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Meckel's diverticulum (MD) occurs in 2% of the population and is often asymptomatic. It is an embryological remnant of the oomphalomesenteric duct and can be associated with another embryonic structure—the urachus. A 23-year-old male presented with generalized abdominal pain and fever on a background of chronic abdominal pain and recurrent urinary infections. A CT scan of the abdomen and pelvis revealed an inflamed MD. Next day, the patient deteriorated and was taken to theatre. The MD was found to be both perforated and tethered to the umbilicus, which itself was directly related to an abnormal extra-peritoneal structure—shown to be a urachal remnant. Such cases pose diagnostic and therapeutic challenges. Young males with chronic abdominal pain and recurrent urinary infections should be thoroughly investigated for such pathology. Laparoscopic approach to such cases should be undertaken with caution due to possible umbilical tethering. [ABSTRACT FROM AUTHOR]

Introduction: Mesh implants are regularly used to help repair both hiatus hernias (HH) and diaphragmatic hernias (DH). In vivo studies are used to test not only mesh safety, but increasingly comparative efficacy. Our work examines the field of in vivo mesh testing for HH and DH models to establish current practices and standards.Method: This systematic review was registered with PROSPERO. Medline and Embase databases were searched for relevant in vivo studies. Forty-four articles were identified and underwent abstract review, where 22 were excluded. Four further studies were excluded after full-text review-leaving 18 to undergo data extraction.Results: Of 18 studies identified, 9 used an in vivo HH model and 9 a DH model. Five studies undertook mechanical testing on tissue samples-all uniaxial in nature. Testing strip widths ranged from 1-20 mm (median 3 mm). Testing speeds varied from 1.5-60 mm/minute. Upon histology, the most commonly assessed structural and cellular factors were neovascularisation and macrophages respectively (n = 9 each). Structural analysis was mostly qualitative, where cellular analysis was equally likely to be quantitative. Eleven studies assessed adhesion formation, of which 8 used one of four scoring systems. Eight studies measured mesh shrinkage.Discussion: In vivo studies assessing mesh for HH and DH repair are uncommon. Within this relatively young field, we encourage surgical and materials testing institutions to discuss its standardisation. [ABSTRACT FROM AUTHOR]

Background: Surgical site infection (SSI) is a well-recognized and potentially catastrophic complication of abdominal wall reconstruction (AWR). The authors present a review of the literature surrounding SSI in AWR, exploring prevention and treatment strategies as well as risk factors. Methods: A comprehensive review of the current literature was undertaken. Evidence was reviewed and summarized with particular focus on prevention and treatment strategies available to hernia surgeons. Results: Patient risk factors for SSI are well described in the literature and include obesity, smoking, and other comorbidities. Contaminated hernias and cases involving enterocutaneous fistulae are also at higher risk of SSI. Surgical decisions such as type of mesh, plane of mesh placement, and fascial release may all contribute to SSI risk. To treat established mesh infection, conservative management with antibiotic agents and negative pressure therapy is a reasonable option in some cases. Removal of prosthesis appears to provide favorable results, however, repeat surgery can be problematic Conclusions: Surgical site infection remains an important pathology in the world of AWR. Surgeons have a wealth of tools in their arsenal to prevent and treat SSI and should be aware of the emerging evidence in the fast-moving specialty of hernia surgery. Complex cases should be handled by surgeons and centers with expertise in treating such patients. [ABSTRACT FROM AUTHOR]

Our work aims to investigate the mechanical properties of the human posterior rectus sheath in terms of its ultimate tensile stress, stiffness, thickness and anisotropy. It also aims to assess the collagen fibre organisation of the posterior rectus sheath using Second-Harmonic Generation microscopy. For mechanical analysis, twenty-five fresh-frozen samples of posterior rectus sheath were taken from six different cadaveric donors. They underwent uniaxial tensile stress testing until rupture either in the transverse (n = 15) or longitudinal (n = 10) plane. The thickness of each sample was also recorded using digital callipers. On a separate occasion, ten posterior rectus sheath samples and three anterior rectus sheath samples underwent microscopy and photography to assess collagen fibre organisation. samples had a mean ultimate tensile stress of 7.7 MPa (SD 4.9) in the transverse plane and 1.2 MPa (SD 0.8) in the longitudinal plane (P < 0.01). The same samples had a mean Youngs modulus of 11.1 MPa (SD 5.0) in the transverse plane and 1.7 MPa (SD 1.3) in the longitudinal plane (P < 0.01). The mean thickness of the posterior rectus sheath was 0.51 mm (SD 0.13). Transversely aligned collagen fibres could be identified within the posterior sheath tissue using Second-Harmonic Generation microscopy. The posterior rectus sheath displays mechanical and structural anisotropy with greater tensile stress and stiffness in the transverse plane compared to the longitudinal plane. The mean thickness of this layer is around 0.51 mm – consistent with other studies. The tissue is constructed of transversely aligned collagen fibres that are visible using Second-Harmonic Generation microscopy. • The posterior rectus sheath displays significant mechanical anisotropy (p < 0.05). • The posterior rectus sheath is stiffer transversely than it is longitudinally. • The posterior rectus sheath is stronger transversely than it is longitudinally. • Tensile strength figures from this study are consistent with the current literature. • Collagen fibres in the posterior rectus sheath are aligned transversely. [ABSTRACT FROM AUTHOR]

Background: Surgical repair is advocated for flexor tendon lacerations deeper than 70%. Repair can be undertaken with different suturing techniques and using different materials. Different materials used for tendon repair will have a different gliding resistance (GR) at the joint. Previous studies have compared strength of repair and gliding resistance for various braided suture materials and for 100% laceration of flexor tendons. We directly compare the GR of two monofilament sutures when used for a peripheral running suture repair of partially lacerated tendons. Methods: Sixteen flexor tendons and A2 pulleys were harvested from Turkey feet. They were prepared, partially lacerated to 50% depth, and then repaired with a core suture (modified Kessler technique with 4-0 Ethibond) as well as an additional superficial running suture of either 6-0 Prolene or Nylon (half randomised to each). Gliding resistance was measured for all tendons before and after repair, at different flexion angles (40 and 60 degrees) and for different loads (2N and 4N). Results: After surgical repair, gliding resistance was increased for all tendons (P < 0.01). The tendons repaired with Prolene had a higher mean gliding resistance than those repaired with Nylon (P = 0.02). Increased flexion angle and load amplified the gliding resistance (both P < 0.01). Conclusions: 6-0 Nylon was associated with a lower gliding resistance than 6-0 Prolene but the minor differences bare unknown clinical significance. [ABSTRACT FROM AUTHOR]