In 2014 the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias”. Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature.MethodsFor the development of the original guidelines all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based-Medicine. For the present update all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne) the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included.ResultsDue to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite still insufficient evidence with respect to these new techniques it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields.ConclusionGuidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initially guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.

AIM:To observe the therapeutic efficacy of high-dose Vitamin C (Vit. C) on acute pancreatitis (AP), and to explore its potential mechanisms. METHODS:Eghty-four AP patients were divided into treatment group and control group, 40 healthy subjects were taken as a normal group. In the treatment group, Vit. C (10 g/day) was given intravenously for 5 days, whereas in the control group, Vit. C (1 g/day) was given intravenously for 5 days. Symptoms, physical signs, duration of hospitalization, complications and mortality rate were monitored. Meanwhile, serum amylase, urine amylase and leukocyte counts were also determined. The concentration of plasma vitamin C (P-VC), plasma lipid peroxide (P-LPO), plasma vitamin E (P-VE), plasma β-carotene (P-β-CAR), whole blood glutathione (WB-GSH) and the activity of erythrocyte surperoxide dimutase (E-SOD) and erythrocyte catalase (E-CAT) as well as T lymphocyte phenotype were measured by spectrophotometry in the normal group and before and after treatment with Vit. C in the treatment and the control group. RESULTS:Compared with the normal group, the average values of P-VC, P-VE, P-β-CAR, WB-GSH and the activity of E-SOD and E-CAT in AP patients were significantly decreased and the average value of P-LPO was significantly increased, especially in severe acute pancreatitis (SAP) patients (P <0.05. P-VC, P =0.045; P-VE, P =0.038; P =0.041; P-β-CAR, P =0.046; WB-GSH, P =0.039; E-SOD, P =0.019; E-CAT, P =0.020; P-LPO, P =0.038). Compared with the normal group, CD 3 and CD 4 positive cells in AP patients were significantly decreased. The ratio of CD 4 /CD 8 and CD 4 positive cells were decreased, especially in SAP patients (P<0.05. CD 4 /CD 8 , P =0.041; CD 4 , P =0.019). Fever and vomiting disappeared, and leukocyte counts and amylase in urine and blood become normal quicker in the treatment group than in the control group. Moreover, patients in treatment group also had a higher cure rate, a lower complication rate and a shorter in-ward days compared with those in he control group. After treatment, the average value of P-VC was significantly higher and the values of SIL-2R, TNF-α, IL-6 and IL-8 were significantly lower in the treatment group than in the control group (P<0.05 P-VC, P =0.045; SIL-2R, P =0.012; TNF-α, P =0.030; IL-6, P =0.015; and IL-8, P =0.043). In addition, the ratio of CD 4 /CD 8 and CD4 positive cells in the patients of treatment group were significantly higher than that of the control group after treatment (P<0.05. CD 4 /CD 8 , P =0.039; CD 4 , P =0.024). CONCLUSION:High-dose vitamin C has therapeutic efficacy on acute pancreatitis. The potential mechanisms include promotion of anti-oxidizing ability of AP patients, blocking of lipid peroxidation in the plasma and improvement of cellular immune function.

INTRODUCTIONThe high mortality and morbidity associated with resection for oesophagogastric malignancy has resulted in a conservative approach to the postoperative management of this patient group. In August 2009 we introduced an enhanced recovery after surgery (ERAS) pathway tailored to patients undergoing resection for oesophagogastric malignancy. We aimed to assess the impact of this change in practice on standard clinical outcomes. METHODS Two cohorts were studied of patients undergoing resection for oesophagogastric malignancy before (August 2008 -July 2009) and after (August 2009 -July 2010) the implementation of the ERAS pathway. Data were collected on demographics, interventions, length of stay, morbidity and in-hospital mortality. RESULTS There were 53 and 55 oesophagogastric resections undertaken respectively for malignant disease in each of the study periods. The median length of stay for both gastric and oesophageal resection decreased from 15 to 11 days (MannWhitney U, p<0.001) following implementation of the ERAS pathway. There was no significant increase in morbidity (gastric resection 23.1% vs 5.3% and oesophageal resection 25.9% vs 16.7%) or mortality (gastric resection no deaths and oesophageal resection 1.8% vs 3.6%) associated with the changes. There was a significant decrease in the number of oral contrast studies used following oesophageal resection, with a reduction from 21 (77

The adverse impacts of climate change exert mounting pressure on agriculture-dependent livelihoods of many developing and developed nations. However, integrated and spatially specific vulnerability assessments in less-developed countries like Bangladesh are rare, and insufficient to support the decision-making needed for climate-change resilience. Here, we develop an agricultural livelihood vulnerability index (ALVI) and an integrated approach, allowing for (i) mapping out the hot spots of vulnerability distribution; (ii) identifying key factors of spatially heterogeneous vulnerability; and (iii) supporting intervention planning for adaptation. This study conceptualized vulnerability as a function of exposure, sensitivity, and adaptive capacity by developing a composite index from a reliable dataset of 64 indicators comprising biophysical, agro-ecological, and socioeconomic variables. The empirical studies of coastal Bangladesh revealed that Bhola, Patuakhali, and Lakshmipur districts, around the mouth of the deltaic Meghna estuaries, are the hot spot of vulnerability distribution. Furthermore, the spatially heterogeneous vulnerability was triggered by spatial variation of erosion, cyclones, drought, rain-fed agriculture, land degradation, soil phosphorus, crop productivity, sanitation and housing condition, infant mortality, emergency shelters, adoption of agro-technology. The integrated approach could be useful for monitoring and evaluating the effectiveness of adaptation intervention by substituting various hypothetical scenarios into the ALVI framework for baseline comparison.