Search

Introduction: Newer extraperitoneal techniques of laparoscopic ventral/incisional hernia repair (LVIHR) have been continually introduced since the popularity of the laparoscopic intraperitoneal onlay mesh technique began in 1993. One of which is the extended totally extraperitoneal (eTEP) approach allowing wide mesh augmentation, concurrent repair of diastasis recti, and performance of transversus abdominis release (TAR) for large/complex hernias. However, minimally invasive/laparoendoscopic ventral hernia repair is not yet widely adopted in the Philippines. We aim to share our preliminary experience with LVIHR using the eTEP approach. Methods: This was a retrospective review of all consecutive eTEP repairs for ventral hernia between January 2019 and September 2023. The clinical profiles of all patients were gathered. Hernia characteristics, operative profile, and postoperative outcomes were reported. Results: Thirty‐five patients were included in the study with a mean age of 54.7; 60% were incisional hernias, and the most common hernia location was the umbilical area. A defect size between 4 and 10 cm was reported in 54.3%. eTEP‐TAR was necessary in 12 patients. At a median follow‐up of 16 months, two patients developed seroma, one hematoma, and two surgical site infections. All were successfully managed conservatively. Only one patient developed recurrence. Conclusion: eTEP approach is safe and feasible for repairing ventral hernias. Our preliminary experience showed acceptable outcomes similar to the published literature. Surgeons interested in this technique should be familiar with the abdominal wall anatomy, carefully select patients during preoperative planning, and undergo mentorship with hernia surgeons experienced with the technique to shorten the learning curve. [ABSTRACT FROM AUTHOR]

Introduction/Aim. An increased survival of patients with extensive and critical burns has increased the number of scar deformities in various parts of the human body. Breast lesions particularly affect the physical and mental health of girls and women. Scar deformities manifest in the form of individual scars or large scar fields of the breast and chest. All of this causes a wide variety of possible types of damage and the complexity of their classification. The aim of the work was to develop a classification of postburn scar deformities of the breast based on the definition of key areas of deformity and severity of the lesion to determine the reconstruction plan with optimal use of available healthy tissues of the surrounding areas. Material and methods. The classification of cicatricial deformities of the breast was based on a retrospective study, which was conducted involving 68 patients with lesions of 96 glands (40 unilateral and 28 bilateral). Clinical assessment of the lesion was used, taking into account the segmentation of the breast and adjacent areas, determination of parenchymal deficiency, and the degree of lesion of the mammaryareolar complex. The surface of the breast and adjacent areas of the chest and anterior abdominal wall are divided into 10 segments. The segmentation of areas allowed us to clarify the development of deformities with the selection of their key areas due to scars and to determine the most suitable areas for obtaining the donor tissue for reconstruction. Results. Four types of breast deformities are proposed based on determining the location of scar tissue transformations, the severity of the lesion of the nipple-areolar complex, parenchymal deficiency, and the nature of the deformity. Conclusions. The presented classification of postburn scar deformities of the breast reflects the main features of structural and functional disorders, makes it easy to determine the severity of the deformity, and helps to differentiate and objectively approach the choice of treatment tactics. [ABSTRACT FROM AUTHOR]

Abdominal wall hernia repair, a common surgical procedure, includes various techniques to minimize postoperative complications and enhance outcomes. This review focuses on the comparison between laparoscopic and robotic approaches in treating inguinal and ventral hernias, presenting the ongoing situation of this topic. A systematic search identified relevant studies comparing laparoscopic and robotic approaches for inguinal and ventral hernias. Randomized control trials, retrospective, and prospective studies published after 1 January 2000, were included. Search terms such as hernia, inguinal, ventral, laparoscopy, robotic, and surgery were used. A total of 23 articles were included for analysis. Results indicated similar short-term outcomes for robotic and laparoscopic techniques in inguinal hernia repair, with robotic groups experiencing less postoperative pain. However, longer operative times and higher costs were associated with robotic repair. Robotic ventral hernia repair demonstrated potential benefits, including shorter hospital stay, lower recurrence and lower reoperation rates. While robotic surgery offers advantages such as shorter hospital stays, faster recovery, and less postoperative pain, challenges including costs and training requirements need consideration. The choice between laparoscopic and robotic approaches for abdominal wall hernias should be tailored based on individual surgeon expertise and resource availability, emphasizing a balanced evaluation of benefits and challenges. [ABSTRACT FROM AUTHOR]

We first described the technique of transgastric drainage of esophageal injuries in 2008. The method establishes vacuum drainage of the lumen of the esophagus, while maintaining patency, effectively exteriorizing the perforation to allow healing. We summarize this technique and present our experiences from the largest published series of patients. Our unit has treated selected esophageal injuries with transgastric drainage for 10 years. Indications include perforations not amenable to primary repair and treatment failure following prior surgical intervention. A 36 French silastic chest drain is pulled through the abdominal and stomach wall and introduced into the esophagus so that it crosses the perforation. Gastropexy is performed. Mediastinal decontamination and drainage are performed as needed. Continuous suction of −10 cm water is applied. Leak resolution is assessed with weekly water-soluble swallows. For this retrospective observational study, we analyzed data for patients with esophageal perforation, between 2012 and 2022. Inpatient mortality and time to leak resolution were set as primary and secondary outcomes. Esophageal perforations were treated with transgastric drain in 35 patients, of whom 68% (n  = 24) were men. Median age was 67 (26–84). Spontaneous perforations accounted for 60% (n  = 21), 31% (n  = 11) were iatrogenic and 6% (n  = 2) were ischemic. Inpatient and 30-day mortality was 14% (n  = 5). Among successful treatments, the median length to resolution of leak on imaging was 34.5 days (6–80). Transgastric drainage can successfully treat esophageal perforations, where primary repair is not feasible. The mortality rate of 14% and reduced morbidity compares favorably with other traditional methods of management for esophageal perforation. [ABSTRACT FROM AUTHOR]

Desmoid fibromatosis (DF) is a connective tissue tumor that grows aggressively in musculoaponeurotic tissues. It has an annual incidence rate of 2–4/million and is commonly seen in individuals aged 15 to 60 years, with female predominance. While it can occur in any body part, it is commonly found in the extremities, abdominal wall, and abdominal mesentery. But it rarely develops in the chest wall. The cause of the tumor is unknown. However, trauma to the tumor site has been identified in 25% of known cases. The primary treatment is surgical resection. Local recurrence after surgical excision is common. Our study highlights the case of a 12-year-old male patient diagnosed with a desmoid tumor on the chest wall 2 years ago, at the age of 10 years, after mild trauma. The tumor was successfully managed with surgery without radiotherapy treatment and no recurrence was observed in the last 2 years. [ABSTRACT FROM AUTHOR]

Summary: This report outlines the diagnosis, surgical treatment and successful outcome following the treatment of a foal presented with a congenital abdominal hernia. A focal ventral abdominal swelling, enlarging since birth, starting just caudal to the intact umbilicus and extending caudally over the prepuce was observed. Once in dorsal recumbency, the hernia was found to originate from a defect of the abdominal wall in the linea alba region. A simple closed herniorrhaphy with inversion of the large peritoneal sac into the abdomen was performed. Post‐operative complications included fever with the development of an abscess at the surgical site. This was diagnosed and drained with ultrasound guidance. Based on culture and sensitivity testing of the abscess exudate, antibiotic therapy was adapted and the foal made a full recovery. A clinical examination undertaken 1 year later revealed complete healing of the linea alba. Herniation due to a muscle wall default has not been previously reported in foals. This article reviews the commonly observed causes of herniation (umbilical and inguinal hernias). However, a third type of congenital ventral body wall hernia should be considered for the differential diagnosis of swelling of the preputial area in foals. [ABSTRACT FROM AUTHOR]

Background: Suturing of the hernia aperture in laparoscopic ventral hernia repair has increased during the past decade. The primary aim of this is to restore the anatomy of the abdominal wall. Closure of the aperture, however, may cause additional tension in the abdominal wall which could increase postoperative pain. The aim of this study was to investigate whether suturing of the hernia aperture affects postoperative pain and hernia-site complications, including seroma, infection, pseudohernia, and mesh migration, 3 months after repair. Methods: Some 192 patients with a midline hernia between 2 and 8 cm in transverse diameter were included in a randomized controlled double-blinded multicentre study. Patients were randomized to mesh repair with (intervention) or without (control) suturing of the hernia aperture before mesh placement. Patients completed the Ventral Hernia Pain Questionnaire before and 3 months after surgery. Abdominal wall pain and hernia-site complications were assessed 3 months after surgery. Results: Ninety-seven patients were randomized to the intervention group and 95 to the control group. Among all patients, median age and BMI was 56 years and 31 kg/m2 respectively. Overall pain experienced decreased by 3 months after operation (P < 0.001). There was no difference between groups regarding hernia-site complications or pain experienced during the past week (13 versus 23 patients; P = 0.111). Seroma and pseudohernia occurred in 13 and 11 patients in the intervention and control groups respectively (P = 0.975 and P = 0.977). Conclusion: Restoration of the abdominal wall anatomy by suturing the hernia aperture before mesh placement does not increase the risk of hernia-site complication or pain 3 months after surgery. This implies that fascial suturing of the aperture can be justified if there are potential long-term benefits such as lower recurrence and/or complication rates. Registration number: ISRCTN51495042 (http://www.controlled-trials.com). This study investigated pain and hernia-site complications 3 months after laparoscopic ventral hernia repair with primary fascial closure. [ABSTRACT FROM AUTHOR]

As an alternative for currently available hernia meshes, electrospun scaffolds represent good biocompatibility and favorable healing performance. However, they usually cannot meet the minimum mechanical requirements for a successful hernia repair. Here, a double‐faced hernia mesh comprised of electrospun polycaprolactone fibers (PCL) and chitosan nanofibers (CS) is developed to address this limitation. The privileged fibrous structure of PCL, in visceral side, can potentially guarantee the required mechanical criteria to withstand intra‐abdominal pressures and minimizing adverse adhesions. On the ventral side (facing incision), a stabilized CS layer is developed to improve cellular behavior and tissue regeneration. According to the results, PCL‐CS scaffold (thickness ≈ 500 µm) properly matches with the mechanical properties of native abdominal wall and closely meets the suggested thresholds in strength (33.3 N cm−1) and elasticity (15.26%). Superior cytocompatibility of PCL‐CS is confirmed by the in vitro studies using L929 fibroblasts and human umbilical vein endothelial cells. Full‐thickness abdominal wall defects are used to compare tissue regeneration and adverse adhesions for PCL‐CS with the polypropylene commercial mesh (Prolene) and suture groups. Gross examinations demonstrate lower rate of unfavorable adhesions in PCL‐CS compared to Prolene and suture groups. Concerning the histological analyses, PCL‐CS exhibits reduced inflammation, less fibrosis, and better tissue remodeling. [ABSTRACT FROM AUTHOR]

Background: Traumatic abdominal wall disruption in children is a rare but severe diagnosis resulting from blunt abdominal trauma (BAT). The clinical diagnosis is not usually straightforward, and the hernia is often discovered at the time of the surgical exploration for intra-abdominal injuries or by imaging studies. Presentation of Case: A 13-year-old boy, a restrained male patient, was the victim of a high-speed road traffic accident. Among other injuries, he showed bruising over the lower abdomen and localized right-side peritonitis upon presentation. A contrast-enhanced computed tomography scan of the chest and abdomen demonstrated abdominal wall muscular disruption over the right lower quadrant with herniation of the large bowel. The patients had immediate exploratory laparotomy with hernia repair. Discussion: Traumatic abdominal wall disruption is a rare form of hernia caused by abdominal wall musculature and fascia disruption. The diagnostic criteria and classification of traumatic abdominal wall disruption are still unclear; furthermore, the ideal timing and method of surgical treatment are still unclear. Herein, we report a case of traumatic abdominal wall disruption and describe the surgical approach used. Conclusion: Children with traumatic abdominal wall disruption have high rates of concomitant abdominal organ injury requiring operative repair. CT scans have low sensitivity and specificity for detecting associated injuries. A high suspicion of injury and low threshold for exploration must be maintained in traumatic abdominal wall disruption cases. [ABSTRACT FROM AUTHOR]

Introduction Abdominal wall dehiscence is one of the critical postoperative complications following abdominal surgeries. Emergency surgery highly contributes to the incidence of a burst abdomen due to a lack of proper preoperative preparation and the presence of intraabdominal sepsis. Anterior component separation was primarily evolved in abdominal wall reconstruction in the open abdomen and huge ventral hernia repair. Methods This prospective study included 50 patients operated by midline laparotomy for non-traumatic abdominal emergencies. Anterior component separation technique was randomly applied in 25 patients before laparotomy closure, the other 25 patients were closed using the traditional midline closure method. Preoperative patient's demographics, operative time, and different postoperative complications were reported. Incidence of burst abdomen in both groups was reported. Results Preoperative patient's demographic data showed no significant difference between both groups; the mean age of the patients was 53.69±7.34. Operative time was significantly longer in the Anterior Components Separation (ACS) group (P<0.001). The incidence of abdominal wall dehiscence after ACS technique (4.3%) was significantly less than after traditional technique (24%). Postoperative seroma and hematoma were the common postoperative complications after ACS however the incidence was not statistically significant. Incisional hernia was detected in (13.04%) in ACS group and in (32%) in traditional group. Conclusion Application of ACS technique during laparotomy closure in abdominal emergencies seems to lower the incidence of abdominal wall dehiscence with no increase in different postoperative complications. [ABSTRACT FROM AUTHOR]

Background Ventral hernia can be defined as noninguinal and nonhiatal hernia in the fascia of the abdominal wall. Laparoscopic repair become a popular method with decreased overall complications nowadays. We aimed to provide an efficient management for ventral hernia through comparison of quality of life (QoL) postlaparoscopic and open techniques according to European registry for abdominal wall hernias quality of life (EuraHS-QOL) score. Patients and methods The data of 54 patients with primary ventral hernia were collected prospectively. Of these patients, 27 underwent open repair, and 27 underwent laparoscopic repair after excluding patients with a complicated and recurrent ventral hernia and incisional hernia. Perioperative QoL was assessed according to the EuraHS score. Results Two groups were designed, each including 27 patients. The most common complication was seroma (25.9%) in open repair, followed by infection (18.5%), while only one case in laparoscopic repair had port site infection; the difference was statistically significant (P<0.05). The mean operative time in open repair was 51.2 ±5.1 and 89.7±9.5 in laparoscopic repair; the difference was highly significant (P<0.001). The mean length of stay in the hospital was 23.1±7.3, and it was 19.1±6 in laparoscopic repair; the difference was significant (P<0.05). All cases in open repair had subcutaneous drain; but not in laparoscopic repair; the difference was highly significant (P<0.001). The EuraHS score in all its items was significant in favor of laparoscopic repair. Conclusion Laparoscopic repair was associated with high QoL, less complications, and recovery time as compared with open repair of ventral hernia. [ABSTRACT FROM AUTHOR]

Background Ventral hernia repair is one of the most common operations performed today, yet when complex and huge, it presents a true challenge for the surgical team. Patients and methods Based on our prospective randomized study, a few preliminary conclusions can be drawn. There was no significant difference in most outcomes between patients who underwent repair with the Transversus abdominis muscle release (TAR) technique or with perforator-preserving component separation when using the same type of polyprolene mesh and in the same retro-muscular position. Results The mean hospital stay was slightly higher when performing the TAR technique (5.2 days), while it was 4.3 days after the perforator-preserving approach. There is a nearly equal incidence of postoperative wound complications and also no statistically significant difference in the rate of recurrence between the two methods, and the rate of wound complications and recurrence is significantly lower than the classic, commonly used method of anterior component separation. Conclusion After this comparative study, both the TAR and anterior component separation (perforator preserving) techniques are effective and reliable methods in experienced hands, and if there is no special indication for one of them, the choice between both should depend on surgeon preference and experience. [ABSTRACT FROM AUTHOR]

Background: From an epidemiological point of view, one third of the population in industrialized countries will undergo abdominal surgery during their lifetime. Depending on the degree of patient-related and procedure-related risks, the occurrence of incisional hernias is associated in a range of up to 30% at 2‑year follow-up and even up to 60% at 5 years. In addition to influencing comorbidities, the type of surgical approach and closure technique are of critical importance. Objective: To present a descriptive evidence-based recommendation for abdominal wall closure and prophylactic mesh augmentation. Material and methods: A concise summary was prepared incorporating the current literature and existing guidelines. Results: According to recent studies the recognized risk for the occurrence of incisional hernias in the presence of obesity and abdominal aortic diseases also applies to patients undergoing colorectal surgery and the presence of diastasis recti abdominis. Based on high-level published data, the short stitch technique for midline laparotomy in the elective setting has a high level of evidence to be a standard procedure. Patients with an increased risk profile should receive prophylactic mesh reinforcement, either onlay or sublay, in addition to the short stitch technique. In emergency laparotomy, the individual risk of infection with respect to the closure technique used must be included. Conclusion: The avoidance of incisional hernias is primarily achieved by the minimally invasive access for laparoscopy. For closure of the most commonly used midline approach, the short stitch technique and, in the case of existing risk factors, additionally mesh augmentation are recommended. [ABSTRACT FROM AUTHOR]

This article, published in the Arab Journal of Interventional Radiology, discusses the use of ultrasound-guided botulinum toxin (BTX) injections into the lateral abdominal wall muscles before hernia repair surgery. The injections aim to relax and lengthen the external oblique, internal oblique, and transversus abdominis muscles, which can contribute to the challenges of ventral hernia repair. The article provides information on the anatomical and technical aspects of ultrasound-guided injection, BTX formulations and dosage, potential complications and their management. The authors highlight that BTX injection can be an effective and safe adjunct to complex hernia repair, improving clinical outcomes and reducing postoperative pain. However, they emphasize the importance of interventional radiologists having a thorough understanding of the indications, formulations, and injection techniques to avoid complications. [Extracted from the article]

This article from the Arab Journal of Interventional Radiology explores the use of preoperative botulinum toxin injections as a treatment option for complex abdominal wall hernias. The study involved 8 patients with an average age of 53.38 years. The results showed a statistically significant decrease in the size of the hernia defect and loss of domain after the Botox injection. Primary fascial closure was achieved in 87.5% of the individuals, and there were no significant side effects. However, the study acknowledges the need for larger studies with longer follow-up times and a control group to confirm these findings. [Extracted from the article]

Morphea, a localized scleroderma variant, is a rare dermatological condition characterized by fibrosis and thickening of the skin. While its etiology remains unclear, there have been reports of its association with viral infections, including COVID-19. We present a case of morphea in a 26-year-old female patient with a history of two episodes of COVID-19. The patient exhibited cutaneous lesions on her left forearm, bilateral axillae, and groin, accompanied by abdominal wall induration Laboratory investigations revealed no significant abnormalities, except for positive antinuclear antibodies (ANA) with various patterns. This case highlights the potential association between COVID-19 infection and the development of morphea, underscoring the importance of considering this relationship in patients presenting with dermatological manifestations following COVID-19. Further research is needed to elucidate the underlying mechanisms and optimize treatment strategies for such cases. [ABSTRACT FROM AUTHOR]

Introduction: Segmental resection of the intestine and its temporary or permanent bypass is a frequent procedure in surgical practice, which involves the construction of a stoma. The disease that leads to surgery, the clinical conditions of the patient and the technical aspects in the construction of the ostomy are key points in the postoperative evolution. Methods: A review of the literature was performed, identifying the complications associated with the construction of stomas, with the aim of offering treatment and decision-making tools to the medical personnel involved in the care of these patients. Results: Emergency surgery, immunosuppression, obesity, and the technique used to open the orifice in the abdominal wall favor the appearance of early complications that require medical management or surgical reintervention. Conclusions. Every patient with a stoma must be carefully evaluated by the surgeon and the enterostomal therapist in the first 72 hours after surgery. [ABSTRACT FROM AUTHOR]

Background Perforator dissection and flap elevation are routinely performed for microsurgical reconstruction; however, there is a steep learning curve to mastering these technical skills. Though live porcine models have been utilized as a microsurgical training model, there are significant drawbacks that limit their use, including cost, limited ability for repetition, and obstacles associated with animal care. Here we describe the creation of a novel perforator dissection model using latex augmented non-living porcine abdominal walls. We provide anatomic measurements that demonstrate valuable similarities and differences to human anatomy to maximize microsurgical trainee practice. Methods Six latex-infused porcine abdomens were dissected based on the deep cranial epigastric artery (DCEA). Dissection was centered over the abdominal wall mid-segment between the second and fourth nipple line. Dissection steps included exposure of lateral and medial row perforators, incision of anterior rectus sheath with perforator dissection, and dissection of DCEA pedicle. DCEA pedicle and perforator measurements were compared with deep inferior epigastric artery (DIEA) data in the literature. Results An average of seven perforators were consistently identified within each flap. Assembly of the model was performed quickly and allowed for two training sessions per specimen. Porcine abdominal walls demonstrate similar DCEA pedicle (2.6 ± 0.21 mm) and perforator (1.0 ± 0.18 mm) size compared with a human's DIEA (2.7 ± 0.27 mm, 1.1 ± 0.85 mm). Conclusion The latex-infused porcine abdominal model is a novel, realistic simulation for perforator dissection practice for microsurgical trainees. Impact on resident comfort and confidence within a microsurgical training course is forthcoming. [ABSTRACT FROM AUTHOR]

Background: In the era of laparoscopic surgery, early recovery and less post-operative pain are major goals to improve patient care and cut down cost. Several studies have demonstrated less post-operative pain and early recovery with the reduction in size and number of ports. Aims and Objectives: To compare three-port laparoscopic cholecystectomy (LC) with four-port LC in chronic calculous cholecystitis patients. We compared the feasibility of the procedure, total operative time, intraoperative difficulties, post-operative pain, incidence of complications, and cosmetic results. Materials and Methods: The study was done in Maharani Laxmi Bal Medical College, Jhansi, between April 2021 and November 2022, including 2 groups of patients (Group A-50 patients of three-port LC and Group B-50 patients of fourport LC). Results: Most of the participants were from 18 to 30 years (32%, 38%) and 31 to 40 years (30%, 12%) in both the groups. The mean duration of surgery in three-port and four-port group was 41.64±6.972 and 42.22±13.784 min, respectively (p=0.79). Hospital stay was three-port and four-port group was 3.33±0.789 and 3.86±0.707 days, respectively (p=0.0001). 100 patients were included, with 2085 patients. The mean age of the studied patients was 46.38 years with female preponderance. The mean operative time for three ports was 66.90 min and for four ports, it was 75.45 min. The mean duration of post-operative stay for three-port was 4.66, and for the conventional group, it was 5.30. Conclusion: Three-port lap cholecystectomy can be advocated to be better than the 4-port technique, but especially in experienced hands, and 4-port LC is better for beginners. [ABSTRACT FROM AUTHOR]

The recent surge in interest surrounds the analysis of physiological signals with a non-linear dynamic approach. The measurement of entropy serves as a renowned method for indicating the complexity of a signal. However, there is a dearth of research concerning the non-linear dynamic analysis of respiratory signals. Therefore, this study employs a novel method known as intrinsic entropy (IE) to assess the short-term dynamic changes in thoracoabdominal movement patterns, as measured by respiratory inductance plethysmography (RIP), during various states such as resting, step test, recovery, and iso-volume maneuver (IVM) trials. The findings reveal a decrease in IE of thoracic wall movement (TWM) and an increase in IE of abdominal wall movement (AWM) following the IVM trial. This suggests that AWM may dominate the breathing exercise after the IVM trial. Moreover, due to the high temporal resolution of IE, it proves to be a suitable measure for assessing the complexity of thoracoabdominal movement patterns under non-stationary states such as the step test and recovery. The results also demonstrate that the instantaneous complexity of TWM and AWM can effectively capture instantaneous changes during non-stationary states, which may prove valuable in understanding the respiratory mechanism for healthcare purposes in daily life. [ABSTRACT FROM AUTHOR]

A desmoid tumor (DT) is a rare benign neoplasm arising from muscle aponeurosis, associated mostly with trauma or pregnancy. DT has an infiltrative and locally aggressive growth pattern and usually does not metastasize. However, it has a high recurrence and complication rate. When it occurs in pregnancy, the pregnancy and delivery is taken as an individual case for optimal management by physicians and midwifes, who need to be cautious in finding the optimal delivery mode for the patient, which depends on the tumor size, location, behavior, and past history. The authors report a case of 29-year-old pregnant woman who previously underwent systemic oncological treatment for a large abdominal wall desmoid tumor and became pregnant afterwards. The history of DT presented a follow-up and delivery challenge. Observational management was chosen with an elective cesarean section at week 38 + 4 of pregnancy with uncomplicated postpartum follow-up. The authors detail the clinical management and chosen therapeutic approach; chemotherapy can be a choice in the treatment options for patients with DTs, although the majority of DTs are treated surgically with subsequent mesh plastic. Moreover, the authors provide a systematic review of the literature focused on the treatment management of DTs in pregnant women during pregnancy and the postpartum period, as pregnancy-associated desmoid tumors are a specific condition, where the optimal management is not well established, despite some guidelines for non-pregnant patients. [ABSTRACT FROM AUTHOR]

Copyright of Tesla Revista Científica is the property of Puerto Madero Editorial Academica 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: This research aimed to evaluate the knowledge and experience of pediatric surgeons in Türkiye regarding multimodal analgesia approaches, and the use of regional anesthesia techniques in pediatric abdominal surgery. The research also aimed to investigate what can be done for better pain management in pediatric abdominal surgeries in Türkiye. Materials and Methods: The study sample included 825 active pediatric surgery specialists and 204 resident physicians in Türkiye. A questionnaire consisting of 27 questions was distributed to Turkish pediatric surgeons via email and WhatsApp. Based on the answers given to the questionnaire, we aimed to investigate the most commonly used postoperative analgesia methods in pediatric abdominal surgeries, whether multimodal analgesia methods are preferred for pain control, and the reasons affecting these preferences. Results: Feedback was received from 122 physicians. Among the participants, 54.09% had worked as pediatric surgeons for 15 years or more, while 8.19% were resident physicians. Anesthesiologists, with whom 55.4% of the participants worked, preferred only intravenous (IV) drugs as the postoperative analgesia method. It was found that 70.8% of the participants did not experience ultrasound-guided anterior abdominal wall blocks in pediatric cases at their institutions. Additionally, a significant proportion of the participants (82%) reported a lack of training on multimodal analgesia. Conclusion:The data show a lack of awareness regarding the importance of using multimodal analgesia approach in pediatric cases, revealing the importance of the benefits of collaborative work and training programs. [ABSTRACT FROM AUTHOR]

Objective: The goal of this article is to compile relevant literature that proposes that perhaps the abdominal drawing-in maneuver (ADIM), also known as the “abdominal hollowing maneuver” (AHM), should not be applied as a general rule during the core training. Methods and Materials: Based on current evidence, this paper evaluates whether general use of this ADIM is beneficial for the core training. In this regard, we have searched for related scientific evidence in PubMed and Google Scholar. The keywords used were: abdominal hollowing maneuver, abdominal drawing-in maneuver, lumbo-pelvic stability, core stability. Results: The literature shows us that the application of ADIM during core strengthening exercises does not meet the requirements for isolated TrA-specific retraining, can increase Inter-Rectus Distance, may be incompatible with postural stability goals, and could interfere the Rectus Abdominis input impairing the lumbo-pelvic stability during high-load exercises. Conclusion: It can be concluded that if the goal is to train core stability and strength with high-load scenarios we should not use the ADIM. [ABSTRACT FROM AUTHOR]

Omphalocele is an abnormality in which fetal abdominal organs protrude through the abdominal wall. We report the case of a 13-year-old female with a history of omphalocele repair who presented with acute periumbilical pain, nausea, and vomiting. A computed tomography scan showed a para-ovarian cyst and mild dilation of the small bowel. During laparoscopy, the right ovary and fallopian tube were detached from the uterus and located behind the cecum. Despite this displacement, the ovary appeared to have retained functionality with intact blood supply. We hypothesize that surgical repair led to pelvic adhesion that caused torsion and avulsion of the fallopian tube and utero-ovarian ligament that led to the displacement. This anatomical change should be considered in surgical patients with a history of omphalocele repair. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: valproic acid (VPA), an epigenetic drug, has potential for the treatment of neoplasms. Its effects on the healing of the peritoneal-musculo-aponeurotic plane (PMA) of the abdominal wall are studied. Method: sixty Wistar rats were allocated into two groups: experimental (VPA) and control (0.9% sodium chloride), treated daily, starting three days before the intervention and until euthanasia. Under anesthesia, a median laparotomy was performed and repaired with two synthetic layers. Assessments took place 3, 7 and 14 days after surgery. The integrity of the wounds, the quality of the inflammatory reaction, the intensity of the leukocyte infiltrate, collagen synthesis, the intensity of angiogenesis and the presence of myofibroblasts were studied. Results: there was dehiscence of the PMA plane in 11 of the 30 animals (p=0.001) in the experimental group. There was no difference in the quality and intensity of the inflammatory reaction. Immunohistochemistry revealed, in the experimental group, less collagen I (p3=0.003, p7=0.013 and p14=0.001) and more collagen III (p3=0.003, p7=0.013 and p14= 0.001). Collagen evaluated by Sirus Supra Red F3BA showed, in the experimental group, less collagen at all three times (p

ABSTRACT BACKGROUND: Umbilical and epigastric hernias are among the most common hernias of the abdominal wall; however, there is a lack of standardization for their treatment. AIMS: To clarify the controversies regarding therapeutic possibilities, indications, and surgical techniques for umbilical and epigastric hernia repair. METHODS: A systematic review and qualitative analysis of randomized clinical trials published in the last 20 years, involving adults (aged 18 years and over) with umbilical and/or epigastric hernias, was performed by systematically searching the PubMed/Medline, Cochrane, SciELO, and LILACS databases. The risk of bias in individual studies was assessed using the Cochrane Risk of Bias Tool. RESULTS: Initially, 492 studies were selected and, subsequently, 15 randomized controlled clinical trials were chosen that met the inclusion criteria and underwent full reading and qualitative analysis, considering possible bias. CONCLUSIONS: This review concluded that it is evident the superiority of the use of meshes in the repair of epigastric/primary umbilical hernias with a defect larger than 1 cm, even in certain emergency situations. However, suture repair is a good option for patients with a defect smaller than 1 cm. In the laparoscopic approach, recent evidence points towards possible superiority in fixation with fibrin sealant, and fascial defect closure is recommended. In addition, due to a scarcity of randomized controlled trials with low risk of bias, further studies are needed on types, positioning and fixation techniques, as well as the real role of video-assisted laparoscopic surgery in the correction of hernias, especially umbilical.

Simulations of human-technology interaction in the context of product development require comprehensive knowledge of biomechanical in vivo behavior. To obtain this knowledge for the abdomen, we measured the continuous mechanical responses of the abdominal soft tissue of ten healthy participants in different lying positions anteriorly, laterally, and posteriorly under local compression depths of up to 30 mm. An experimental setup consisting of a mechatronic indenter with hemispherical tip and two time-of-flight (ToF) sensors for optical 3D displacement measurement of the surface was developed for this purpose. To account for the impact of muscle tone, experiments were conducted with both controlled activation and relaxation of the trunk muscles. Surface electromyography (sEMG) was used to monitor muscle activation levels. The obtained data sets comprise the continuous force-displacement data of six abdominal measurement regions, each synchronized with the local surface displacements resulting from the macro-indentation, and the bipolar sEMG signals at three key trunk muscles. We used inverse finite element analysis (FEA), to derive sets of nonlinear material parameters that numerically approximate the experimentally determined soft tissue behaviors. The physiological standard values obtained for all participants after data processing served as reference data. The mean stiffness of the abdomen was significantly different when the trunk muscles were activated or relaxed. No significant differences were found between the anterior-lateral measurement regions, with exception of those centered on the linea alba and centered on the muscle belly of the rectus abdominis below the intertubercular plane. The shapes and areas of deformation of the skin depended on the region and muscle activity. Using the hyperelastic Ogden model, we identified unique material parameter sets for all regions. Our findings confirmed that, in addition to the indenter force-displacement data, knowledge about tissue deformation is necessary to reliably determine unique material parameter sets using inverse FEA. The presented results can be used for finite element (FE) models of the abdomen, for example, in the context of orthopedic or biomedical product developments.

Benign metastasizing leiomyoma (BML) is a rare disease that results from metastasis of uterine leiomyoma to distant sites with benign pathologic features. The lung is the most common metastatic site for BML. This report describes the case of a 49-year-old woman who presented with a mass in the abdominal wall with a surgical history of uterine myomectomy. Ultrasound and Magnetic resonance imaging (MRI) revealed multiple mass lesions. The histopathology of the mass specimen indicated BML. The imaging and clinical features of BML are discussed based on the characteristics of this case and related literature reports.

ABSTRACT BACKGROUND: One of the primary complications associated with large incisions in abdominal surgery is the increased risk of fascial closure rupture and incisional hernia development. The choice of the fascial closure method and closing with minimal tension and trauma is crucial for optimal results, emphasizing the importance of uniform pressure along the suture line to withstand intra-abdominal pressure. AIMS: To evaluate the resistance to pressure and tension of stapled and sutured hand-sewn fascial closure in the abdominal wall. METHODS: Nine abdominal wall flaps from human cadavers and 12 pigs were used for the experimentation. An abdominal defect was induced after the resection of the abdominal wall and the creation of a flap in the cadaveric model and after performing a midline incision in the porcine models. The models were randomized into three groups. Group 1 was treated with a one-layer hand-sewn small bite suture, Group 2 was treated with a two-layer hand-sewn small bite suture, and Group 3 was treated with a two-layer stapled closure. Tension measurements were assessed in cadaveric models, and intra-abdominal pressure was measured in porcine models. RESULTS: In the human cadaveric model, the median threshold for fascial rupture was 300N (300-350) in Group 1, 400N (350-500) in Group 2, and 350N (300-380) in Group 3. Statistical comparisons revealed non-significant differences between Group 1 and Group 2 (p=0.072, p>0.05), Group 1 and Group 3 (p=0.346, p>0.05), and Group 2 and Group 3 (p=0.184, p>0.05). For porcine subjects, Group 1 showed a median pressure of 80 mmHg (85-105), Group 2 had a median of 92.5 mmHg (65-95), and Group 3 had a median of 102.5 mmHg (80-135). Statistical comparisons indicated non-significant differences between Group 1 and Group 2 (p=0.243, p>0.05), Group 1 and Group 3 (p=0.468, p>0.05), and Group 2 and Group 3 (p=0.083, p>0.05). CONCLUSIONS: Stapled and conventional suturing resist similar pressure and tension thresholds.

Introduction: The transverse rectus abdominis muscle flap (TRAM) is a method of breast reconstruction with good aesthetic results and does not require the use of silicone implants for better body contouring. It was originally described by Holmstrom in 1979 as an ellipse of skin and fat based on an isolated muscle on its vascular pedicle. The systematic reconstruction of the wall defect installed after flap transposition using polypropylene mesh was described in a previous study by Cunha. The article aims to evaluate changes in the abdominal wall, after the systematization of polypropylene mesh placement during TRAM reconstruction surgery. Method: This is a retrospective cohort study that evaluates possible changes in the abdominal wall of patients undergoing the TRAM flap with preand postoperative abdominal computed tomography. Results: A reduction in the size of the abdominal cavity of, on average, 14.5% and 14.2% in the thickness of the abdominal wall subjected to TRAM was evidenced. The greatest reduction in abdominal wall thickness was in a patient who underwent a bipedicled flap, with 50.7%. The complications presented were umbilical hernia, late seroma, perithellal fibrosis, and thread granuloma. Conclusion: In this study, tomography after surgery demonstrated a reduction in the volume of the abdominal cavity and thickness of the abdominal wall, which did not statistically influence the appearance of abdominal hernia, bulging, mesh extrusion, or other deformities.

Lumbar incisional hernia is an uncommon complication that affects the abdominal wall integrity, accounting for approximately 3.5% of all cases. It typically occurs following open nephrectomy or aortic aneurysm repair surgeries. Although rare, lumbar hernias can lead to discomfort, aesthetic issues, or even intestinal obstruction. In extremely rare cases, lumbar herniation of the liver can occur. Here, the authors present a case of a 60-year-old female patient with liver herniation through a lumbar incisional hernia and a history of pyelolithotomy for renal calculi. The authors performed an open hernia repair with meshplasty. Lumbar incisional hernias are rare and still difficult to manage. Computed tomography is the diagnostic method of choice in the evaluation of the parietal wall defect to choose the appropriate therapeutic management. Surgical management modalities are still poorly codified, with no precise recommendations, and this is probably due to the relative rarity of the cases.

This article discusses the use of a modified thoracoabdominal nerves block through a perichondrial approach (M-TAPA) for nephrectomy in children. The M-TAPA block has been successfully used for postoperative analgesia in various procedures in adults, but there are limited reports on its efficacy in pediatric cases. The article presents two cases where M-TAPA blocks were used for nephrectomy in pediatric patients, providing sufficient pain relief without the need for additional analgesics. However, more studies are needed to determine the optimal volume and efficacy of M-TAPA blocks in children. [Extracted from the article]

A 76-year-old woman was investigated for epigastric pain on a background of a laparoscopic distal pancreatectomy and splenectomy for pancreatic ductal adenocarcinoma 4 years prior. Imaging revealed an isolated 32 mm fluorodeoxyglucose avid lesion contacting both the anterior abdominal wall and greater curvature of the stomach. Immunohistochemistry and fine needle biopsy confirmed a phenotype consistent with metastatic pancreatic adenocarcinoma. Laparoscopic excision of the mass and partial gastrectomy for clearance of margins was performed. Histopathology demonstrated a poorly differentiated pancreatic ductal adenocarcinoma, and the patient received adjuvant gemcitabine/capecitabine following an uncomplicated postoperative course. This article presents a rare case of isolated abdominal wall recurrence of pancreatic ductal adenocarcinoma, which was successfully treated with surgical resection and adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

This article, published in the journal Abdominal Radiology, discusses abdominal wall endometriosis (AWE), which occurs when endometrial tissue grows outside of the uterus in the abdominal wall. AWE is often associated with surgical scars, but can also appear spontaneously. The article describes the characteristic Gorgon sign of AWE, which is a linear infiltration radiating from a central soft-tissue nodule on contrast-enhanced computed tomography (CT) images. Magnetic resonance imaging (MRI) can help determine the depth of infiltration and the location of the nodule. The article also mentions the differential diagnosis of AWE and states that no funding was received for the study. [Extracted from the article]

Epidermal cyst •Most common types of simple dermal epithelial lesions, showing well-encapsulated subepidermal mobile nodules •Arise in hair-bearing areas of the body, including the scalp, face, neck, trunk, and back •< 10%: extremities, palms, soles, breast •Filled with loose lamellae of keratin debris and bounded by stratified squamous epithelium, probably due to traumatic implantation of the epidermis into the dermis or subcutis •Mechanism: remnant ectodermal tissues misplaced during embryogenesis, occlusion of the pilosebaceous unit, or traumatic or surgical implantation of epithelial elements, human papillomavirus type 57 or 60 •Asymptomatic > infected or rupture if grow •If rupture, a secondary foreign body–type reaction, granulomatous reaction, or abscess formation may occur. •The radiological findings of epidermal cysts can be variable according to the compositions of the cysts. •US findings: circumscribed, hypoechoic, solid or complex-appearing masses •Purpose of this study: to evaluate US or CT findings of surgically proven epidermal cysts in the trunk. •63 patients with pathologically proved epidermal cysts of the trunk for 4 years •US: high frequency (12∼15 MHz) transducer •CT: pre- and postcontrast images with 5 mm slice thickness •US or CT findings: compared with surgical findings in regard to location, size, shape, number, echogenicity, posterior sound enhancement, septa, perilesional infiltration, calcifications and cystic wall enhancement. •All 63 patients (M:F=41:22; US in 36, CT in 27) had only one cyst. •Located in buttock (n=27), back (n=17), inguinal (n=6), posterior neck (n=5), perineum (n=3), abdominal wall (n=3), presternal (n=1), and axilla (n=1). •Mean size: 4.2 ´ 2.2 ´ 3.3 cm (range: 0.5∼13 cm) •Shape: oval (n=51), round (n=10), spindle (n=2) •US (n=36): - Homogeneously hypoechoic mass (n=11, 30.6%, Fig. 1) - Inhomogeneously hypoechoic mass (n=11, 30.6%) - Homogeneously hypoechoic mass with internal hypoechoic lines and echogenic spots (n=10, 27.8%, Fig. 2) - Homogeneously hypoechoic mass with internal echogenic spots (n=4, 11.1%) - Posterior sound enhancement (n=29, 80.6%) - On color Doppler study, no remarkably increased vascular flow in all cases with color Doppler study (n=28, Fig. 3). •CT (N=27): - Simple cyst (n=20, 74.1%) - Abscess-like lesion (n=7, 25.9%, Fig. 4) - Overlying skin thickening (n=18) - Contrast enhancement of cystic wall (n=15) - Perilesional infiltration (n=10) - Internal septa (n=8, Fig. 5) •All cysts were surgically well removed and internal contents of cysts were histologically keratinous (n=38, 60.3%, Fig. 1) or greasy (n=21, 33.3%, Fig. 2) materials. •Greasy materials mean the attenuated squamous epithelium with 'waxy' keratin in addition to usual layered keratin. •Variable echogenicity on US according to variable compositions - Type I: lesion with a simple lobulation - Type II: lesion with a protrusion - Type III: lesion with a focal wall perforation, a short neck, and a deep large protruding mass-like portion (abscess pocket formation). •For the inner contents of a complicated ganglion cyst or bursitis, anechoic fluid and echogenic debris are commonly noted and can move with compression by transducer. However, an epidermal cyst with moving debris is not seen and is not compressed. •Compared with neoplastic solid masses, ruptured epidermal cysts have multiple hyperechoic dot-like contents and can show increased color Doppler signals not in the inner contents but mainly in the wall or pericystic soft tissue. •Malignant degeneration of epidermal cysts is uncommon, but some reports of low-grade squamous cell carcinomas with incidence of 2.2% •Although epidermal cysts are generally solitary or few, patients with Gardner's syndrome may have multiple lesions, particularly on the face and scalp •The most important difference of contours between US findings of unruptured and ruptured epidermal cysts was not a lobulation but the combined protruding portions from epidermal cysts •Secondary change due to rupture or infection may make the preoperative diagnosis difficult, because the lesion mimics any other soft tissue mass. • Differential diagnosis: - abscesses, complicated ganglion cysts, complicated bursitis, neoplastic solid masses - synovial lesions, fibromas, xanthomas, lipomas, sacrococcygeal teratomas •Epidermal cysts showed homogeneous or inhomogeneous hypoechoic mass with posterior sound enhancement, variable echogenic spots, and no color Doppler signals on US. •In case of ruptured cyst, abscess-like lesion with wall enhancement, perilesional infiltration and lobulated contour was noted on CT scan. [ABSTRACT FROM AUTHOR]

• Primary cutaneous CD4+ small/me dium T-cell lymphoproliferative dis order (PCSM-TCLD) is a rare, indolent, poorly understood disease, a recently recognized entity. • Clinically, it usually manifests as an erythematous-violaceous plaque or nodule of firm consistency, usually localized on the trunk or face. • The diagnosis of these lesions alwa ys requires histopathologic confirm ation, skin ultrasound is an additional tool that can be helpful for the initial diagnosis. • Age / gender: 75 / Male • Chief complaint: growing (for 2 months) erythematous, purple colored nodule at right lower anterolateral abdominal wall • Past medical history: non-specific About 5 × 2.3 × 5.2cm sized, relatively well-defined, heterogeneous dermal nodule at right lower anterolateral abdominal wall. Easy touch bleeding skin lesion showed bullae like hypo- or an-echoic lesion, and then well-defined hyperechoic soft tissue mass with deep extension into the subcutaneous fat layer with moderate neovascularization on color Doppler study. Deep layer fascia and rectus abdominis muscles were well preserved. Diffuse enhancing thickening at skin and subcutaneous fat layer of right lower anterolateral abdominal wall. Also, multiple enlarged, conglomerated lymph nodes at both inguinal and right internal iliac areas were seen. Atypical CD4+ T-cell infiltrate in dermis, the possibility of primary cutaneous CD4+ small/medium T cell lymphoproliferative disorder was confirmed on skin biopsy. Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder accounts for 3% of all primary cutaneous lymphoma s. It most often occurs in the patient in their 50s and 60s. Considering that PCSM-TCLD shows various clinical and histopathologic findings, it can be assumed that this disease will also show various US findings. Referring to soft tissue lymphoma findings, this disease can also show hypoechoic and heterogeneous areas with diffuse infiltration on US. Intense neovascularization can be considered as a characteristic finding of soft tissue lymphoma. Although the prognosis of these lesions is usually excellent, aggressive forms have very rarely been described. There is no specific consensus regarding treatment, previous reports have suggested chemotherapy, radiation therapy, doxycycline, steroid therapy and complete resection. [ABSTRACT FROM AUTHOR]

This article explores the impact of incisional hernias on abdominal wall strength. It highlights that incisional hernias, which commonly occur after abdominal surgeries, can lead to complications and a decrease in quality of life for patients. The study focuses on analyzing abdominal muscle strength in patients with incisional hernias compared to healthy individuals. The results indicate significant differences in abdominal muscle strength between the two groups, suggesting that incisional hernias can have a negative effect on abdominal wall strength. The study also identifies factors such as sex, hernia size, and BMI as influential factors in abdominal strength. It suggests that identifying reduced abdominal strength in individuals with hernias could improve their overall quality of life and inform perioperative management. The study proposes the use of a strain gauge as a cost-effective alternative for assessing abdominal muscle strength. However, it is important to note that the study has limitations, such as not considering baseline physical activity levels and back pain. This information can be valuable for individuals researching the effects of incisional hernias on overall health and quality of life. [Extracted from the article]

We present a patient who developed an incisional hernia, from epigastrium to umbilicus, after omphalocele repair. The hernia gradually enlarged to a 10 cm × 10 cm defect with significant rectus abdominis muscle diastasis at the costal arch attachment point. At 6 years of age, the abdominal wall defect in the umbilical region was closed using the components separation technique. For the muscle defect of the epigastric region, composite flaps were made by suturing together the flap of the upper rectus abdominis muscle, after peeling it away from the costal arch attachment point, and the vertically inverted flap of the lower rectus abdominis fascia, created with a U-shaped incision. The composite flaps from each side were reversed in the midline to bring them closer and then sutured; the abdominal wall and skin were then closed. Five months after surgery, the patient had no recurrent incisional hernia and no wound complications. [ABSTRACT FROM AUTHOR]

Copyright of Agri: Journal of the Turkish Society of Algology / Türk Algoloji (Ağrı) Derneği'nin Yayın Organıdır is the property of KARE Publishing 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.)

Peripheral magnetic stimulation has recently been introduced as a non-invasive but effective physical agent to improve muscle strength and everyday function. The aim of this study was to evaluate the feasibility and safety of an exercise program focusing on the abdominal muscles in combination with the peripheral magnetic stimulation of the abdominal muscles. Male and female overweight and obese adults (n = 19) participated in an eight-week exercise program with the additional peripheral magnetic stimulation of the abdominal muscles. Outcome measures included changes in abdominal subcutaneous fat thickness, trunk muscle strength, body composition, and self-reported body satisfaction. Subcutaneous fat thickness was significantly reduced after the intervention (p < 0.01–p < 0.001). Trunk flexion and left side flexion strength increased significantly after the intervention, although no significant changes were observed for trunk extension (p = 0.07) and right side flexion strength (p = 0.13). The body satisfaction self-assessment score significantly increased (p < 0.01), while body mass, body mass index, and fat mass significantly decreased after the intervention (p < 0.05). Our findings suggest that an exercise program with the additional peripheral magnetic stimulation is feasible and safe for overweight and obese participants. These results support the use of peripheral magnetic stimulation as a safe adjunct to the voluntary abdominal muscle contraction. Future studies are needed to evaluate the efficacy of the additional peripheral magnetic stimulation of the abdominal muscles compared to the voluntary contraction of the abdominal muscles alone.

Background: Large subcostal incisional hernias are considered as complex defects, and a few different approaches have been described for repair. The purpose of this comparative cross-sectional study is to evaluate the outcomes of patients with large subcostal incisional hernias treated with either the open anterior components separation technique (ACS) or with the open transversus abdominis release technique (TAR). Methods: From the database of patients with large complex incisional hernias who underwent abdominal wall reconstruction with open techniques between April 2007 and October 2022 at our institution, on May 25th, 2023 we identified those whose hernias were located in the subcostal areas and who underwent reconstruction with a components separation technique and mesh. Perioperative variables and outcomes were compared between the patients with large subcostal hernias who underwent abdominal wall reconstruction with either the ACS or the TAR techniques. Results: Thirty-one patients with large subcostal hernias were included in the study. ACS and intra-abdominal mesh was used in 11 patients; TAR and retro-muscular mesh was performed in 20 patients. More postoperative local abdominal wall complications were seen in patients who had ACS as opposed to TAR (55% vs 15%, p = 0.02). Hernia recurrence was more common in patients who had ACS as opposed to TAR (55% vs 5%, p = 0.008). Conclusions: More post-operative complications and recurrences were seen in patients who had ACS as opposed to TAR. [ABSTRACT FROM AUTHOR]

Simple Summary: The quadratus lumborum (QL) block is an ultrasound-guided locoregional anesthetic technique which aims to provide analgesia to the abdomen. Previous studies in dog cadavers have shown that a dorsal injection point, between the psoas minor muscle and the vertebral body of L1, is able to stain the truncus sympathicus and the T13–L3 rami ventrales, potentially providing analgesia to the abdominal wall and viscera. This dorsal approach could be feasible in cats and is probably able to offer similar results to those in canine cadavers. To assess this objective, 10 cat cadavers were used, and a mixture of methylene blue and iopromide (0.4 mL kg−1) was injected dorsal to the QL muscle in the abovementioned location. Computerized tomography and anatomical dissection were employed to evaluate the injectate spread. Our results showed the feasibility of this approach in cat cadavers as a consistent staining of the truncus sympathicus (T13–L3) and the rami ventrales of the spinal nerves (T13–L3) was observed. These results are compatible with the induction of somatic and visceral analgesia of the abdomen, although the cranial abdominal wall may not be covered. The quadratus lumborum (QL) block is an ultrasound-guided locoregional anesthesia technique which aims to provide analgesia to the abdomen. The main objective of this study was to assess a modified ultrasound-guided dorsal QL block in cat cadavers. For this purpose, a volume of 0.4 mL kg−1 of a mixture of iopromide and methylene blue was administered between the psoas minor muscle and the vertebral body (VB) of the first lumbar vertebra, and its distribution was assessed in thirteen cat cadavers. We hypothesized that this injection point would be feasible, offering a more cranial distribution of the injectate and a more consistent staining of the truncus sympathicus. The study was divided into two phases. Phase 1 consisted of an anatomical study (three cadavers were dissected). Phase 2 consisted of the ultrasound-guided administration of the injectate and the assessment of its distribution by computed tomography and anatomical dissection. The results showed a consistent distribution of contrast media within five (4–8) VBs from T10 to L5. Methylene blue stained three (2–6) rami ventrales, affecting T11 (10%), T12 (20%), T13 (60%), L1 (85%), L2 (95%) and L3 (65%). The truncus sympathicus was dyed in all cadavers with a spread of five (3–7) VBs. Finally, the splanchnicus major nerve was stained in all cadavers (100%). These results suggest that this technique could provide analgesia to the abdominal viscera and the abdominal wall, probably with the exception of the cranial aspects of the abdominal wall. [ABSTRACT FROM AUTHOR]

Background: Congenital Anomalies were responsible for 303,000 deaths in the neonatal period, according to the WHO, they are among the world's top 20 causes of morbidity and mortality. Expensive simulators demonstrate several diseases, but few are related to congenital anomalies. This study aims to develop, validate, and evaluate low-cost simulator models (WALL-GO) of the most common abdominal wall defects, gastroschisis, and omphalocele, to enable diagnosis through an accessible tool with study value and amenable to replication. Methods: Market research was conducted to find materials to build low-cost models. The researchers built the model and underwent validation assessment of the selected experts who scored five or more in the adapted Fehring criteria. The experts were assessed through a 5-point Likert scale to 7 statements (S1-7). Statements were assigned values according to relevance in face and transfer validities. Concomitantly, the model was also evaluated by students from 1st to 5th year with the same instruments. Content Validity Indexes (CVIs) were considered validated between groups with concordance greater than 90%. Text feedback was also collected. Each statement was subjected to Fisher's Exact Test. Results: Gastroschisis and omphalocele model costs were US $15 and US $27, respectively. In total, there were 105 simulator evaluators. 15 experts were selected. Of the 90 students, there were 16 (1st year), 22 (2nd), 16 (3rd), 22 (4th), and 14 (5th). Students and experts obtained CVI = 96.4% and 94.6%, respectively. The CVIs of each statement were not significantly different between groups (p < 0,05). Conclusions: The WALL-GO models are suitable for use and replicable at a manufacturable low cost. Mannequins with abdominal wall defects are helpful in learning to diagnose and can be applied in teaching and training health professionals in developing and low-income countries. [ABSTRACT FROM AUTHOR]

A 13-year-old neutered male Korean short-hair cat presented with anorexia, lethargy, and a severely distended abdomen, suggestive of ascites. Abdominocentesis yielded serosanguineous fluid. A subsequent diagnostic workup, including blood tests, ascitic fluid analysis, imaging studies [radiography, ultrasound, and computed tomography (CT)], and histopathological examination, was performed to identify the underlying cause. Imaging studies revealed characteristics of encapsulating peritoneal sclerosis (EPS) such as peritoneal thickening, fat stranding, and calcification. During laparotomy, fibrous membranes encapsulating the abdominal organs and ascites were observed, and multiple calcified regions were detected on the abdominal wall. Histopathological analysis confirmed the diagnosis of poorly differentiated invasive malignant neoplasms, which were further classified as carcinomatosis based on positive cytokeratin and negative vimentin immunohistochemistry results. To our knowledge, this is the first report of sclerosing peritoneal carcinomatosis with osseous metaplasia in a cat. [ABSTRACT FROM AUTHOR]