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Introduction and objective: Guidelines on inguinal hernia repair focus on decreasing the recurrence rate and chronic pain. Since self-adherent meshes do not require additional fixation, they can help, among other factors, to prevent postoperative chronic pain without increasing the frequency of recurrences. We present our results of inguinal hernioplasty by endoscopic TAPP approach with self-adherent mesh in a tertiary hospital to assess the presence of postoperative chronic pain. Method: Retrospective, descriptive, observational, retrospective study, over a period of 24 months, performing laparoscopic inguinal hernioplasty with preperitoneal transabdominal approach using self-adherent mesh (ProGrip™). We analyzed, among others, type of hernia, surgical time, incidents and postoperative complications, postoperative pain and satisfaction at 7 days, 1, 2, 4 and 6 months, as well as recurrence. Results: A total of 131 inguinal hernias were operated on in 100 patients, 31 bilateral and 68 unilateral, in 66 males and 34 females. There were 28 left and 41 right hernias. With respect to postoperative pain, a 1-2 ANS 1-2 was observed in the first 7 days in 14 patients, 9 patients with ANS 1 in the first month, no patient presented chronic pain. There were 9 complications, 8 related to the surgical wound of which 6 were seromas, 2 hematomas and 1 intestinal obstruction that required surgery. There was no recurrence to date, with an average follow-up of 16 months. Conclusion: Inguinal hernioplasty with endoscopic TAPP approach using self-adherent mesh did not increase the frequency of chronic pain or recurrences. Patient satisfaction is very satisfactory. [ABSTRACT FROM AUTHOR]

Obturator hernia has an incidence of less than 1% of all abdominal wall hernias, it is predominantly observed in elder women and it is characterized by protrusion of intra-abdominal viscera into the shutter hole. The preoperative diagnosis is difficult due to the lack of external manifestations, nonspecific symptoms and lack of clinical suspicion. Delaying diagnosis and treatment is associated with high mortality. We report the case of a female patient with a complicated obturator hernia with concomitant bilateral inguinal hernias that underwent minimally invasive surgery with no complications and a seven day stay in hospital. [ABSTRACT FROM AUTHOR]

Background: Parastomal hernia is the eventration that develops in the vicinity of a stoma, its incidence associated with Bricker-type ileal conduits can reach 50 % according to the study. The indication for scheduled surgery is established according to the symptoms derived from it. Urgent repair is less frequent. Methodology: Bibliographic review and presentation of a personal series of three cases of urgent surgery due to incarceration of the content of the parastomal hernia associated with urostomy. Conclusion: The different surgical techniques used in our hospital are described. There are few publications on emergency surgery associated with this type of hernia. The type of repair to be performed will depend on factors such as the oncological status of the patient, their general condition, contamination of the surgical field, the size of the wall defect or the presence of an associated midline hernia. [ABSTRACT FROM AUTHOR]

Introduction and objective: To describe the results published in the literature about the perioperative management of giant hernias or hernias with loss of domain in obese patients, their preoperative optimization as well as the use of preoperative progressive pneumoperitoneum and botulinum toxin A with or without associated paniculectomy. Methods: A systematic search has been conducted using PubMed, the Cochrane Library and another manual search of articles published until April 2020 according to the inclusion criteria for the review. 39 articles have been analyzed. Results: Obesity doubles the risk of comorbidity in the repair of giant hernias or loss of domain hernias in patients with BMI greater than 40 kg/m2. Proper prehabilitation with diet or bariatric surgery would involve a decrease in comorbidity. In addition, preoperative use of progressive pneumoperitoneum and botulinum toxin A infiltration contributes to a progressive adaptation of abdominal pressure with abdominal muscles elongation, as a result, an easier hernia repair is possible with better results. Concomitant paniculectomy increases surgical site complications but could be beneficial in symptomatic cases improving outcomes and risk of long-term recurrence. Conclusion: Actions on modifiable factors such as obesity or preoperative techniques facilitates hernia repair improving its results. However, more studies are needed to determine the optimal BMI to operate, the required prehabilitation time, or the most appropriate method in each case. [ABSTRACT FROM AUTHOR]

Introduction: Obturator hernias are those in which the hernia sac and its contents are introduced into the obturator orifice and protrude through the canal of the same name. They are the most frequent hernias of those that affect the pelvic floor, but overall, they are a very rare variety since they account for less than 1 % of all hernias of the abdominal wall. Clinically, they usually present as a picture of mechanical intestinal obstruction, although they are a very infrequent cause of it (0.2-1.6 % of cases). Material and methods: Review of 10 cases of obturator hernia operated in our Service between november 2010 and march 2021. Results: All of our patients were women with a mean age of 85.2 years (range, 77-92). In all cases, the presentation was a small bowel occlusion. Two patients (20 %) had a history of significant weight loss. Computerized Tomography was performed in all of our patients, which was diagnostic of incarcerated obturator hernia in 80 % of the cases. In the remaining 20 % the diagnosis was femoral hernia. The laterality of the hernia was distributed 50 % on the right and left. All of the cases were operated on urgently through an infraumbilical median laparotomy. In 4 patients (40 %) an initial intestinal resection was necessary and, in another case, it was performed after 48 h. of the first laparotomy. Hernia repair was performed by simple suture in 8 cases (80 %) and with the placement of a mesh plug in two (20 %). The average hospital stay was 6.5 days (range, 3-12). Practically all of our cases presented postoperative morbidity of greater or lesser severity associated with pre-existing pathology. Mortality was 40 %. Conclusion: Obturator hernia is an infrequent cause of intestinal occlusion, but it must be suspected as a cause of it, especially when it occurs in elderly female patients. The diagnostic and therefore therapeutic delay make these hernias present a high morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Spiegelian hernia is an extremely rare ventral hernia, with an incidence of less than 2 %. The laparoendoscopic approach has become the surgical method of choice, with successful use of transabdominal (IntraPeritoneal Onlay Mesh [IPOM]) and preperitoneal (TransAbdomino-PrePeritoneal [TAPP] and Totally ExtraPeritoneal [TEP]) techniques. We present our experience in the implementation of these techniques, over the last 10 years, in an outpatient and short stay surgery hospital. Methods: We present a series of 31 patients operated by laparoendoscopic approach between February 2011 and June 2021. The three techniques were used according to the location of the defect and the progressively acquired experience in laparoendoscopic abdominal wall surgery. Demographic, clinical, diagnostic, surgical and postoperative characteristics are evaluated in the short and medium term. Results: 33 hernias were operated on in 31 patients (22 females and 9 males) with a mean age of 66.43 years, all ASA I-II. 14 IPOM were performed at the beginning of the series, 11 TAPP and 8 TEP with subsequent implementation. The mean operative time was 58.14 minutes. The mean hospital stay was 24.76 hours. The most frequent complication was seroma. Follow-up was between 1 month and 2 years. All histories were reviewed and no recurrence was found in any patient. Conclusion: Laparoendoscopic surgery offers excellent results and should become the standard of care. It has not been demonstrated which technique is superior and the choice will depend on the type of patient and the surgeon's expertise, experience and results. [ABSTRACT FROM AUTHOR]

The article describes a clinical case of a patient with a deep supraforaminal hernia, a rare variant of interparietal hernia in the inguinal region. During surgery, an indirect inguinal hernia type IIIB and a lobulated and pedunculated preperitoneal lipoma were found. The hernia was repaired using the plug technique and the region was reinforced with another mesh using the Lichtenstein technique. The patient recovered successfully and there have not been many reports on this variant of hernia. [Extracted from the article]

Background: Parastomal hernia is defined as a defect at the level of the abdominal wall related to the presence of an enterostomy. It is a common complication in stoma formation. Sugarbaker's laparoscopic repair technique consists of reinforcing the posterior wall with a flat mesh that rides over the intestinal loop of the stoma as a bridge, tunneling a portion of it. Case report: We present the case of a 42-year-old patient with the presence of a 10 × 10 cm parastomal hernia and an uncomplicated umbilical hernia, undergoing repair of the abdominal wall with placement of a double-component mesh using a laparoscopic approach with the Sugarbaker technique. Conclusion: The laparoscopic approach for parastomal hernia repair using the Sugarbaker technique is safe and associated with favorable short-term outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The e-TEP approach has traditionally been used for the management of inguinal hernias and since 2017 has also been indicated for the treatment of ventral hernias. We present a modification to the e-TEP Rives-Stoppa, with technical and ergonomic advantages for the surgeon, better cosmetic results and low complications rate. Method: We present a prospective, multicenter cohort of patients with ventral hernias, primary hernias associated with diastasis recti abdominis, operated by modified endoscopic technique in two tertiary care hospitals. We analyzed demographic information, perioperative characteristics, complications, and the Carolina Comfort Scale (CCS) was applied. Results: We included 35 patients, 68.6 % had previous hernia repair, average defect area of 71.5 cm2, large meshes were used, without fixation, minimal intraoperative bleeding, minimal length of hospital stays, short disability, and low postoperative morbidity. We applied CCS preoperative, at 30, 90 and 180 postoperative days, showing improvement in the items evaluated. Follow-up was 310 ± 115 days with no recurrences, readmissions, or additional surgeries. Conclusions: The eTEP-SA approach offers technical and ergonomic improvements, excellent cosmetic results, reduces costs and operative time, compared to the classic technique, in selected cases. We suggest its implementation in the treatment of ventral hernias M1, M2, M3, L1, L2 and primary midline hernias associated with diastasis recti abdominis. We believe that eTEP-SA is a valuable option to consider. [ABSTRACT FROM AUTHOR]

Introduction: Umbilical hernia surgery is a procedure that has aroused the interest of surgeons worldwide due to its high prevalence, advances in knowledge and techniques in the abdominal wall. The objective of this study is to carry out a critical review of the literature from an analytical and reflective position in order to generate a document that promotes understanding among surgeons. Methods: A search of the available literature in English and Spanish since 1990 (time interval: 30 years) was performed using PubMed, the Cochrane Library, and a journal search. Search terms included 'umbilical hernia', 'treatment' and 'surgery'. Results: They are presented in response to the questions: How has umbilical hernia surgery evolved? What is the current status of treatment? What is the role of biomaterials? What are the expectations? What are your treatment options? Conclusions: New advances in umbilical hernia surgery create opportunities for their implementation by surgeons and institutions in order to adapt and improve our clinical practice. [ABSTRACT FROM AUTHOR]

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Introduction: Peritoneal dialysis is an option for chronic kidney disease. Percutaneous placement is usually the technique of choice for nephrologists, but it is not exempt from pericatheter hernias that require surgical management. The objective of this work is to present an alternative surgical technique for the repair of pericatheter hernias by percutaneous placement. Material and methods: Prospective, observational and descriptive study of a series of cases with patients who developed pericatheter hernias after percutaneous placement. The variables analyzed were sex, age, BMI, hypertension, diabetes, etiology of renal failure, previous hernia repairs, ASA, post-operative complications of the surgical wound or catheter and recurrence of the hernia. Results: Eight patients, 5 men (63 %) and 3 women (37 %) with pericatheter hernias operated with our technique. The average BMI in men was 31 kg/m2 and in women 30 kg/m2. The average surgical time was 78 minutes and the average hospital stay was 51 hours. The average follow-up time was 13.8 months with no recurrence of the hernia. Conclusions: The surgical technique we describe is an alternative to repair the pericatheter hernia secondary to percutaneous Tenckhoff catheter insertion, which avoids the risk of generating another hernia by relocating the catheter to another site in the abdominal wall. [ABSTRACT FROM AUTHOR]

Introduction: The history of hernias has been transmitted based on the possibilities of each era, socio-economic and cultural conditions. The objective of this work is to update the history of hernia illustration, from an international or country perspective and of surgical development. Method: Literature review of PubMed, LILACS, Cochrane Library databases; supplementary search using Google (Google play), of university libraries, by bookstores (Archiveorg., Boston Medical Library and Medical Heritage Library) and in networks on antiquarian pages. As keywords have been used: “hernia”, “anatomy” and “surgery”. A critical analysis of published articles, theses, books and monographs is carried out. Manuscripts obtained from any country, by any institution or researcher and in any language, without time limit, are stored in PDF format. Results: The study of the history of hernias with current methodology has discovered new contributions in Holland and Germany. The history of the English and French texts is the best known. Gimbernat’s Spanish contribution is valued, demonstrating the necessary union between topographic anatomy and surgery, being him the first surgeon to use the term “surgical anatomy” and the true father of modern hernia surgery. Andreas Bonn’s atlas for the Dutch school, 6 years before Cooper’s, is the first and complete visual approach to the specialty with 20 lithographs (1773-1798). Conclusions: The forgotten legacy of Adam K. Hesselbach, son of Frank, with 3 major works on diagnosis and treatment (1819, 1821 and 1829) and an atlas of 20 plates (1840) made by his brother Sebastian, is the German example of the relationship between surgeon-painter brothers. The importance of the Langenbecks (uncle and nephew) as a reflection of the development of surgical science and of hernia as the basis of learning for all surgeons. The contribution of the von Froriep family, as surgeons and editors, summarizing all the anatomical and surgical knowledge of the hernia learned in previous centuries and facilitating the training of surgeons in their own language. [ABSTRACT FROM AUTHOR]

Introduction: Lumbar hernia is a very rare type of abdominal wall hernia with a small number of published cases. It can occur through two anatomical triangles: an upper one or Grynfelt-Lesshaft triangle and a lower one or Petit triangle. Case presentation: We present the case of a 64-year-old woman with a soft and reducible tumor in the left posterolateral region of the abdominal wall. Computerized tomography confirmed the existence of a lumbar hernia through the superior triangle or Grynfelt-Lesshaft triangle. Patient was operated through a transabdominal laparoscopic approach in which after reduction of hernial content (fatty tissue) a double-layer mesh was placed in an intraperitoneal position. She was discharged 24 hours after the intervention and no immediate complications were observed. Discussion: Lumbar hernia is a very rare type of abdominal wall hernia and its diagnosis requires high clinical suspicion and often radiological confirmation by computerized tomography. Conclusion: Lumbar hernia repair is indicated to avoid possible complications and can be performed with an open or laparoscopic approach. Repair should include a mesh to reduce the risk of recurrence. [ABSTRACT FROM AUTHOR]

Amyand's hernia is a rare type of inguinal hernia presentation whose content is the cecal appendix, with reports of an incidence lower than 1%. Due to the low frequency in the presentation of this type of hernia, it is interesting to analyze the case of an 80-year-old male patient with a clinical case of sudden onset right inguinal pain, with CT scan compatible with a complicated right inguinal hernia. The finding of the cecal appendix in the hernial sac comes on as a surprise, where finally it was decided to perform a hernioplasty associated with an appendectomy. It is known that hernioplasty is among the most frequent procedures with standardized surgical techniques. However, in the literature, we find disagreements about the proper management of an Amyand-type hernia. Therefore, after a review of the bibliography that was motivated by the case, it is possible to consider that for the final repair of an Amyand hernia, the clinical and pathological presentation of each patient, the experience of the surgeon and the supplies available in the operating room must be taken into account for a greater benefit that will guide the best therapy for the patient. [ABSTRACT FROM AUTHOR]

The use of bioprosthesis in the hernia surgery is an irrefutable reality, because the benefits are undeniable. Nevertheless, it is necessary that surgeons have a correct knowledge of them, in general, and of their characteristics, particularly, in order to apply scientifically and ethically each of the implant that there are in the international market. In this work the current and necessary concepts in this surgery are established; also, the origins, complications, adverse reactions, the ways of solving complications and the present time in the bioprosthesis industry are exposed. The indicated topics allow a characteristic updated knowledge of the main characteristics and the uses of meshes in the hernia surgery, what can be of great usefulness for the general surgeon, specialized or not in the topic. [ABSTRACT FROM AUTHOR]

Purpose. To describe short and long term hystopathological effects of n-butyl-2-cyanoacrylate to fix meshes in the tissue and demonstrate that n-butyl-2-cyanoacrylate is a safe and efficient material to fix meshes, and could be used to substitute suture. Material and methods. Two study groups were formed, the first group covered a 30 day time study and the second was 90 days, allocation to any of the groups was random, each group included n of 10 Wistar strain female rats, one month ± of age, and an average weight of 250 ± 50 g. Rats were submitted to a surgical procedure in which four 1 cm cross incisions were made in the rat abdomen, one for each one of the three types of polypropylene meshes fixed with one drop of Histoacryl® and one with only the glue. Meshes used by BG Medical. After placing the meshes wounds were closed with Histoacryl®. According to the group they belonged to, thirty or ninety days after surgery, rats were submitted to tissue pathological analysis. Results. Mesh integration using n-butyl-2-cyanoacrylate glue occurred in 100% of the examined samples. In all of them, tissue was found over the mesh, including giant cells, neutrophils, fibroblasts, neoformation vessels and collagen. Conclusion. The n-butyl-2-cyanoacrylate glue is effective, safe and efficient to fix meshes to tissue, resulting in an appropriate integration of the material to the abdominal wall. Side effects in the tissue were minimum, and the resulting inflammatory response decreases 90 days after its application. [ABSTRACT FROM AUTHOR]

The knowledge of biomaterials is nowadays compulsory for surgeons, due to the increasingly acceptance in their use in the surgical procedures. In fact, the obtained results with implants: very low relapses cases and minimal number of complications, demonstrate it. The introduction in Cuba of the Surgimesh® mesh, developed by the Aspide Medical company, with physical-chemical characteristics of polypropylene which provide optimal effects, motivated to carry out this literature review on the topic. [ABSTRACT FROM AUTHOR]

Background: Gastroesophageal reflux after congenital diaphramatic hernia surgical correction occurs in up to 89 % of patients, out of which 20 to 30 % will require surgical management. Identification of risk factors for the development of this complication might allow for a Nissen fundoplication to be performed at the sime surgical time in those requiring it. The purpose of this research was to identify those factors in children with diaphragmatic hernia surgery. Methods: A case-control study was conducted, where patients with diaphragmatic hernia surgery treated between 2006 and 2011 were included. Patients with severe gastroesophageal reflux were regarded as the cases, whereas those who did not develop it over the 1-year follow up were the controls. Results: Nine patients developed severe gastroesophageal reflux after the diaphragmatic hernia surgery. A large size of the hernia, it containing 4 or more organs, 10 days or more of ventilatory support requirement after the surgery or high mechanical ventilation variables significantly increased the risk for the development of severe gastroesophageal reflux. Conclusions: Presurgical risk factors such as large hernias or hernias containing more than 4 organs might suggest the convenience of conducting a fundoplication at the same time of the diaphramatic hernia surgical correction. [ABSTRACT FROM AUTHOR]

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Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Médicas UIS is the property of Universidad Industrial de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Iatreia is the property of Universidad de Antioquia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To ponder the influence of the proper application of the selection criteria on the surgical results of these patients. Methods: All patients in which lumbar discectomy was performed from September of 2005 until July of 2008 were studied. All were homogeneously selected according to the following surgical selection criteria: prevalence of radicular pain, detection of radicular signs, and non-improvement of the symptoms with conservative treatment during a minimum of two months, establishment of positive diagnosis of Lumbar Disc Herniation by means of CT scan or Magnetic Resonance, nonassociation with spinal stenosis or instability. According to neurosurgeon's preference, patients were operated by means of standard laminectomy or Caspar's microdiscectomy. Using the statistical package SPSS 15.0, tests of Chi square and ANOVA were applied. Results: When comparing the affected vertebral level, predisposing and demographic factors, complications and postoperative evolution by means of Oswestry's index at three and six months, they were not significant differences in relation to the surgical technique used. Conclusions: The proper application of the surgical selection criteria to practice lumbar discectomy and the performance of a correct surgical technique, are the most important factors to achieve short term good results in these patients. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The aim of this study was to describe the technique of subtrigonal sling with abdominal fascia and demonstrate its usefulness in resolving complex stress urinary incontinence (SUI). Methods: We performed a cohort, longitudinal, observational study in adult females who attended the Urodynamics Department of the Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City, with recurrent SUI or with risk factors for recurrence, whether or not associated with urge urinary incontinence (UUI). Results: Between 1995 and 2006, 40 patients were included. Mean follow-up was 41.95 months (9-106), and the average patient age was 55 years. In 35 patients (87.5%) SUI was resolved, in two patients (5%) it improved, and in three patients (7.5%) it persisted. Of the 40 study patients, 18 had UUI and in only 7/18 patients (39%) was it resolved postoperatively. UUI de novo was noted in 12/40 patients (30%). One patient presented crural hernia, two patients presented postincisional hernia and two patients required blood transfusion. No patient presented acute urinary retention or urinary voiding problems postoperatively. Conclusions: Results obtained by this surgical technique are effective and long-lasting in patients with complex SUI. We did not observe bladder emptying dysfunction but there were formations of abdominal wall hernias. The minimally invasive approach consisting of the subtrigonal placement of synthetic tapes may maintain efficacy with minimal morbidity. [ABSTRACT FROM AUTHOR]

Introduction: The repair hernias diaphragmatic retroesternales has been described successfully through laparoscopic techniques, demonstrating its feasibility and reproducibility. Described a technique videoasistida for repair of these defects diaphragmatic through points extracorporeal placed through the abdominal wall. Presentation of the Case Clinico: Female four months of age that the performed an x-ray thoracoabdominal by constipation is displayed default diafragmático earlier. The patient is scheduled in the form elective for repair laparoscopically. The surgical time was 25 minutes. Its recovery was satisfactory tolerating mouth the same day and egresándose the following day. The follow-up to the patient is 14 months and radiologicámente there is no evidence of recurrence. Discussion: The first repair laparoscopic diaphragmatic hernia retroesternales was described pos Kuster in 1992. Described a technique for closure of the defect placing the points through the abdominal wall, taking with the needle the edge of the defect and emerging points outside the wall leaving the knots subcutaneous, obtained good results, and with greater technical ease. [ABSTRACT FROM AUTHOR]

Background: Nowadays, the power to provide better quality treatment at less cost. Two recent meta-analysis have established that the mass closure technique with nonabsorbable suture material is the ideal form of abdominal wall closure in adult patients cancer and a study in female patients where cancer has not been able to show differences between ideal forms and materials for closure of the abdominal wall in pediatric oncology patients. Objective: To establish the effectiveness of the closure of massive abdominal wall with nonabsorbable suture material compared with the traditional form of closure in layers with absorbable suture material in pediatric oncology patients at a lower cost without increasing the risks for patients about it. Hypothesis: The closure of the abdominal wall mass with non-absorbable suture material is less than or equal frequency of surgical site infection, wound dehiscence and hernia surgery postincisional that layered closure with absorbable sutures in pediatric oncology patients lower costs and shorter surgical closure. Hypothesis: The closure of the abdominal wall mass with non-absorbable suture material is less than or equal frequency of surgical site infection, wound dehiscence and hernia surgery postincisional that layered closure with absorbable sutures in pediatric oncology patients lower costs and shorter surgical closure. Methods: Randomized controlled trial of patients younger than 18 years with a diagnosis of malignancy associated in any region of the body and surgically in the abdomen with open technique in the hospital. It will calculate the minimum number needed to treat and cost of the closure according to the group that owns the patient, number of sutures and surgical closure time employee. Results: We included 23 patients randomized to 12 in the mass closure 11 with closure plans, with no significant differences in both groups, no difference was found regarding postoperative complications, hernias postincisionales, surgical wound infection or hernia, Sin But if you look close time decreased statistically significant (p = 0.025), so also in economic analysis cost less than half the mass closing costs, concluding that mass closure is more efficient than the closing levels since both methods are comparable but cheaper mass closure with nonabsorbable material. Discussion: It has already demonstrated in multicenter studies that the mass closure with absorbable or nonabsorbable material is ideal for adult patients having no further studies reported in pediatric patients or pediatric cancer patients. Our economic analysis found that the cost per patient is less mass closure for closing surgical time, finding no significant difference in the clinical course of patients. As important as it now if you plan to cost reduction in a hospital, the studies should evaluate are studies which show that a more effective method such as mass closure material nonabsorbable suture. In this study, costs were reduced surgical time and cost end of suture material, without being put at risk the patient's prognosis. This way you can increase the productivity and effectiveness at a lower cost without worsening the patient's prognosis. [ABSTRACT FROM AUTHOR]

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The instruments for an original technique of percutaneous cervical arthrodhesis (PCA) under local anesthesia and soothing, and the technique itself are reported here. The procedure is ambulatory and it can be performed in the operating theater or in the x-ray room. It is reported the two-year evolution for the first seven patients given this treatment, four from the female sex and three from the male one, ranging from 36 and 68 years old. These patients had been diagnosed as presenting single or multiple disk hernia with a relapse to percutaneous nucleotomy embracing less than 25% of the vertebral groove, disk hernia with spine instability or discarthrosis. The patients suffering from medullar compression, non-reducible spondylolisthesis or progressive neuropathy were discarded from this study. The results were satisfactory in six patients (85.7%) with pain having disappeared, neurological recovery and activity return at two weeks after the treatment. The result was not so satisfactory in one case due to grafting reabsorption, which led to a new open surgery. There were just a few problems and they consisted of pharyngitis and dysphagia presented by three patients after the immediate post-operative period and they were inherent in trachea, pharynx and esophagus manipulation, with a complete recovery in a maximum of three weeks. We recommend practicing this technique in patients who have been diagnosed single cervical disk hernia or when it is present along with discarthrosis and/or reducible instability, engaging at most two levels. We have some prudence or caution in level C2-C3. [ABSTRACT FROM AUTHOR]