The application of bioabsorbable PhasixST™ mesh in the laparoscopic repair of large hiatal hernias has emerged as a promising strategy to address the limitations associated with permanent synthetic meshes, particularly the risk of mesh-related complications and long-term morbidity. Recent studies have demonstrated that PhasixST™ mesh, composed of poly-4-hydroxybutyrate (P4HB), is slowly absorbed over 12 to 18 months, providing a scaffold that supports native tissue integration and healing during the critical postoperative period. This gradual absorption profile may confer an advantage over more rapidly degrading bioabsorbable meshes, as it allows for more robust tissue ingrowth and potentially enhances the durability of hiatal reinforcement. The association between P4HB mesh use and low recurrence rates has been highlighted, with an average of 2.82 hernia recurrences per 100 patients within one year, and no mesh-related complications in the current literature. The surgical technique for PhasixST™ mesh placement involves meticulous crural reinforcement, with careful attention to mesh orientation and fixation to minimize the risk of migration or erosion. The primary objective is to restore the anatomical integrity of the hiatus, reduce the size of the defect, and prevent recurrence, while minimizing perioperative morbidity.

The application of bioabsorbable PhasixST™ mesh in the laparoscopic repair of large hiatal hernias has emerged as a promising strategy to address the limitations associated with permanent synthetic meshes, particularly the risk of mesh-related complications and long-term morbidity. Recent studies have demonstrated that PhasixST™ mesh, composed of poly-4-hydroxybutyrate (P4HB), is slowly absorbed over 12 to 18 months, providing a scaffold that supports native tissue integration and healing during the critical postoperative period. This gradual absorption profile may confer an advantage over more rapidly degrading bioabsorbable meshes, as it allows for more robust tissue ingrowth and potentially enhances the durability of hiatal reinforcement. The association between P4HB mesh use and low recurrence rates has been highlighted, with an average of 2.82 hernia recurrences per 100 patients within one year, and no mesh-related complications in the current literature [1,2]. The surgical technique for PhasixST™ mesh placement involves meticulous crural reinforcement, with careful attention to mesh orientation and fixation to minimize the risk of migration or erosion. The primary objective is to restore the anatomical integrity of the hiatus, reduce the size of the defect, and prevent recurrence, while minimizing perioperative morbidity [3].

Intracorporeal anastomosis has gained increasing acceptance in minimally invasive colorectal surgery due to its association with improved perioperative outcomes compared with extracorporeal techniques. However, the role of intracorporeal handsewn anastomosis remains insufficiently explored in laparoscopic colorectal procedures. This study describes a standardized technique for a side-to-side handsewn intracorporeal ileocolic anastomosis following laparoscopic right colectomy and evaluates its safety and feasibility through a review of the relevant literature and institutional experience. The procedure is performed using a medial-to-lateral approach and a single-layer isoperistaltic handsewn anastomosis is constructed entirely intracorporeally. Over a three-year period, 68 laparoscopic right colectomies were completed using this technique, predominantly for malignant disease, all performed by a single surgeon. No anastomotic leaks or anastomosis-related complications, including bleeding, stenosis, or hematoma formation, were observed. Available evidence supports the advantages of intracorporeal anastomosis, including reduced surgical trauma, lower wound-related complications, faster recovery of bowel function, and comparable oncological outcomes, while data from robotic colorectal surgery suggest potential benefits of handsewn techniques in terms of hemostasis and anastomotic quality. Intracorporeal handsewn ileocolic anastomosis following laparoscopic right colectomy appears to be a safe and reproducible technique in experienced hands, warranting further prospective and comparative studies to define its broader applicability and long-term outcomes.

Intracorporeal anastomosis (IA) has gained increasing acceptance in minimally invasive colorectal surgery, primarily owing to its demonstrated association with improved perioperative outcomes compared with extracorporeal techniques. Nevertheless, the specific role of intracorporeal handsewn anastomosis remains insufficiently explored within the context of laparoscopic colorectal procedures. The present study describes a standardized technique for performing a side-to-side isoperistaltic handsewn intracorporeal ileocolic anastomosis following laparoscopic right colectomy and evaluates its safety and feasibility through a review of the relevant literature and institutional experience. The procedure is executed employing a medial-to-lateral dissection approach, and a single-layer isoperistaltic handsewn anastomosis is constructed entirely intracorporeally. Over a three-year period, 68 laparoscopic right colectomies were completed using this technique, predominantly for malignant disease, all performed by a single surgeon. Notably, no anastomotic leaks or anastomosis-related complications, including bleeding, stenosis, or hematoma formation, were observed. Available evidence supports the advantages of intracorporeal anastomosis, including reduced surgical trauma, lower incidence of wound-related complications, faster recovery of bowel function, and comparable oncological outcomes. Furthermore, emerging data from robotic-assisted colorectal surgery suggest potential benefits of handsewn techniques with respect to hemostasis and anastomotic quality. In conclusion, intracorporeal handsewn ileocolic anastomosis following laparoscopic right colectomy appears to represent a safe and reproducible technique when performed by experienced surgeons, thereby warranting further prospective, comparative and multicenter studies to delineate its broader applicability and long-term outcomes.