Background Surgery for obesity and metabolic diseases has been evolved in the light of new scientific evidence, long-term outcomes and accumulated experience. EAES has sponsored an update of previous guidelines on bariatric surgery. Methods A multidisciplinary group of bariatric surgeons, obesity physicians, nutritional experts, psychologists, anesthetists and a patient representative comprised the guideline development panel. Development and reporting conformed to GRADE guidelines and AGREE II standards. Results Systematic review of databases, record selection, data extraction and synthesis, evidence appraisal and evidence-todecision frameworks were developed for 42 key questions in the domains Indication; Preoperative work-up; Perioperative management; Non-bypass, bypass and one-anastomosis procedures; Revisional surgery; Postoperative care; and Investigational procedures. A total of 36 recommendations and position statements were formed through a modified Delphi procedure. and Other Interventional Techniques Disclaimer This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g. surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g. surgical nurses, dietitians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by healthcare authorities (e.g. regional and national authorities, healthcare institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point Electronic supplementary material The online version of this article (

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Background Inguinal hernia repair is one of the most frequent surgical procedures worldwide. Several minimally invasive approaches have been developed. Laparoscopic hernioplasty offers less pain, faster recovery and a lower incidence of wound infection. However, the best approach in repairing large inguinoscrotal hernias and the optimal management of the distal sac and its risks are still debated. There may be a higher risk of visceral or cord structures damage, ischemic orchitis, seroma or haematoma when opting for a complete dissection of the hernia sac which may extend deep into the scrotum. Objective To show a video of a transabdominal preperitoneal (TAPP) approach using the primary abandon of the sac technique. The aim of this is to reduce the complications above-stated. Method We report a case of a 33 year old man, without previous abdominal surgery, diagnosed with a large right inguinoscrotal hernia, which appeared 1 year ago and became painful. The patient was scheduled electively for a TAPP surgery. Results Surgery was performed by means of day surgery. No intraoperative complications. No seroma nor haematoma detected in the postoperative period. Conclusion Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. The primary abandon of the sac is a feasible and reproducible technique and is a safe manner to overcome the difficulties of the distal sac management.

Background Diastasis of the rectus abdominis muscles (DRAM) is frequent and may be associated with abdominal wall hernias. In 2017 subcutaneous onlay laparoscopic approach (SCOLA) was described which combines diastasis recti plication and abdominal wall hernia repair without requiring a great incisions nor skin resections. Objective To show a video of a SCOLA technique with open periumbilical dissection through 2.5 cm periumbilical mini-incision. The aim is to reduce operative time and to improve the quality of life with good aesthetic results by a minimal invasive procedure. Method We report a case of a 39 years old woman with 3 previous caesarian deliveries, diagnosed with umbilical hernia and diastasis recti with a 95mm internal gap. The patient was scheduled electively for a SCOLA technique. Results Surgery was performed with no intraoperative complications. Persistent hematic output through drains was seen first 24h postoperatively which required blood transfusion for anemization, but no need for reoperation, correct hemoglobin controls afterward. Small hematoma detected in 1st month control, with correct resolution on 4th month control. No recurrence of umbilical hernia nor diastasis recti observed during this short follow-up. Conclusion SCOLA technique has been proven to be a reproductive and secure technique for those patients with DRAM associated with abdominal wall hernia that do not require nor need skin resection or great incisions. The aim of the periumbilical dissection through mini-incision is to decrease surgical time. One must consider the risk of bleeding or seroma associated with the extensive dissection in cases with great diastasis gap.

Background Lateral incisional hernia surgery represents an underappreciated challenge for general surgeons. McBurney's incisional hernia (L3) after appendectomy is rare, with an incidence between 0.1 and 0.9%. Several studies have found fewer postoperative complications with the laparoscopic approach compared with open approach. Objective To show a video of a transabdominal preperitoneal (TAPP) approach for McBurney's incisional hernia associated with a small right lateral inguinal hernia. Method We report a case of a 52 years old man, with previous open appendectomy in 2013, diagnosed with McBurney's incisional hernia (L3W2R0) and small right inguinal hernia (L1M0F0P). The patient was scheduled for laparoscopic TAPP incisional hernia repair. Results The patient was operated as ambulatory surgery with no intraoperative complications. No recurrence nor other complications detected during short, 4th month, follow up after surgery. Conclusions Minimal invasive hernia repair with preperitoneal mesh of lateral abdominal hernias cause less postoperative pain, have a short hospital stay, lower incidence of surgical site and mesh infection, and possibly can reduce recurrence as a wider mesh overlap of the defect is possible. This technique has shown to be feasible and reproducible in selected cases.