period MIS (≤ 2016, n = 62), late-period MIS (≥ 2017, n = 109), early-period open (≤ 2016, n = 536), and late-period open (≥ 2017, n = 374). In-hospital mortality was assessed for the "Intended-MIS" group (including conversions), while surgical outcomes and recurrence were evaluated for the "Complete-MIS" group (successfully completed procedures without conversion). In the Intended-MIS group, the conversion rate dropped significantly from 29% in the early period to 10% in the late period (p < 0.01). Compared with the early period, the late-period MIS group had lower severity indices (oxygenation index < 8: 76.6% vs. 93.3%, p = 0.012; Terui category 3: 11.4% vs. 1.1%, p = 0.007). In the Complete-MIS group, early postoperative recovery improved, with a higher rate of ventilator weaning within 7days (20% vs. 58.3%, p < 0.001). The recurrence rate at discharge in the Complete-MIS group decreased significantly (8.2% vs. 1.0%, p = 0.044), while remaining unchanged in the open surgery group. In-hospital mortality in the Intended-MIS group was eliminated in the late period (3.2% vs. 0%, p = 0.252). Following nationwide protocol implementation, MIS for CDH has evolved into a safe and effective alternative to open surgery in carefully selected neonates. Improved patient selection based on physiologic severity, stabilization of technical proficiency, and advances in perioperative management have led to earlier respiratory recovery and a significant reduction in recurrence.

To evaluate hernia recurrence,postoperative complications,and patient reported outcomes after combined open ventral hernia repair(OVHR)and rectus diast asis(RD)reconstruction with abdominal wall contour correction in postpartum women. This retrospective study included women (BMI < 30kg/m2) with symptomatic ventral hernia ≥ 1cm and concomitant RD ≥ 3cm who underwent elective combined repair between 2018 and 2024. All patients had completed childbearing, experienced functional complaints, and maximized physiotherapy benefit. Primary outcomes were hernia recurrence and postoperative complications, classified as surgical site occurrences (SSO) and SSO requiring procedural intervention. Secondary outcomes included functional, physical, and cosmetic patient-reported outcomes. Fifty-nine patients were included. Wound-related complications occurred in 38.9%,mainly wound dehiscence (18.6%) and umbilical necrosis (13.6%).Wound infection occurred in5.1%, with 3.4% requiring radiologic drainage and1.7%reoperation. Significant postoperative improvements were observed in abdominal pain (93.2% to 15.3%, p < 0.001), back pain (64.4% to3.4%, p < 0.001) abdominal swelling (59.3% to5.1%, p < 0.001), abdominal wall dysfunction (100% to8.5%, p < 0.001), and physical limitations (61.0% to 0%, p < 0.001). Dissatisfaction with abdominal aesthetics decreased from 100% preoperatively to 18.6% postoperatively (p < 0.001). No hernia recurrence occured. Combined OVHR and RD reconstruction in postpartum women results in substantial improvements in pain, function, and abdominal wall aesthetics without hernia recurrence. Despite notable wound-related complications, outcomes support the functional and quality-of-life benefits of a multidisciplinary surgical approach. Prospective studies are needed to confirm these findings and optimize perioperative strategies.

Postoperative pain management is a significant concern in surgery. This study aimed to compare the effects of two drug combinations, ropivacaine-dexmedetomidine and ropivacaine-ketamine, administered subcutaneously for postoperative pain control in patients undergoing inguinal hernia repair. In this double-blind clinical trial, 140 patients scheduled for inguinal hernia surgery using the Lichtenstein technique at Valiasr Hospital in Arak were enrolled. They were randomly allocated into two treatment groups: dexmedetomidine + ropivacaine and ketamine + ropivacaine. The first group received dexmedetomidine 1µg/kg plus ropivacaine 0.75% (3mg/kg) diluted to a total volume of 10 mL with distilled water. The second group received ketamine 100mg plus ropivacaine 0.75% (3mg/kg) diluted to a total volume of 10 mL with distilled water. In both groups, subcutaneous injections were administered at the surgical incision site, which was then marked. Pain was assessed using the Visual Analog Scale (VAS) in the recovery room and at 2, 4, 6, 12, and 24h postoperatively by a specialized surgical assistant. Changes in heart rate, mean arterial pressure, duration of analgesia, total opioid consumption, and complications were also recorded. Data were analyzed using SPSS version 20. The mean pain score was significantly lower in the dexmedetomidine + ropivacaine group compared to the ketamine + ropivacaine group (P < 0.001). The mean duration of analgesia was significantly shorter in the ketamine + ropivacaine group (P = 0.001). The mean opioid consumption was significantly higher in the ketamine + ropivacaine group (P = 0.01). Dexmedetomidine, compared to ketamine, provides superior pain reduction, prolongs analgesia duration, and decreases opioid requirements following inguinal hernia repair using the Lichtenstein technique.

Paraconduit hernia after esophagectomy: Impact of operative technique on its incidence and recurrence.

Current guidelines recommend both anterior and posterior approaches for groin hernia repair; however, open preperitoneal techniques remain underrepresented due to the limited availability of large-scale data. This study evaluated the perioperative and short-term outcomes of a tailored open groin hernia repair strategy in an ambulatory setting. This retrospective single-center study included all adult patients who underwent open groin hernia repair between April 2003 and November 2021 at a specialized ambulatory clinic in Japan. Repair techniques were individualized according to hernia morphology and patient characteristics, incorporating anterior and preperitoneal approaches. Perioperative variables, complications, chronic pain, and recurrence were analyzed descriptively using the SPSS software program. A total of 7,424 patients with 7,516 groin hernia lesions were included in the analysis. Indirect hernias accounted for 73.8% of the lesions, and preperitoneal repair was the most frequently performed procedure (60.9%). Most procedures were performed under local anesthesia (70.7%). The mean operative time was 52.7 ± 13.5min. Postoperative complications occurred in 0.34%, reoperation in 0.07%, and unplanned admission in 0.13%. Chronic pain was observed in three patients in the study. Recurrence occurred in 0.41% of patients at a mean follow-up of 68.1 ± 65.8 months. Tailored open groin hernia repair can be safely implemented in a high-volume ambulatory setting, supporting individualized open strategies beyond the conventional Lichtenstein technique.

Since laparoscopic surgery is performed with carbon dioxide (CO2) insufflation, it is known to have some metabolic consequences. Due to these metabolic changes, some clinicians may prefer open surgery for inguinal hernia in patients with pulmonary comorbidities. Our study aimed to compare the metabolic and systemic perioperative effects of preperitoneal insufflation with those of intraperitoneal insufflation. This prospective controlled study included 20 patients who underwent totally extraperitoneal (TEP) inguinal hernia repair and 20 patients who underwent laparoscopic cholecystectomy. End-tidal carbon dioxide (ETCO2), peak inspiratory pressure (PIP), vital parameters, and arterial blood gas analysis results [pH, bicarbonate (HCO3-), partial pressure of carbon dioxide (PCO2), and lactate] were recorded before insufflation and at 10 and 20 minutes after insufflation. These parameters were compared between the 2 groups. In comparison between groups, no statistically significant differences were found in terms of age, gender, ASA score, or BMI (P>0.05). In both groups, within-group analyses of HCO3, ETCO2, and PCO2 showed that 10-minute measurements were significantly higher than preinsufflation and 20-minute measurements (P<0.05), whereas lactate levels did not show significant variation. When vital parameters were evaluated within-group analysis, diastolic blood pressure and pulse were observed to be lower in both groups at preinsufflation compared with the 10- and 20-minute measurements (P>0.05). No statistically significant difference was observed between the groups when preinsufflation 10-minute and 20-minute analyses were evaluated for all parameters (P<0.05). On the basis of the standardized intergroup analyses of pulmonary and metabolic parameters, preperitoneal and intraperitoneal CO2 insufflation demonstrated similar perioperative respiratory and metabolic effects. Laparoscopic inguinal hernia repair, which offers rapid postoperative recovery, does not appear to impose a greater metabolic burden than laparoscopic cholecystectomy. Therefore, laparoscopy may be considered a primary surgical approach for inguinal hernia repair, similar to cholecystectomy.

Neoumbilical reconstruction after complex abdominoplasty or abdominal wall reconstruction (AWR) remains inadequately addressed by conventional techniques, which anchor cutaneous flaps to the anterior rectus fascia and require aggressive defatting to the deep fascia - principles incompatible with the presence of surgical mesh and with the compromised vascular territory of the post-abdominoplasty abdominal wall. We describe the Trisquel neoumbilicoplasty, a three-flap spiral technique designed to provide a reproducible and AWR-safe reconstructive option for high-risk patients in whom umbilical preservation is not feasible. The technique is performed as a delayed procedure, no earlier than three months after the index operation, under local anesthesia in an office setting. A central 15mm circle with three curvilinear arms at 120° separation is marked over the neoumbilical position. Three strictly cutaneous flaps are elevated in the plane of Camper's fascia, preserving the full thickness of subcutaneous fat and the subdermal vascular plexus. A central pocket is then created down to the deep surface of Scarpa's fascia, which is rigorously preserved as the anchoring substrate; the lateral cellular walls of the pocket are deliberately left intact. Three absorbable monofilament sutures invert and anchor each flap tip to Scarpa's fascia. A small intradermal antiseptic gauze bolster is secured in place with a tie-over suture and removed on postoperative day 5. The technique was performed in 15 consecutive patients (13 female, 2 male; mean age 45.9 ± 9.0 years; mean body mass index 27.4 ± 3.0kg/m²), with a follow-up ranging from 22 to 46 months (mean 30.5 ± 6.6 months). Eight patients (53.3%) had previous polypropylene mesh placement for abdominal wall reconstruction. Flap viability was preserved in all cases, and no mesh-related complications, deep surgical site infections, reoperations, or cases of progressive flattening were observed. Minor complications occurred in 4 patients (26.7%), all of them mesh-bearing and with clustered high-risk features (active smoking, body mass index ≥ 30kg/m², or diabetes mellitus); all four were limited subcutaneous seromas managed by percutaneous aspiration, without impact on the underlying hernia repair. Final morphological outcome was graded as excellent in 9 patients (60.0%) and good in 6 (40.0%). The Trisquel neoumbilicoplasty is a reproducible three-flap spiral technique specifically designed for the constraints of abdominal wall reconstruction. The three cutaneous flaps behave biologically as pedicled dermo-cutaneous grafts, an analogy borrowed from mucogingival and maxillofacial surgery that explains their consistent survival in compromised tissue beds. The technique offers a safe reconstructive option at the intersection of hernia surgery and body contouring, an area currently underserved by the neoumbilicoplasty literature.

Spermatic cord lipomas (SCLs) are benign adipose lesions commonly encountered during inguinal hernia evaluation or surgery. Their clinical significance lies in their frequent mimicry of inguinal hernias and other inguinoscrotal masses, which may lead to diagnostic confusion and inappropriate management. A systematic review of literature from databases including PubMed, Scopus, Embase, and SpringerLink was conducted. Studies focusing on prevalence, diagnosis, management, and outcomes of SCLs were included. SCLs account for 30%-35% of benign spermatic cord tumors and are often confused with inguinal hernias. Imaging modalities such as ultrasound, CT, and MRI have improved diagnostic accuracy. Surgical excision remains the primary treatment, with both open and laparoscopic techniques showing high success rates. Increased awareness of SCLs among surgeons is crucial for accurate diagnosis and optimal management. Further research is needed to evaluate long-term outcomes of surgical versus conservative management.

We evaluate the association between pre-extracorporeal membrane oxygenation (ECMO) markers of impaired oxygen delivery, as quantified by the impaired oxygen delivery index (iD o2 ; Etiometry, Boston, MA) and neurologic outcomes in infants supported on ECMO. A single-center retrospective cohort study using demographic and clinical data along with iD o2 metrics calculated at 120-minute intervals before ECMO initiation. Primary outcomes included mortality, electroencephalography abnormalities, and head imaging findings. The secondary outcomes included brain MRI abnormalities and Functional Status Score (FSS) at discharge. Pediatric ECMO center in North America. We included infants younger than 1 year old who were supported on ECMO between 2013 and 2017. We excluded cases with congenital diaphragmatic hernia or postcardiac surgery ECMO. None. We identified 47 infants meeting the inclusion criteria. Median (interquartile range [IQR]) age and weight at ECMO initiation were 16 days (IQR, 6-112 d) and 3.3 kg (IQR, 2.8-4.8 kg). The overall mortality was 26 of 47 (55% [95% CI, 41-69%]). Nonsurvival compared with survival was associated with a greater proportion of patients with congenital heart disease ( p = 0.03) and pre-ECMO cardiac arrest ( p = 0.006). Time spent above iD o2 thresholds of 25%, 50%, and 75% increased closer to ECMO initiation. Higher iD o2 dose correlated with adverse neurologic outcomes, including electroencephalography abnormalities and abnormal imaging. Last, a logistic regression model for poor outcome (composite of death and FSS), including the time spent above the three iD o2 thresholds at the three time intervals pre-ECMO, showed classification model performance with an area under the receiver operating characteristic curve 0.81 (95% CI, 0.7-0.92; p = 0.0002). Markers of impaired oxygen delivery, such as iD o2 in the 6 hours before ECMO are associated with subsequent outcome. Incorporation of these metrics into clinical decision-support systems need to be prospectively tested and evaluated.

The Effect of Reflective Blankets on Reducing Inadvertent Perioperative Hypothermia in Abdominal Surgery Patients: A Randomized Controlled Trial.

We aimed to investigate the impact of rationalizing general surgery surgical tray sets at an elective surgical hub in England. This was an analysis of data collected prospectively for a clinical quality improvement project between 25th March and 20th June 2024. Baseline data on use of surgical instruments for four general surgery procedures were collected, and the items categorized as high, medium and low use. Meetings were then held with surgical and operational teams involved in delivering each procedure and a set of surgical instruments for each procedure agreed upon and a rationalized tray was formed. Data were collected for 39 rectal procedures, 42 open hernia repairs, 15 laparoscopic hernia repairs and 14 laparoscopic cholecystectomies. A tailored rectal procedure tray was formed with 16 items from the original53 items small basic tray; the two trays used for open hernia repair were rationalized from 53 to 43 items (small basic tray) and 75 to 60 items (large basic tray). The same laparoscopic tray was used for hernia repairs and cholecystectomies and was rationalized from 55 to 45 items. Estimated base-case annual financial savings were £16,863 and carbon savings 42.6 kgCO2e for these four procedures. Saving of up to £62,648 and 3612.9 kgCO2e annually may be realized if rationalization avoids opening a second tray to obtain items not present for use on a single tray. Rationalization of surgical trays can reduce financial costs and carbon emissions. It may also yield co-benefits in terms of enhancing theater efficiency.

PurposeMany studies compared the outcomes of hernia repair in children between open and laparoscopic techniques. However, the results still need to be clarified. Moreover, the reports from developing countries are also limited.MethodsWe compared the outcomes of hernia repair between the open and laparoscopic techniques in children and associated them with risk factors.ResultsWe involved 92 children, consisting of laparoscopy (36 males and 10 females) and open (42 males and 4 females) methods. There was a significant difference between 2 groups regarding the gestational age and age at surgery (both P < 0.001). Laparoscopy had a shorter length of stay (LOS) than the open group (1.09 ± 0.28 days vs. 1.37 ± 0.57 days, P = 0.004), while the duration of surgery was similar in both groups (P = 0.801). Multivariate analysis revealed no significant association between the recurrence of hernia and risk factors, including the surgical procedure, sex, age at surgery, and prematurity (P > 0.05).ConclusionLaparoscopic surgery might have a beneficial effect on shorter LOS compared with open hernia repair. None of the risk factors is significantly associated with hernia recurrence after repair. A further prospective multicenter study with a larger sample size is necessary to clarify our findings.

Introduction: Effective postoperative pain management following inguinal hernia surgery remains a clinical challenge. Quadratus lumborum block (QLB) is an emerging regional anesthesia technique that provides both somatic and visceral analgesia. Among its various approaches, posterior and transmuscular techniques are commonly used; however, comparative evidence regarding their efficacy is limited. This study aimed to compare the efficacy of posterior and transmuscular quadratus lumborum block in patients undergoing inguinal hernia surgery with respect to postoperative pain scores, duration of analgesia, total analgesic consumption, adverse effects, and patient satisfaction. Materials and Methods: This prospective randomized comparative study was conducted at a tertiary care hospital from January 2025 to December 2025 and included 60 patients, divided equally into posterior QLB (n=30) and transmuscular QLB (n=30) groups. All patients underwent inguinal hernia surgery under spinal anesthesia followed by ultrasound-guided QLB. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 1, 4, 8, 12, and 24 hours. Time to first rescue analgesia, total tramadol consumption, adverse effects, and patient satisfaction were recorded. Results: VAS scores were significantly lower in the transmuscular group at all time intervals (p≤0.003). Time to first rescue analgesia was prolonged (13.6 ± 3.2 vs 8.4 ± 2.1 hours; p&lt;0.001), and total tramadol consumption was reduced (95 ± 28 mg vs 145 ± 35 mg; p&lt;0.001) in the transmuscular group. Incidence of adverse effects was comparable between groups (p&gt;0.05). Patient satisfaction was significantly higher in the transmuscular group, with excellent satisfaction reported in 18 (60.0%) patients compared to 10 (33.3%) in the posterior group (p=0.04). Conclusion: Transmuscular QLB provides superior postoperative analgesia with prolonged duration, reduced opioid requirement, and higher patient satisfaction compared to posterior QLB, without increasing adverse effects.