Introduction: Incisional hernia represents a common surgical complication resulting from fascial tissue healing failure after laparotomy. While the introduction of prosthetic mesh has revolutionized management by drastically reducing recurrence rates, the optimal placement technique remains debated. Aims: This study evaluates the etiology, risk factors, and management of incisional hernias, specifically comparing the clinical outcomes, complications, and recurrence rates between Onlay and Preperitoneal mesh repair techniques. Materials and Methods: The present study was a prospective observational study. This Study was conducted for 18 months. Department of surgery, Tertiary care Hospital in West Bengal. Study population 60 patients with incisional hernia were included in the study. Result: The study included 60 patients, predominantly females (91.7%), with a mean age of 41.85 years. Swelling at the previous scar site was universal, while pain occurred in 68.3%. LSCS was the commonest previous surgery (38.3%). Lower midline scars predominated (70.0%). Onlay and preperitoneal mesh repairs were performed in 28 patients each. Complications occurred in 35.7% and 21.4%, respectively (p=0.375), with no recurrence. Mean hospital stay was 10.57 ± 5.34 and 8.29 ± 3.54 days, respectively (p=0.328). Surgical interventions included Onlay mesh repair (n=28) and Preperitoneal mesh repair (n=28). Conclusion: Synthetic prosthetic materials provide a tension-free repair that effectively prevents recurrence. Preperitoneal mesh placement is superior to the Onlay technique, offering significantly lower complication rates and shorter hospitalizations.

Background: External ventricular drain (EVD)-related infection (ERI) is a significant complication of neurosurgical care, contributing to morbidity, prolonged hospitalization, and increased healthcare costs. Although intraventricular vancomycin can achieve high cerebrospinal fluid concentrations, its prophylactic role and potential effect on microbial patterns remain insufficiently characterized. Objective: To evaluate the feasibility and preliminary association of adjunctive intraventricular vancomycin with intravenous cephalosporin, compared with intravenous cephalosporin alone, in reducing ERI among adults undergoing EVD placement. Methods: In this retrospective cohort study, 90 adults undergoing EVD placement were allocated equally to receive intraventricular vancomycin 10 mg daily for 7 days plus intravenous ceftriaxone or ceftazidime, or intravenous cephalosporin alone. The primary outcome was ERI within 30 days. Secondary outcomes included ICU and hospital length of stay, microbial profile, EVD duration and replacement, mortality, and adverse events. Results: ERI occurred in 3/45 patients (6.7%) receiving vancomycin versus 12/45 (26.7%) controls (absolute risk reduction, 20.0%; 95% CI, 5.2–34.8%; RR, 0.25; 95% CI, 0.08–0.81; p=0.02). All infections in the vancomycin group were caused by gram-negative organisms compared with 2/12 (16.7%) in controls (p=0.02). Hospital and ICU stays were significantly shorter with vancomycin. Transient chemical ventriculitis occurred in 2 patients (4.4%). Mortality was 11.1% versus 26.7% (p=0.10). Conclusion: Adjunctive intraventricular vancomycin was associated with lower ERI rates and shorter hospital and ICU stays but with a shift toward gram-negative infections. Given the small, retrospective sample, these findings are preliminary and hypothesis-generating. Larger multicenter studies are warranted to confirm efficacy, safety, and microbial consequences.