A mesh at subcostal closure cut two-year incisional hernia from 38% to 8% in a blinded trial

The edition in brief

In a double-blinded randomised trial from Seville, adults with two or more risk factors for incisional hernia undergoing open right subcostal hepatobiliary surgery had a radiological incisional hernia rate at 24 months of 8.1% with a prophylactic synthetic mesh against 37.5% with conventional closure, with no rise in wound events, complications or pain; J incisions herniated more often than Kocher incisions. Follow-up was incomplete and the trial was small and single-centre. A four-centre European trial of 202 patients with oesophageal or junctional adenocarcinoma found robotic oesophagectomy retrieved more lymph nodes than thoracolaparoscopic oesophagectomy (median 36 vs 32), with similar complications and no one-year survival difference. A meta-analysis of 43 randomised trials (3,277 patients) found bipolar vessel-sealing haemorrhoidectomy was associated with less pain in the first two weeks, less bleeding and urinary retention, and a faster return to activity than conventional excision, with no difference in recurrence or incontinence. A Danish cohort of 1,145 patients found that leaving a normal-looking appendix at diagnostic laparoscopy led to a second laparoscopy in 3.5% over about five years, and appendicitis in under 1%. The pearl covers the small-bites fascial closure for midline laparotomy.