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Laparoscopic repair of paraesophageal hernia with organo-axial intrathoracic gastric volvulus

Siow SL, Chuah JS, Mahendran HA

Asian J Endosc Surg, 2020 Jul;13(3):437-440.
PMID: 31338969 DOI: 10.1111/ases.12740

Intrathoracic organo-axial gastric volvulus is a rare clinical entity associated with paraesophageal hernia. It is characterized by migration of the stomach into the thoracic cavity through an enlarged hiatal defect and rotation around its long axis connecting the cardia and the pylorus. A 72-year-old woman presented with epigastric pain that radiated to the left scapula for 1 week prior to presentation. Computed tomography scan of her thorax and abdomen demonstrated paraoesophageal hernia with organo-axial intrathoracic gastric volvulus. Laparoscopically, the stomach was returned to its abdominal position, the mediastinal sac was excised and after adequate intra-abdominal length of the esophagus was attained, the hiatal defect was closed primarily and reinforced with a composite mesh. An anterior 180° partial fundoplication was performed as both an anti-reflux procedure and also as a form of gastropexy. She had an uneventful recovery and remains well after 2 years.
Prospective diagnostic study on the use of narrow-band imaging on suspicious lesions during colonoscopy examination

Yaacob H, Ikhwan SM, Hashim MN, Syed Abd Aziz SH, Wan Zain WZ, Tuan Sharif SE, et al.

Asian J Endosc Surg, 2018 Nov;11(4):318-324.
PMID: 29424061 DOI: 10.1111/ases.12463

INTRODUCTION: Colonoscopy is the gold standard to detect colorectal neoplasm. Narrow-band imaging (NBI) has a good diagnostic accuracy to differentiate between neoplastic and non-neoplastic colorectal lesions. This study explores the diagnostic validity of NBI colonoscopy as well as its associated factors related to neoplastic and non-neoplastic colorectal lesions.
METHODS: This study enrolled 100 patients in a single-center tertiary teaching hospital. Patients presented for screening colonoscopy, and those with suspicious colorectal lesions were included in this study. During colonoscopy, the most suspicious lesion in each patient was analyzed using the NBI system based on Sano's classification. Each lesion was biopsied for histopathological analysis, the gold standard. Endoscopic images were captured electronically. The sensitivity, specificity, and diagnostic accuracy of NBI colonoscopy were assessed. Other associated factors related to neoplastic and non-neoplastic lesions were analyzed accordingly.
RESULTS: The sensitivity and specificity of the NBI were 88.2% and 71.9%, respectively. The area under the receiver-operator curve was 0.801, indicating that NBI has a good ability to differentiate between disease and non-disease. There are significant associations between histopathological examination outcomes and both presenting symptoms, especially weight loss, and lesion site, even after other variables were controlled (P
Quality of life following laparoscopic totally extraperitoneal repair of a unilateral reducible inguinal hernia

Chuah JS, Siow SL, Bujang MA

Asian J Endosc Surg, 2024 Jul;17(3):e13320.
PMID: 38720454 DOI: 10.1111/ases.13320

BACKGROUND: Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has become increasingly favored over open Lichtenstein tension-free mesh repair owing to its associated benefits, including reduced postoperative pain, early return to normal activities, and a comparable recurrence rate. In recent years, emphasis has been placed on patient-reported outcomes, particularly health-related quality of life (QOL), as a critical metric for evaluating surgical success. This study aimed to evaluate the overall QOL following laparoscopic TEP repair of unilateral inguinal hernia.
METHODS: This prospective study enrolled patients aged 18 years or older who underwent elective laparoscopic TEP hernia repair for unilateral inguinal hernia from April 2020 to March 2022. Data collected include demographic details, hernia characteristics, postoperative complications, and postoperative QOL assessment. The Short Form 36 Health Survey Version 2 (SF-36v2), a validated general QoL questionnaire, was administered preoperatively and at 1 month, 6 months, and 1 year postoperatively. Statistical analysis utilized paired t-tests for comparisons, with significance set at a p-value
Hybrid Laparoscopic and Open Repair of a Transdiaphragmatic Intercostal Hernia: A Case Report

Hanis AL, Siow SL, Nurazim S, Kamaruzaman IA

Asian J Endosc Surg, 2025;18(1):e70034.
PMID: 39978797 DOI: 10.1111/ases.70034

Transdiaphragmatic intercostal hernia is a rare condition that presents unique management challenges. We describe a 68-year-old morbidly obese male (BMI 40) with multiple comorbidities who underwent successful hybrid laparoscopic and open repair of a right transdiaphragmatic intercostal hernia. The hernia developed following blunt trauma 5 years earlier, which caused fractures of the right 4th-7th ribs. The patient presented with a swelling in the right flank region. CT imaging revealed a 5.9-cm diaphragmatic defect and a 10.6 × 11.9 cm intercostal defect containing small and large bowels, and omentum. Preoperative optimization included a very low-calorie diet and stabilization of diabetes, hypertension, and dyslipidemia. Surgery involved lateral decubitus positioning, customized laparoscopic port placement, an additional incision for defect closure, and laparoscopic onlay mesh placement. Recovery was uneventful, with discharge on postoperative Day 5 and no recurrence at 6 months. This case underscores the importance of meticulous preparation and hybrid techniques in managing complex hernias.
Fulltext Comments on: Clinical Impacts of Minimally Invasive Transperineal Abdominoperineal Resection in Crohn's Disease

Mohammad Azmi N, Hayati MFM, Azman ZAM, Sagap I

Asian J Endosc Surg, 2026;19(1):e70215.
PMID: 41527743 DOI: 10.1111/ases.70215
Fulltext Clinical Consensus on the Role of Self-Fixating Mesh in Laparoscopic Inguinal Hernia Repair

Wijerathne S, Rastogi S, Seo K, Park J, Thakur M, Weijie MO, et al.

Asian J Endosc Surg, 2026;19(1):e70255.
PMID: 41655995 DOI: 10.1111/ases.70255

INTRODUCTION: The global burden of inguinal hernia (IH) has significantly increased. Mesh with self-fixating technology helps provide superior tissue integration, reducing the need for additional fixation compared to conventional mesh. Benefits include shorter operative time, reduced hospital stay, lower recurrence rates, and improved quality of life. However, variability remains in its adoption and application. To address this, a panel of Asian hernia experts convened to develop a consensus and formulate recommendations on self-fixating mesh (SFM) use in IH repair.
METHOD: A panel of 13 hernia experts participated in the consensus discussion and manuscript development. A comprehensive literature review was conducted using PubMed, Embase, and Google Scholar to identify relevant articles and formulate statements. Consensus was assessed using a modified three-step Delphi method, with an acceptance level of > 80%.
RESULTS: In phase 1 of consensus development, 11 statements were reviewed, with 9 reaching consensus and 1 facing disagreement. Five additional statements were introduced based on expert input. Phase 2 reviewed all 16 statements, with one failing to reach consensus. In phase 3, an online reassessment of the revised version of the failed statement in the previous round was conducted via Microsoft Forms, leading to consensus on all 16 statements.
CONCLUSION: SFM offers significant advantages over conventional sutured meshes in IH repair. However, further research and multicenter trials are recommended to refine surgical protocols. Based on expert recommendations, SFM may be preferred in IH repair, and structured training can enhance its adoption, improving patient outcomes.
Fulltext A Rare Coexistence of Gastric Fundal False Diverticulum and Sliding Hiatal Hernia: Technical Considerations and Literature Review

Siow SL, Fu JH, Hanis AL, Nurazim S

Asian J Endosc Surg, 2026;19(1):e70244.
PMID: 41540740 DOI: 10.1111/ases.70244

Gastric fundal false diverticula are exceedingly rare, and to our knowledge, this is the first reported case occurring in association with a sliding hiatal hernia. We describe a 49-year-old woman who presented with persistent dysphagia, regurgitation, heartburn, and halitosis refractory to medical therapy. Imaging revealed a 5.0 × 3.6 × 4.7 cm false diverticulum at the posteromedial fundus and a sliding hiatal hernia. Esophageal manometry demonstrated normal motility with ineffective bolus clearance. Laparoscopic management was employed, combining intraoperative endoscopy for diverticulum localization and staple-line verification with laparoscopic dissection and repair. The procedure included diverticulum excision with an endoscopic stapler, posterior crural closure reinforced with pledgeted sutures, and anterior partial fundoplication. Histopathology confirmed a false diverticulum with complete absence of the muscularis propria layer and no malignancy. At the 1-year follow-up, the patient reported significant symptom resolution. This case highlights the laparoscopic management in complex gastric diverticula and provides a valuable surgical option for similar cases.