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Gracias al desarrollo continuo de las tecnologías en telecomunicaciones, el uso de los teléfonos inteligentes se ha ido enaumento, favoreciendo el crecimiento de las aplicaciones móviles (app). Actualmente, existen más de 700.000 en las diversas plataformas, de las cuales el 3% están relacionadas con temas de salud. Las apps en salud se encuentran enmarcadas en el concepto de salud móvil o mHealth, que en la actualidad no tiene una definición clara, pero la OMS se ha referido a este como la práctica de la medicina y la salud pública soportada por dispositivos móviles. Hasta el momento existen varias revisiones sobre aplicaciones móviles en otras disciplinas médicas, la cantidad de dichas revisiones sobre apps siendo utilizadas en áreas de las neurociencias son pocas, muy a pesar de que su uso en pacientes y personal médico ha ido en aumento. Dentro de los beneficios por su uso se han descrito el poder realizar seguimientos más objetivos y estandarizados, mayor comunicación entre los integrantes del equipo médico y respuestas más rápidas en casos de emergencias. Por parte de los pacientes estos han tenido mayor adquisición de conocimiento en relación a su enfermedad y mayores tasas de adherencia a los tratamientos.

To clarify the factors related to recurrence after component separation technique (CST). A retrospective study was conducted of 381 patients who underwent CST between May 2006 and May 2017 at a tertiary center. All patients had a transverse hernia defect grade W3 in EHS classification. Recurrence rate was determined by clinical examination plus confirmation by abdominal CT scan. At a median of 61.6 months of postoperative follow-up, we reported 34 cases of hernia recurrence (8.9%). On multivariate analysis, BMI > 30 (OR 2.20; CI 1.10–3.91, p = 0.031), immunosuppressive drug use (OR 1.06 CI 1.48–2.75, p = 0.003) and development of surgical site infection (OR 2.7; CI 1.53–4.01, p = 0.002) were factors of recurrence after CST. There was no difference in recurrence rate among repairs of primary and recurrent hernias, urgent repair, operative time, type of prosthesis, or concomitant procedures, even planned or unplanned enterotomies. Obesity (BMI > 30), immunosuppressive drug use, and postoperative wound infections were predictors of recurrence after CST.

Background An increasing number of patients have large or complex abdominal wall defects. Component separation technique (CST) is a very effective method for reconstructing complex midline abdominal wall defects in a manner that restores innervated muscle function without excessive tension. Our goal is to show our results by a modified CST for treating large ventral hernias. Materials and methods A total of 351 patients with complex ventral hernias have been treated over a 10-year period. Pre-and postoperative CT scans were performed in all patients. All ventral hernias were W3, according to the EHS classification 1. We analyzed demographic variables, co-morbidities, hernia characteristics, operative, and post-operative variables. Results One hundred and seventy patients (48.4%) were men; the average age of the study population was 51.6 +/- 23.2 years with an average BMI of 32.3 +/- 1.3. The hernia was located in the midline in 321 cases (91.5%) versus the flank in 30 (8.5%). In 45 patients, preoperative botulinum toxin (BT) and progressive pneumoperitoneum (PPP) were needed due to giant hernia defects when the VIH/VAC ratio was > 20%. Postoperative complications related to the surgical site were seroma (35.1%), hematoma (9.1%), infection (7.2%), and wound necrosis (8.8%). Complications related to the repair were evisceration in 3 patients (1.1%), small bowel fistula in 4 patients (1.5%), 11 cases of mesh infection (2.9%), and abdominal compartment syndrome (ACS) in 2 patients. There were 29 hernia recurrences (8.2%) with a mean follow-up of 31.6 +/- 8.1 months. Conclusion The modified CST is an effective strategy for managing complex ventral hernias that enables primary fascial closure with low rates of morbidity and hernia recurrence.

Introduction Incisional hernias secondary to renal transplantation (IHRT) are considered complex hernias because they are lateral to the sheath of the rectus abdominis muscle. The presence of the graft in the iliac fossa and the proximity to the inguinal area, costal margin and iliac bones, as zones with difficult fixation for prostheses, increases repair complexity. In addition, these patients have specific characteristics, such as treatment with immunosuppressive medication, that could alter postoperative evolution. The objective of this study was to analyze the results obtained in IHRT repair at a tertiary hospital, and to compare these data with the international literature. Methods Retrospective observational study of patients treated surgically for IHRT in our unit from January 1, 2011 to January 31, 2018. Preoperative conditions, intraoperative factors and postoperative complications during follow-up were analyzed. Results Twenty-five patients underwent hernia repair, finding a 4% hernia recurrence rate during a median follow-up of 27.5 months (20–39). The most frequently used technique was the posterior transversus abdominis release component separation technique in 42%, followed by preperitoneal repair in 27% and interoblique repair in 12%. The overall postoperative morbidity was 23%, which was frequently related to the surgical site (12%). Conclusions IHRT repair is a safe procedure at our medical center, with an acceptable rate of hernia recurrence, but it is not without complications.

Background The main objective was to identify predictive factors associated with prosthesis infection and mesh explantation after abdominal wall hernia repair (AWHR). Methods This is a retrospective review of all patients who underwent AWHR from January 2004 to May 2014 at a tertiary center. Multivariate analysis identified predictors of mesh infection and explantation after AWHR. Results From 3,470 cases of AWHR, we reported 66 cases (1.9%) of mesh infection, and 48 repairs (72.7%) required mesh explantation. Steroid or immunosuppressive drugs use (odds ratio [OR] 2.22; confidence interval [CI] 1.16 to 3.95), urgent repair (OR 5.06; CI 2.21 to 8.60), and postoperative surgical site infection (OR 2.9; CI 1.55 to 4.10) were predictive of mesh infection. Predictors of mesh explantation were type of mesh (OR 3.13; CI 1.71 to 5.21), onlay position (OR 3.51; CI 1.23 to 6.12), and associated enterotomy in the same procedure (OR 5.17; CI 2.05 to 7.12). Conclusions Immunosuppressive drugs use, urgent repair, and postoperative surgical site infection are predictive of mesh infection. Risk factors of prosthesis explantation are polytetrafluoroethylene mesh, onlay mesh position, and associated enterotomy in the same procedure.

ResumenIntroducciónEl esfínter urinario artificial se utiliza en el tratamiento de la incontinencia urinaria secundaria a cirugía prostática. Los pacientes con esfínter urinario pueden precisar cirugía por una hernia inguinal ipsilateral.Caso clínicoPresentamos el caso de un paciente de 66 años con esfínter artificial tras resección transuretral prostática y una hernia inguinal izquierda sintomática, y describimos la técnica quirúrgica.DiscusiónEl esfínter urinario consta de un manguito oclusivo situado en la uretra bulbar, una bomba de control en el escroto y un balón regulador de presión en el espacio preperitoneal situado en la región inguinal, conectados por tubos. La vía de abordaje más utilizada para su colocación es a través de una incisión perineal y otra inguinal. Las recomendaciones durante la hernioplastia en estos pacientes son: utilizar profilaxis antibiótica y una técnica meticulosa para disminuir el riesgo de infección, y evitar la manipulación de los tubos conectores con material traumático, y evitar la manipulación del reservorio con cualquier instrumental y el contacto con el bisturí eléctrico por riesgo de rotura. Las complicaciones específicas son: infección del sistema que requiere la retirada del dispositivo y antibioterapia, y la rotura de algún componente que requiere su sustitución.ConclusionesLa hernioplastia inguinal ipsilateral en pacientes con esfínter artificial es una técnica segura si se siguen unas pautas respecto a la manipulación intraoperatoria de los componentes del sistema en la región inguinal.AbstractIntroductionThe artificial urinary sphincter is used to treat urinary incontinence following prostate surgery. Patients treated with this device and with symptomatic ipsilateral inguinal hernia may require hernioplasty.Case reportWe present the case of a 66 year-old man who had an artificial urinary sphincter after transurethral prostatic resection and a symptomatic left inguinal hernia; and we describe the surgical approach.DiscussionThe artificial urinary sphincter consists of different parts: an inflatable cuff placed in bulbar urethra, a control pump placed in scrotum, a pressure regulating balloon placed in the preperitoneal space and connectors. Most frequently two incisions are made for device placement: in the midline of the perineum and in the right or left lower quadrant just above the inguinal canal. During ipsilateral hernia repair we recommend: administering antibiotic prophylaxis preoperatively and using a meticulous surgical technique to reduce risk infection; to avoid handling connectors with traumatic instruments; to avoid manipulating the balloon and to avoid contact with the electric scalpel. Specific complications are: infection, that would require removal of the device and antibiotic treatment, or balloon or connectors tear,which would require replacing the component.ConclusionsIpsilateral hernia repair is a safe procedure in patients with artificial urinary sphincter, provided that we know how to manipulate the device and its components in the inguinal region during surgery.

ResumenLa extirpación quirúrgica es el tratamiento de elección en los tumores de la pared abdominal. La radioterapia puede resultar muy útil para reducir el volumen de los tumores y hacerlos accesibles a la cirugía, además de servir como tratamiento adyuvante en casos de tumores de alto riesgo de recidiva o cirugías subóptimas. El tipo de exéresis variará en función del tipo de tumor. Así, en tumores benignos, una exéresis simple será suficiente. En caso de tumores de malignidad intermedia (poca capacidad de metástasis pero con alto riesgo de recaídas locales), la cirugía se irá adaptando a esta, pasando de una cirugía amplia para el tumor desmoide a una cirugía micrográfica de Mohs para el dermatofibrosarcoma protuberans y a una cirugía radical compartimental con reconstrucción de la pared para el sarcoma de partes blandas. Las metástasis en la pared abdominal se tratarán de la misma forma que los sarcomas. En cualquier caso, para el éxito de cualquier intervención es fundamental conseguir unos márgenes quirúrgicos libres de tumor, junto a una estética y funcionalidad aceptables.AbstractSurgical removal is the cornerstone of treatment of tumours of the abdominal wall. Radiation therapy can be very helpful in reducing tumour volume and make them accessible to surgery and adjuvant treatment for tumours at high risk of recurrence or suboptimal surgery. Excision type vary depending on the type of tumour. Thus, a simple excision for benign tumours will suffice. In case of tumours of intermediate malignancy (metastasis but little capacity at high risk of local relapse) surgery will adapt to it; going from a wide desmoid tumour surgery for a Mohs micrographic surgery for dermatofibrosarcoma protuberans and one compartment radical surgery with reconstruction of the wall for soft tissue sarcoma. Metastases in the abdominal wall are treated in the same way as sarcomas. In any case for the success of any intervention it is critical to achieve tumour-free surgical margins, along with acceptable aesthetics and functionality.

ResumenLos tumores que afectan a la pared abdominal pueden tener su origen en diversas estructuras anatómicas o tejidos de la pared. En el presente artículo de revisión se describen los hallazgos macroscópicos, histopatológicos e inmunohistoquímicos de las lesiones que con más frecuencia asientan en la pared abdominal. Se propone un algoritmo diagnóstico que combina las características clínicas y morfológicas que permiten clasificar cada uno de los procesos localizados en pared abdominal.AbstractTumors involving the abdominal wall arise from a large number of etiologies. This review article describe a diagnostic approach with macroscopic, histopathological and immunohistochemical features of the most common causes of abdominal wall masses. We propose a diagnostic algorithm for abdominal wall tumors which combines clinical data and morphologic appearances to classify each lesion.

ResumenIntroducciónLas hernias obturatrices son extremadamente raras (aproximadamente menos del 1% de todas las hernias). Normalmente se dan en mujeres ancianas, multíparas y desnutridas. La tomografía computarizada es una herramienta útil para el diagnóstico. Presentamos el caso de un paciente diagnosticado de hernia obturatriz incarcerada y tratado por vía laparoscópica.Material y métodoVarón de 55 años de edad con antecedentes de cirrosis alcohólica (estadio B de Child Pugh), que ingresó en el hospital por presentar dolor abdominal y vómitos. La radiografía de abdomen simple reveló signos compatibles con suboclusión intestinal. El paciente fue tratado de modo conservador, con tratamiento médico del cuadro suboclusivo, pero el dolor abdominal empeoró y se le irradió a la cara medial del muslo derecho (signo de Howship-Romberg). Se le realizó una tomografía computarizada, que reveló un segmento de íleon terminal que protruía por el orificio obturador.ResultadosSe decidió el abordaje laparoscópico del paciente. Se redujo el contenido herniario hacia la cavidad abdominal, usando pinzas atraumáticas. No se evidenciaron signos de sufrimiento intestinal. Se cubrió el orificio obturador con un tapón preformado de polipropileno y luego se cubrió con un flap de peritoneo.ConclusionesUn diagnóstico y tratamiento temprano son esenciales para reducir el tiempo de estrangulación y mortalidad en estos pacientes. El tratamiento laparoscópico es una alternativa diagnóstica y terapéutica.AbstractIntroductionObturator hernias are considered very rare, accounting for approximately less than 1% of all hernias, and usually occur in multiparous women or elderly emaciated individuals. Abdominal computed tomography is a useful tool for diagnosis. We report a case of an obturator hernia repaired laparoscopically.Material and methodA 55-year old patient with Child-Pugh stage B alcoholic cirrhosis, was admitted to our hospital due to abdominal pain and vomiting. Plain abdominal radiography showed dilated small bowel loops indicating obstruction. The patient was managed conservatively, but abdominal pain worsened, radiating along the medial side of the right thigh (Howship-Romberg sign). A computed tomography scan was then ordered, revealing a loop of small bowel protruding into the obturator canal.ResultsFinally, the patient underwent laparoscopic surgery. The herniated ileum was replaced into the peritoneal cavity using atraumatic graspers. The obturator orifice was closed with a polypropelene plug and then covered with peritoneum flap.ConclusionsEarly diagnosis and treament are essential in order to reduce the rate of strangulation and mortality in these cases. Laparoscopic approach is an alternative option in the diagnosis and treatment of obturator hernias.

Preoperative progressive pneumoperitoneum and botulinum toxin type A are useful tools in the preparation of patients with loss of domain hernias. Both procedures are complementary in the surgical repair, especially with the use of prosthetic techniques without tension, that allow a integral management of these patients. The aim of this paper is to update concepts related to both procedures, emphasizing the advantages that take place in the preoperative management of loss of domain hernias.

Flank or lateral incisional hernias are very rare but may be very challenging to manage them. To handle these hernias a previous classification, an early diagnosis, and a tomography are necessary. Delaying surgery only prolongs the patient’s suffering, aggravates the problem, and worsens the prognosis. Knowledge about the topographic anatomy is essential to perform surgery safely. The dissection of the bone edges and medial areas (rectus sheath) is difficult and limited. Fixation on these areas must be firm. The laparoscopic approach is a safe option for small or moderate defects in patients with BMI 15 cm) and on obese patients this approach should be preferred and the double-mesh technique is the best choice. As with other complex abdominal wall hernias, we advise that patients with complex lateral hernias should be treated in specialized units.

Background: To compare the results with complete mesh removal (CMR) versus partial mesh removal (PMR) in the treatment of mesh infection after abdominal wall hernia repair (AWHR). Methods: Retrospective review of all patients who underwent surgery for mesh infection between January 2004 and May 2014 at a tertiary center. Results: Of 3470 cases of AWHR, we reported 66 cases (1.9%) of mesh infection, and 48 repairs (72.7%) required mesh explantation. CMR was achieved on 38 occasions, while PMR was undertaken ten times. We observed more postoperative complications in CMR than PMR group (p = 0.04). Three patients with intestinal fistula were reoperated in postoperative period after a difficult mesh removal; one of them died due to multiple organ failure. The overall recurrence rate after explantation was 47.9%: recurrence was more frequent in CMR group (p = 0.001), although persistent or new mesh infection was observed more frequently with PMR (p = 0.001). Conclusions: Although PMR has less postoperative morbidity, shorter duration of hospitalization and lower rate of recurrence than CMR, prosthetic infection persists in up to 50% of cases. (C) 2016 Elsevier Inc. All rights reserved.

Prosthesis infection is an infrequent but important complication in abdominal wall surgery. The aim of this study is to evaluate the incidence and risk factors for the infection of the prosthesis after hernia repair, as well as the treatment to apply.Between January 2002 and December 2006, we performed 1055 prosthetic hernia repairs: 761 inguinal hernias (72.1%), 74 umbilical hernias (7%) and 220 ventral hernias (20.9%). We prospectively analysed preoperative, intraoperative and postoperative variables, as well as the incidence of infection of surgical wound and of prosthesis. We used ASA classification for preoperative anaesthetic evaluation.The overall percentage of infection of the prosthesis was 1.3%. Infection was observed in 11 repairs with polypropylene mesh (PPL), in 4 with PTFE mesh, and one case in combined mesh. Risk factors of mesh infection were: obesity (p=0.002), diabetes (p=0.020), the type of repair (p=0.047), emergency surgery (p=0.001), the type and size of mesh (p=0.003; p=0.007) and time of surgery180 min (p0.001). Seven of the 11 patients with infection of PPL prosthesis were resolved with conservative treatment, whereas all the cases with PTFE infection or mixed mesh needed removal to solve the problem.Several factors are involved in producing a prosthesis infection. Whereas antibiotic treatment and surgical drainage of the infection can be sufficient in most PPL mesh infection, PTFE prostheses need to be removed prematurely in order to halt the infection process.

Resumen Introduccion El objetivo de este estudio es valorar la influencia de la edad en la colecistectomia laparoscopica (CL) para el tratamiento de la colecistitis aguda (CTTA), determinando los beneficios y complicaciones postoperatorias en los pacientes mayores de 65 anos. Material y metodo Entre enero de 2003 y marzo de 2006, se practico un total de 134 CL por CTTA en el area de urgencias: 58 pacientes tenian edades superiores a 65 anos (grupo 1) y se los comparo con 76 pacientes mas jovenes (grupo 2). Se analiza las variables preoperatorias, intraoperatorias y postoperatorias en el grupo 1 y se las compara con el resto de la serie. Se utilizo la clasificacion ASA para valoracion preoperatoria anestesica. Resultados El grupo 1 presento en un 31,2% alto riesgo quirurgico (un 24%, ASA III y el 9,2%, ASA IV). La tasa de conversion a colecistectomia abierta fue del 24,1%, frente al 11,3% en el grupo 2 (p = 0,04), debido a dificultad en la diseccion quirurgica y hallazgo de vesicula colecistitica muy evolucionada. La estancia media postoperatoria fue de 4,7 ± 3,2 dias en el grupo 1 y de 3,3 ± 2,4 dias en el grupo 2 (p = 0,001). La tasa general de complicaciones postoperatorias fue del 33,1 y el 18,7%, respectivamente, y prevalecieron las de tipo infeccioso. Conclusiones Aunque la edad no debe ser un factor excluyente para la CL, la tasa de conversion, las complicaciones postoperatorias y la estancia hospitalaria son mayores en estos pacientes que en el resto de la poblacion. Son caracteristicas la mayor morbilidad por la enfermedad de base, y una evolucion mas larga del cuadro con hallazgos mas frecuentes de colecistitis evolucionada, que complican el abordaje laparoscopico en estos pacientes.

ResumenLas hernias traumáticas intercostales con diafragma intacto son poco comunes. Algunas veces aparecen como resultado de una laceración en los músculos intercostales, que facilita la progresión de la bolsa con hernia pulmonar o cualquier víscera abdominal. Por lo general, hay fracturas costales en el 52% de los casos. Una tomografía computarizada es muy importante, porque es diagnóstica: informa del contenido del saco, la ubicación y el tamaño del defecto y otras lesiones. Se presenta un caso de un varón de 20 años que fue llevado a la sala de urgencias de nuestro hospital con traumatismo toracoabdominal. La tomografía computarizada mostró traumatismo esplénico, renal, laceraciones de hígado y hernia intercostal izquierda con contenidos del intestino delgado y preservación del diafragma. Se realizó una laparotomía, que mostró hemoperitoneo y herniación torácica entre 9 y 10. Se redujo el contenido herniario y se realizó esplenectomía, nefrectomía izquierda y hemostasia de las laceraciones hepáticas. Liberamos el espacio preperitoneal y colocamos una malla de polipropileno de 5.9×5.9cm para cerrar la hernia, fijándola con grapas helicoidales no absorbibles y cubriéndola luego con un colgajo de peritoneo. La reparación protésica sin tensión, hoy en día, es la más recomendable. Algunos estudios sugieren el uso de pegamento para reducir el riesgo de neuralgia intercostal.AbstractTraumatic Intercostal hernias with an intact diaphragm are an uncommon case. Sometimes they appear as a result of a tear in the intercostal muscles that facilitates the progression of the sack with lung herniation or any abdominal viscera. Rib fractures are usually present in 52% of the cases. Performing a computed tomographyscan is very important because it is diagnostic: it reports the contents of the sac, the location and size of the defect, as well as other lesions. We report a case of a 20 years old male who was taken to the emergency room of our hospital with thoracoabdominal trauma. Total body computed tomography showed splenic rupture, renal failure, liver lacerations and left intercostal hernia with small bowel contents. We performed a laparotomy, which showed hemoperitoneum and herniation between the 9th and 10th ribs. Splenectomy was performed and hemostasis of liver lacerations, left nephrectomy and intercostal hernia repair left. We liberated the preperitoneal space and placed a polypropelenemesh of 5.9×5.9cm to close the hernia. We fixed it to the ribs with non-absorbable staples, and then we covered the mesh with a flap of peritoneum. Tension-free prosthetic repair today is the most recommended. Some studies suggest the use of glue to reduce the risk of intercostal neuralgia.

In the last two decades, the surgery of the abdominal wall has experienced an important development from being considered a matter of little interest for general surgeon, to having a greater presence at scientific meetings and to being increasingly prominent in the specialist training in surgery. In 1990 the plastic surgeon Oscar Ramirez published a method to repair defects in the abdominal wall that called “Component Separation Technique” thereafter general surgeons fixed his attention on the techniques of autoplastic repair of the abdominal wall that had already developed throughout the twentieth century. This interest grows with the emergence of new prosthesis and the use of laparoscopic surgery to repair eventrations since Le Blanc and Booth published in 1993. The development of techniques and materials encourages surgeons to repair large defects in the abdominal wall, using preoperative procedures to avoid complications arising from the return of viscera to a reduced abdominal cavity; it recovers the use of preoperative progressive pneumoperitoneum and the muscular expanders; it applies the use of botulinum toxin in transverse abdominal muscles. Surgery of the large eventrations, however, is not free of complications such as skin necrosis which is treated by negative pressure therapy; it is necessary to control the intra-abdominal pressure (IAP) and the development of techniques for the treatment of the open abdomen with subsequent progressive or delayed closure of the abdominal cavity. The complexity of surgical techniques and the knowledge of pre- and postoperative procedures to prevent and treat complications, in addition to the wide variety of prosthetic materials used, they justify the creation of abdominal wall surgery units in large hospitals, thus contributing to become an exciting topic for new generations.

Fundamento Determinar si la presencia de sofocos durante la menopausia se asocia a alteracionesen el metabolismo del oxido nitrico, actividad antioxidante total y otros parametros bioquimicos.Determinar el efecto del tratamiento hormonal sustitutivo (THS) sobre el metabolismodel oxido nitrico, actividad antioxidante total y otros parametros bioquimicos en mujeres menopausicascon sofocos y sin ellos. Pacientes y metodos Estudio experimental que incluye 29 mujeres menopausicas con sofocos(se les aplico THS a 12) y 20 sin sofocos (se les aplico THS a 6), sanas, de 45 a 55 anos deedad, con un periodo de menopausia de entre uno y 5 anos. Grupo control formado por 14 mujeresen edad fertil. Determinacion de estradiol, nitritos-nitratos, actividad antioxidante total yparametros generales, antes y 4-6 meses despues del THS. Resultados Previamente al THS la presencia de sofocos se asocio a un menor nivel de actividadantioxidante total (p Conclusiones La presencia de sofocos durante la menopausia indica un mayor grado de estresoxidativo y por tanto un mayor riesgo cardiovascular. El THS disminuye el grado de estres oxidativoy aumenta los metabolitos derivados del oxido nitrico en las mujeres menopausicas cono sin sofocos.

A 62-year-old patient was studied after an episode of fainting with oppressive pain that appeared and recurred during exercise. Abdominal-pelvic CT revealed a heterogeneous retroperitoneal mass from the infrarenal distal third of the inferior vena cava (IVC) with calcifications that was highly vascularized, partially extraand endoluminal, with cranial extension up to the right auricle, that was implanted in the septum and up to the tricuspid valve to the RV (Figs. 1 and 2). Given the obstruction of the IVC and the existence of collateral venous return, and considering the differential diagnosis between leiomyosarcoma and angiosarcoma with associated thrombosis, surgery was performed and the IVC was resected in 2 stages using laparotomy and sternotomy. Final pathology diagnosis: high-grade leiomyosarcoma. c i r e s p . 2 0 1 3 ; 9 1 ( 3 ) : e 1 7

Introduction: Subxiphoid incisional hernia has characteristics that differentiate it from the rest and make it a distinctive entity. The fact that it has its sac very near the rib cage and sternum determines the pressure in the margins. The repair, by open or by laparoscopic approach, has not demonstrated good results despite the generalised use of a prosthesis. They are uncommon, and have a significant comorbidity in patients (severe heart diseases, transplants, immunosuppressed), after surgery of the hepato-bilio-pancreatic area with transverse incisions, or very high mid-laparotomies for gastro-oesophageal surgery. Material and methods: A new technique has been developed in our Unit, based on a double mesh and adapted to the anatomical and physiological characteristics of the region. The series consisted of 35 consecutive patients operated on between 2004 and 2010, following an agreed surgical and management protocol. Results: There were no significant complications−the most frequent (17.4%) was a seroma−except one case of a wound infection due to skin ischaemia in one patient who had had multiple operations and a transplant. During the post-surgical follow up to the present (between 4 and 80 months), there has been no recurrence of the incisional hernia and no significant local discomfort has been reported. Conclusions: The “adjusted double mesh” technique achieved good results in our hands, from the surgical point of view (reproducibility, recurrence), and for the patient, with minimal discomfort and recovery of quality of life..

Introduction Our goal is to show the surgical community a new technique developed by our team for treating complex and catastrophic ventral hernias: Separation of Anatomical Component (SAC) amended by Carbonell–Bonafe. Material and method A total of 100 patients with complex incisional hernias have been treated. The size, content and reducibility of ventral hernia (preoperative CT scan), recurrences and pre-closure techniques, height and weight, trophic skin alterations and need for preoperative pneumoperitoneum were all documented. The operation was performed following a standardised protocol; intra-abdominal pressure (IAP) was measured before, during and after the intervention. Patients were evaluated in the clinic at 15 and 30 days, monthly for 3 months, at sixth months and annually for up to 5 years. Results A total of 100 consecutive patients were operated on between January 2003 and May 2008. In the immediate post-surgical period there were 12% seromas, 8% of partialischaemia on the edges of the wound and 1 death due to multi-organ failure. In the later period, 6% had transitional pain in bone anchorage points. They resumed their normal activities after an average of 2 months, with great improvement in their quality of life. There have been no recurrences to date. Conclusions The SAC technique, as modified by our Unit, is an excellent resource in managing large ventral hernias: successfully closing with low morbidity, as well as reconstructing the biomechanics of the abdominal wall.

Resumen Un 10% de los feocromocitomas son bilaterales. Ademas el 10% es familiar y puede asociarse de forma mas frecuente con el sindrome MEN 2a o 2b, o bien con la enfermedad de Von Hippel-Lindau, la enfermedad de Von Recklinghausen y el sindrome de Sturge-Weber. Presentamos el caso de una mujer de 18 anos con dos tumoraciones dependientes de ambas glandulas adrenales que se visualizan en una resonancia magnetica (RM). Se realiza una adrenalectomia bilateral, asi como un estudio genetico de la paciente, en el que se detecta una mutacion en el exon 3 del gen VHL. El estudio genetico de los progenitores fue negativo.