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Objective To investigate the presence of widespread pressure pain sensitivity in cancer patients following partial colorectal resection in the abdominal and lower back area and to describe the presence of abnormalities in abdominal and lower back muscle morphology. Methods Twenty colon cancer survivors (eight females, mean age 56.60 ± 7.76 years) and 20 matched healthy controls (10 females, mean age 54.22 ± 8.12 years) participated. Abdominal and lower back pain was assessed after undergoing surgery using a Visual Analogue Scale (VAS) and Brief Pain Inventory (BPI). Pressure pain thresholds (PPTs) were bilaterally assessed over the supraumbilical, infraumbilical, and lower back areas and the second metacarpal. Ultrasound imaging was used to measure the depth of the abdominal muscles, the width of the midline abdominal fascia and the width of the lumbar multifidus. Results Ten months after finishing oncological treatments, patients who underwent partial colorectal resection reported significantly higher pain levels in the low-back area (P = 0.003) but not in the abdominal area (P = 0.426) compared with the matched controls. After surgery, the colon patients reported significantly higher BPI-intensity (P

Objective The surgical treatment of recurrent coarctation in adults supposes a redo left thoracotomy with adhesions and high risk of bleeding and injury of adjacent nerves. The rate of paraplegia in these cases may reach 2.6%. Extra-anatomic aortic bypass avoids these complications. We present our results with ascending-to-abdominal aorta extra-anatomic bypass for recurrent aortic coarctation in adults. Methods Between September 1979 and November 2006 12 patients underwent ascending-to-abdominal aorta bypass. There were 10 males and 2 females. Mean age was 36.2+/-11.3 (range 21-57) years old. Mean age at primary repair was 14.3+/-4.2 years old (range 8-21). Operative technique consisted of performing an ascending-to-abdominal aorta bypass via median sternotomy extended into the epigastrium with a supra-umbilical laparotomy through the mid-line abdominal fascia. Concomitant procedures were performed in six patients: three isolated aortic valve replacements (AVR), two ascending aorta graft replacements and one AVR associated with coronary artery bypass graft (CABG). Results No postoperative mortality was observed. Mean follow-up time was 10.4+/-9.3 years (range 0.3-27.8). No patients had any graft-related complication or death and all grafts were patent at the end of the follow-up. One patient developed a dilated myocardiopathy, dying at 14 years of follow-up. Four patients had persistence of arterial hypertension controlled with one drug therapy and five patients were asymptomatic. Conclusions Ascending-to-abdominal aorta extra-anatomic bypass is a safe, effective and less invasive technique for aortic recoarctation in adults with good results at long-term.

Background Combined abdominoplasty and lipoplasty is fequently performed to achieve improved body contour in a single surgical session. Objective We describe a procedure that combines vertical and transverse plication of the abdominal fascia with lipoplasty of the anterior abdominal wall. Methods Lipoplasty of the anterior abdominal wall was performed using a superwet technique. The amount of extracted fat ranged from 200 to 6000 mL. Abdominoplasty was performed using traditional methods. Plication of the abdominal fascia combined the traditional longitudinal method with a half-moon plication, located in the lower abdomen. Results Seventy-six women ranging in age from 20 to 62 years underwent combined abdominoplasty and lipoplasty between January 2002 and January 2003. Patient satisfaction was rated as excellent in 74 cases. Patient satisfaction was rated as good in the other 2 cases, in which the only patient complaint was hypertrophy of the scar, which improved over time with the use of massage. Seromas developed in 8 patients (10.52%) and were treated successfully by syringe extraction. Conclusions Benefits of combining abdominoplasty with lipoplasty include reduction of abdominal flap volume, improvement in the final quality of the scar, and improved tissue contraction. The anchor plication reduces strain in the abdominal fascia and also diminishes the vertical abdominal diameter, facilitating the descent of the flap.

Background Various randomized studies have evaluated techniques of abdominal fascia closure but controversy remains, leaving surgeons uncertain about the optimal method of preventing incisional hernia. Method Medline and Embase databases were searched. All trials with a follow-up of at least 1 year that randomized patients with midline laparotomies to closure of the fascia by different suture techniques and/or suture materials were subjected to meta-analysis. Primary outcome was incisional hernia; secondary outcomes were wound dehiscence, wound infection, wound pain and suture sinus formation. Results Fifteen studies were identified with a total of 6566 patients. Closure by continuous rapidly absorbable suture was followed by significantly more incisional hernias than closure by continuous slowly absorbable suture (P < 0·009) or non-absorbable suture (P = 0·001). No difference in incisional hernia incidence was found between slowly absorbable and non-absorbable sutures (P = 0·75), but more wound pain (P < 0·005) and more suture sinuses (P = 0·02) occurred after the use of non-absorbable suture. Similar outcomes were observed with continuous and interrupted sutures, but continuous sutures took less time to insert. Conclusion To reduce the incidence of incisional hernia without increasing wound pain or suture sinus frequency, slowly absorbable continuous sutures appear to be the optimal method of fascial closure.