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Hypertension affects 1–5% of children and adolescents, and the incidence has been increasing in association with obesity. However, secondary causes of hypertension such as renal parenchymal diseases, congenital abnormalities and renovascular disorders still remain the leading cause of pediatric hypertension, particularly in children under 12 years old. Other less common causes of hypertension in children and adolescents, including immobilization, burns, illicit and prescription drugs, dietary supplements, genetic disorders, and tumors will be addressed in this review.

El Síndrome de Prune Belly (abdomen en ciruela pasa) es una enfermedad congénita rara en la que, además de las manifestaciones genitourinarias, la pared abdominal se ve afectada en todos los pacientes en diferentes grados. Presentamos el caso de un varón con seguimiento de 15 años en el que se realizaron 2 cirugías de pared abdominal: la primera a la edad de 8 años con técnica de Montfort y la última 14 años después para corregir pliegues cutáneos y asimetría abdominal, realizando abdominoplastia con acceso de Grazer con el objetivo de colocar una malla de polipropileno para obtener mejor contención y a la vez mejorar la estética de la pared abdominal. No se presentaron complicaciones en ninguno de los 2 procedimientos y los resultados estéticos obtenidos fueron muy satisfactorios. Ofrecemos una alternativa quirúrgica para el tratamiento de aquellos casos en los que la primera cirugía no resuelve el defecto de pared y la anomalía estética abdominal. Prune Belly Syndrome is a rare congenital disease in which besides the genitourinary manifestations, the abdominal wall is affected in all patients with various degrees of involvement. We present the case of a male with a follow-up of 15 years, during which 2 surgeries were performed in the abdominal wall: the first at age 8 with the Montfort technique, and the last one 14 years afterwards to correct skin folds and abdominal asymmetry, carrying out and abdominoplasty with the Grazer approach to achieve a better containment through a polypropilene mesh and enhancement of abdominal wall aesthetics. There were no complications during the 2 procedures and very satisfactory aesthetic results were obtained. We propose a surgical alternative for those cases in which the first surgery does not resolve wall defects and abdominal aesthetics.

Sixteen clinically healthy New Zealand white rabbits of either sex were divided into 2 equal groups (I and II) of 8 animals each. Under thiopental sodium (2.5 %) anaesthesia a 2 × 3 cm full-thickness abdominal wall defect in the mid-ventral abdominal wall was created and repaired with an acellular dermal graft (ADG) in all the animals of group I (test group). In animals of group II (control group) a full-thickness linear midline abdominal muscular wall incision was made and repaired with a continuous suture pattern using 2-0 nylon.

O prognóstico de gastrosquise permanece adverso nos países em desenvolvimento e os fatores associados a óbito não são conhecidos. O estudo objetivou avaliar os fatores associados com morte neonatal em casos de gastrosquise atendidos no IMIP. Foram incluídos 49 casos de gastrosquise atendidos no IMIP, Recife-Brasil, entre 1995 e 2001. A variável dependente foi morte neonatal e as independentes foram: diagnóstico pré-natal, local e tipo de parto, idade gestacional, peso ao nascer, intervalo entre parto e admissão e parto-cirurgia, correção cirúrgica primária ou em estágios, necessidade de ventilação mecânica e infecção pós-operatória. Calculou-se a razão de prevalência (RP) de morte neonatal com intervalo de confiança a 95%, realizando-se análise de regressão logística para determinar o risco ajustado de óbito. A mortalidade foi de 53% (26 casos), sendo infecção a principal causa de óbito (92%). O diagnóstico pré-natal associou-se com significante redução (74%) do risco de morte. Esse risco foi significantemente aumentado ( > 2 vezes) para RNs, com peso menor que 2,5Kg e provenientes de outros hospitais. Também verificou-se aumento significante do risco para o intervalo entre parto-admissão e parto-cirurgia maior que duas e quatro horas (respectivamente, 2,5 e 3,4). O risco de morte foi 2,6 vezes maior nos casos com ventilação mecânica. Na análise multivariada, persistiram associadas ao óbito a prematuridade e o intervalo entre parto e cirurgia maior que 4h. Observou-se uma elevada mortalidade entre recém-nascidos com gastrosquise, que pode ser explicada por fatores como ausência de pré-natal, prematuridade, baixo peso, parto fora dos centros terciários, longos intervalos entre parto e cirurgia e necessidade de ventilação mecânica.Gastroschisis remains associated with an adverse outcome in developing countries and the factors associated with neonatal death are not known. The aim of this study was to determine the factors associated with neonatal death in cases of gastroschisis managed in a tertiary hospital in Brazil. It was included 49 cases of gastroschisis managed at IMIP, Recife - Brazil, between 1995 and 2001. The dependent variable was neonatal death and the independent variables were: prenatal diagnosis, route and site of delivery, gestational age, birthweight, birth-to-admission interval, birth-to-surgery interval, primary or staged-silo repair, need of mechanical ventilation and postoperative infection. Prevalence ratio (PR) and its 95% confidence interval of neonatal death was determined. Logistic regression analysis was performed to determine adjusted relative risk of neonatal death. Overall mortality was 53% (26 cases) and infection was the main cause of death (92%). Prenatal diagnosis was associated with significant reduction of 74% in the risk of death. This risk was significantly increased ( > twice) among newborns with gestational age below 37 weeks, birthweight below 2.5Kg and outborn babies. A significantly greater risk of neonatal death was observed for birth-to-admission interval of 2h or more and birth-to-surgery interval of 4h or more (2.5 and 3.4 times, respectively). Need of mechanical ventilation was associated with an increased risk of death (2.6 times). In multivariate analysis, variables that persisted strongly associated to neonatal death were gestational age below 37 weeks and birth-to-surgery interval greater than 4h. A high mortality was observed among babies of gastroschisis which is explained by factors like absence of prenatal diagnosis, prematurity, low birthweight, delivery outside the tertiary center, longer birth-to-surgery intervals and need of mechanical ventilation.

Introducción: Onfalocele y gastrosquisis son los defectos de la pared abdominal (DPA) más frecuentes, que por su importancia y las diferencias entre ellos merecen ser estudiados en forma especial. Objetivos: Establecer las tasas de prevalencia de onfalocele y gastroaquisis al nacimiento. Verificar variaciones de ellas en distintos períodos. Estudiar la morbimortalidad asociada y su sobrevida. Pacientes y Método: Se revisó la base de datos ECLAMC (Estudio Colaborativo Latino Americano de Malformaciones Congênitas) para el período 1996-2010. Resultados: Se pesquizarón 33 recién nacidos (RN) con DPA. (11,6 por 10.000 nacimientos). De ellos 19 fueron onfalocele (6,7 por 10.000) y 14 (4,9 por 10.000) gastrosquisis. Los niños con onfalocele tenían significativamente mayor asociación con otras malformaciones, su frecuencia en el sexo masculino fue mayor y mostró mayor letalidad que la gastrosquisis. Todos los niños con gastrosquisis nacieron vivos, con predominio del sexo femenino, sus madres eran significativamente más jóvenes. Conclusión: Onfalocele y gastros-quisis presentaron una prevalencia al nacimiento mayor que lo publicado, probablemente por ser el HCUCH un Centro de Referencia. Ambas anomalías mostraron un aumento significativo en sus tasas de prevalencia al nacimiento al compararlas con las obtenidas anteriormente por nosotros en el mismo hospital. Se demostró diferencias significativas entre estas dos entidades: Onfalocele tiene mayor mortinatalidad, mortalidad y letalidad, mayor frecuencia de malformaciones asociadas y mayor promedio de edad materna. Introduction: Omphalocele and Gastroschisis are the two most common congenital abdominal wall (AWD) defects. Objectives: To determine birth prevalence of Omphalocele and Gastroaquisis; to verify variations in different periods and to study the associated morbidity, mortality and survival. Patients and Method: The database of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) was searched between the years 1996 and 2010. Results: 33 newborns (NB) with AWD were investigated (11.6 per 10,000 births). 19 of the cases corresponded to omphalocele (6.7 per 10,000 births) and 14 to gastroschisis (4.9 per 10,000 births). Children with omphalocele had significantly greater association with other malformations and the frequency in males was higher and showed higher mortality rates than gastroschisis. All children with gas-troschisis were born alive; they were predominantly female infants whose mothers were significantly younger. Conclusion: Birth omphalocele and gastroschisis prevalence were higher than published information, perhaps due to the fact that the HCUCH (Clinical Hospital of Universidad de Chile) is a reference center. Both anomalies showed a significant increase in their birth prevalence rates when compared with those previously obtained by us in the same hospital. Significant differences between these two entities were described. Omphalocele presented higher stillbirth, mortality and fatality rates; higher frequency of associated malformations and higher average maternal age.

We present the extremely rare case of a male newborn with Beckwith-Wiedemann Syndrome (BWS) presenting as delayed abdominal wall closure and neonatal intussusception. Fetal ultrasound had shown omphalocele that resolved spontaneously. When feeding was attempted, he had various episodes of vomiting. An x-ray showed signs of high bowel obstruction. Jejunal intussusception was found on laparotomy. Enterectomy and primary jejuno-jejunal anastomosis was performed. During post-operative period subtle physical findings became prominent: plain hemangioma, posterior helical indentations, and macroglossia. Cardiac ultrasonography showed a patent foramen oval with small left-to-right shunt. Ultrasonography showed renal hyperplasia. Genetic study showed hypomethylation of DMR2 region of 11p15 chromosome.

Background: Abdominal wall defect presents a great challenge when it is large, ruptured, or associated with other anomalies. Objective: To review the challenges and outcome of management of anterior abdominal wall defects (AAWD). Materials and Methods: A retrospective review of omphalocele and gastroschisis managed over 8 years at our institution. Results: Omphalocele (n=49) and gastroschisis (n=7) constituted 2.4% of total admission. The median age was 23.5 hours, with male-female ratio of 1:1.1. Term infants were 91.7% and more than 75% weighed above 2.5 kg. The mean maternal age was 28.5±5.87 years and mean parity was 3.1±2.0, with P values of 0.318 and 0.768, respectively. More than 92.9% of infants were out-born, 46 pregnancies (82.1%) were booked, and 51 (91.1%) had at least one ultrasound scan, but only 1 (1.8%) was diagnosed with gastroschisis. Ruptured omphalocele were 11 (6 major, 5 minor) in number, 3 of which presented with enterocutaneous fi stula, and 3 (6.1%) were syndromic omphalocele. Positive blood culture confi rmed septicaemia in 21 cases (37.5%). Surgical repair was done in 35 cases (62.5%), 44.6% as emergency, and 17.9% as elective. Non-operative management was done in 21 patients (37.5%) and 5 (8.9%) were discharged against medical advice. Median length of hospital stay was 10 days (mean, 15.98±14.38). Postoperative complication rate was 32.1% and overall mortality was 30.4%, with the highest case fatality among gastroschisis (57.1%) and omphalocele major (32.1%). Conclusions: There were large numbers of out-born infants due to poor prenatal diagnosis in spite of high instances of antenatal ultrasound scan. Many patients presented with complications that resulted in poor outcome.Key words: Abdominal wall defects, challenges, gastroschisis, omphaloceles, outcomes

The reconstruction of large abdominal wall defects still is a major surgical problem. Many different techniques have been developed for this purpose, most of which appeared to be unsatisfactory. The lack of sufficient tissue requires the insertion of prosthetic material. Non-absorbable prostheses used to reconstruct abdominal wall defects showed the best results. Polypropylene mesh (PPM) and expanded polytetrafluoroethylene (ePTFE) soft-tissue patch are the most frequently used materials for this purpose. However, PPM induces extensive visceral adhesions and erosion of the skin, whereas ePTFE is insufficiently anchored to the adjacent tissue and therefore both materials are not ideal. As a result of own clinical and experimental studies, we constructed a new prosthesis that combines the favourable properties and avoids the drawbacks of PPM and ePTFE and tested it in an experimental study in the rat. The results are promising and warrant future study to find the ideal non-absorbable prosthesis to reconstruct large abdominal wall defects.

WOS: 000237015800053 PubMed: 16567201 Purpose: To show the effect of botulinum A toxin-induced paralysis of abdominal muscles oil intraabdominal pressure. Material and Methods: Fifteen Sprague-Dawley rats were divided into 2 groups. An abdominal skin incision was done, and 2 catheters were placed for the pressure monitoring and saline infusion. Saline Solution was given to the abdomen until reaching to a pressure level of 9 cm H2O and 6 min Hg in pressure device, and the amounts of injected saline were recorded. Then intraabdominal saline was drained. Two milliliters (5 U/mL) botulinum A toxin was applied to the abdominal muscles in group 2. Saline was injected at the same points in same amounts in group 1. After 3 days, catheters were placed, and the saline volumes needed to obtain the same pressure levels were recorded for each rat. Spontaneous motor unit potential (MUP), single MUP analysis and interference patterns of the muscles, respiratory rates, and vascular pressure measurements were recorded before and after botulinum toxin (Botox) injections. Results: Mean intraabdominal saline volumes in the first and third days were 63.8 and 64.4 mL in group 1 and 67.6 and 80.6 mL in group 2, respectively. Mean MUP amplitude and duration of the rectus muscles in group 2 (17.1 mu V and 1.47 milliseconds) were significantly lower than those of group I (187 mu V and 4.9 milliseconds) in the third day. There were no pathological changes in respiratory rates and pressure measurements before and after Botox injections. Conclusion: This pilot experimental study showed that local injection of botulinum A toxin causes paralysis in abdominal wall muscles, increases the intraabdominal volume, and decreases the pressure, and this application may be used as ail adjunct in abdominal Wall Closure in selective cases. (c) 2006 Elsevier Inc. All rights reserved.

Myoblasts were obtained by culturing in vitro, single muscle fibers, isolated by enzymatic digestion from rat flexor digitorum brevis, and their phenotype was confirmed by myogenic differentiation factor, myogenic factor-5, myogenin and desmin. Cultured myoblasts were harvested and seeded on patches of homologous acellular matrix, obtained by detergent-enzymatic treatment of abdominal muscle fragments. Myoblast-seeded patches were inserted between obliqui abdominis muscles on the right side of 1-month-old rats, while non-seeded patches were implanted on the left side. Thirty days after surgery, non-seeded patches were completely replaced by fibrous tissue, while the structure of myoblast-seeded patches was well preserved until the 2nd month. Seeded patches displayed abundant blood vessels and myoblasts, and electromyography evidenced in them single motor-unit potentials, sometimes grouped into arithmic discharges. Ninty days after implantation, the thickness of myoblast-seeded patches and their electric activity decreased, suggesting a loss of contractile muscle fibers. In conclusion, the present results indicate that autologous myoblast-homologous acellular muscle matrix constructs are a promising tool for body-wall defect repair, and studies are under way to identify strategies able to improve and maintain the structural and functional integrity of implants for longer periods.

OBJECTIVES: Evaluation of the current effectiveness of routine prenatal ultrasound screening in detecting abdominal wall defects and associated conditions in unselected population across Europe. Analysis of the impact of associated malformations, syndromes, and chromosomal abnormalities on pregnancy outcome and parental decisions concerning termination of pregnancy (TOP). METHODS: 19 Congenital Malformation Registries from 11 European countries collected data on the family history, mother, fetus/infant, results of prenatal scans and outcome of pregnancy. The study period was 30 months (01/07/96 to 31/12/98) and total number of monitored pregnancies 690, 123. RESULTS: From the total of 243 abdominal wall defects, associated malformations were found in 56.2 % (77/137) of omphalocele and 22.6% (24/106) of gastroschisis. Overall 25 % (34/137)of fetuses with omphalocele had an abnormal karyotype, 31.4 % (43/137) had a recognisable syndrome, association, or an unspecified pattern of malformations. Of the 106 gastroschisis, 15 (14%) had aditional abnormalities. Only 2 (2%)cases could be atributted to a chromosomal and 7 (7%) to a recognisable nonchromosomal syndrome. Prenatal ultrasound examination detected 75 % (103/137) of omphalocele and 83% (88/106) of gastroschisis. The detection rate was higher and the mean gestational age at detection lower in multiple affected fetuses. In 51 (37%) cases with omphalocele and in 31 (29%) with gastroschisis, parents opted for TOP. PČroportion of TOP was higher in multiple affected fetuses compared to syndromic, chromosomal, and multiple cases. CONCLUSION: A high proportion of abdominal wall defects is associated with concurrent malformations and/or chromosomal abnormalities. Associated conditions clearly influence perinatal outcome. Therefore, a detailed search for other structural malformations and karyotyping should be performed whenever an abdominal wall defect is identified.

O prognóstico de gastrosquise permanece adverso nos países em desenvolvimento e os fatores associados a óbito não são conhecidos. O estudo objetivou avaliar os fatores associados com morte neonatal em casos de gastrosquise atendidos no IMIP. Foram incluídos 49 casos de gastrosquise atendidos no IMIP, Recife-Brasil, entre 1995 e 2001. A variável dependente foi morte neonatal e as independentes foram: diagnóstico pré-natal, local e tipo de parto, idade gestacional, peso ao nascer, intervalo entre parto e admissão e parto-cirurgia, correção cirúrgica primária ou em estágios, necessidade de ventilação mecânica e infecção pós-operatória. Calculou-se a razão de prevalência (RP) de morte neonatal com intervalo de confiança a 95%, realizando-se análise de regressão logística para determinar o risco ajustado de óbito. A mortalidade foi de 53% (26 casos), sendo infecção a principal causa de óbito (92%). O diagnóstico pré-natal associou-se com significante redução (74%) do risco de morte. Esse risco foi significantemente aumentado ( > 2 vezes) para RNs, com peso menor que 2,5Kg e provenientes de outros hospitais. Também verificou-se aumento significante do risco para o intervalo entre parto-admissão e parto-cirurgia maior que duas e quatro horas (respectivamente, 2,5 e 3,4). O risco de morte foi 2,6 vezes maior nos casos com ventilação mecânica. Na análise multivariada, persistiram associadas ao óbito a prematuridade e o intervalo entre parto e cirurgia maior que 4h. Observou-se uma elevada mortalidade entre recém-nascidos com gastrosquise, que pode ser explicada por fatores como ausência de pré-natal, prematuridade, baixo peso, parto fora dos centros terciários, longos intervalos entre parto e cirurgia e necessidade de ventilação mecânica. Gastroschisis remains associated with an adverse outcome in developing countries and the factors associated with neonatal death are not known. The aim of this study was to determine the factors associated with neonatal death in cases of gastroschisis managed in a tertiary hospital in Brazil. It was included 49 cases of gastroschisis managed at IMIP, Recife - Brazil, between 1995 and 2001. The dependent variable was neonatal death and the independent variables were: prenatal diagnosis, route and site of delivery, gestational age, birthweight, birth-to-admission interval, birth-to-surgery interval, primary or staged-silo repair, need of mechanical ventilation and postoperative infection. Prevalence ratio (PR) and its 95% confidence interval of neonatal death was determined. Logistic regression analysis was performed to determine adjusted relative risk of neonatal death. Overall mortality was 53% (26 cases) and infection was the main cause of death (92%). Prenatal diagnosis was associated with significant reduction of 74% in the risk of death. This risk was significantly increased ( > twice) among newborns with gestational age below 37 weeks, birthweight below 2.5Kg and outborn babies. A significantly greater risk of neonatal death was observed for birth-to-admission interval of 2h or more and birth-to-surgery interval of 4h or more (2.5 and 3.4 times, respectively). Need of mechanical ventilation was associated with an increased risk of death (2.6 times). In multivariate analysis, variables that persisted strongly associated to neonatal death were gestational age below 37 weeks and birth-to-surgery interval greater than 4h. A high mortality was observed among babies of gastroschisis which is explained by factors like absence of prenatal diagnosis, prematurity, low birthweight, delivery outside the tertiary center, longer birth-to-surgery intervals and need of mechanical ventilation.

Omphalocele and gastroschisis are now frequently diagnosed prenatally using ultrasound scanning and prenatal maternal serum á – fetoprotein (AFP) screening. Timely prenatal diagnosis allows careful search for associated anomalies or chromosomal aberrations that can influence fetal prognosis, obstetric outcome and parental decisions concerning termination of pregnancies. Although mid trimester prenatal ultrasound screening for fetal anomalies has become a standard procedure of prenatal care, the impact of routine obstetric ultrasound on the perinatal outcome in low-risk pregnancies is still under debate. We have evaluated the effectiveness of routine prenatal ultrasound screening in detection of abdominal wall defects occurring among pregnancies monitored from July 1st 1996 to December 31st 1998 in 19 European Congenital Malformation Registries. From the total of 690,123 pregnancies there were 243 cases of abdominal wall defects, 137 cases of omphalocele and 106 cases of gastroschisis giving the mean prevalence rates of 2,72 and 1,54 per 10 000 respectively. Of the total of 137 omphalocele there were 59 (43%) cases with isolated omphalocele, 34 (25%) with chromosomal aberration, 14 (10%) with a recognisable syndrome, and 30 (22%) were associated to other major malformations. Less than a half of cases were live births (57 or 42%). A high number of cases resulted in fetal deaths (30 or 22%) and termination of pregnancy (50 or 36%). Proportion of TOP for isolated omphalocele (8 or 14%) was significantly lower compared to those that are part of a recognizable syndrome (7 or 50%), chromosomal aberration (23 or 68%), or non- identified multiple malformation syndrome (12 or 40%). Of the total of 106 gastroschisis 83 (78%) were considered to be isolated, 14 (13%) to have additional anomalies, while only 2 could be attributed to a chromosomal and 7 to the recognisable non-chromosomal syndrome. There were 61 (58%) live births, 13 (12%) ended with intrauterine fetal death, and 32 (30 %) had the pregnancies terminated. In pregnancies with gastroschisis TOP was performed in 30% of pregnancies. Of 83 cases of isolated gastroschisis 17% resulted in termination of pregnancy. Only one of the 14 cases associated to another major malformation and no cases of syndromic of chromosomal origin were carried out to term. Antenatal routine ultrasound screening was performed in 132 (96%) of pregnancies with omphalocele and in 101 (95%) cases of gastroschisis. Overall 101 (74 %) fetuses with omphalocele and 95% with gastroschisis were diagnosed before birth. Mean gestational age at first detection of anomaly was 18 weeks (6-40) for omphalocele and 19 weeks for gastroschisis. There is significant regional variation in detection rates between different European regions reflecting policies, equipment and operators, experience.

In fetuses with abdominal wall defects prenatal deteciton of associated malformations and chromosomal abnormalities influence fetal prognosis, obstetric outcome and parental decisions concerning termination of pregnancies. We have analysed 252 cases of abdominal wall defects occurring among 593.799 pregnancies monitored over 2-year period by 19 European congenital malformation registries. 56.7% (143/252) of cases were omphalocele and 43.2% (109/252) were gastroschisis. The mean prevalence rate for omphalocele was 2.41 and for gastroschisis 1.84 per 10,000. Associated malformations were found in 57.3% of omphalocele compared with 22% of gastroschisis. Overall 25.9% of fetuses with omphalocele had an abnormal karyotype, 31.5% had a recognisable syndrome, association or an unspecified malformation pattern. Chromosomal abnormalities were identified in 2 cases of gastroschisis. Twenty two fetuses with gastroschisis had additional malformations that were not of chromsomal origin. Gastroschisis was associated with significantly younger maternal age than omphalocele. Prenatal ultrasound examinations were able to detect 78.3% of omphalocele and 80.7% of gastroschisis. In 39.2% (56/143) cases of omphalocele and in 29.4 (32/109) of gastroschisis parents opted for termiantion of pregnancy. 58.1% of terminations were performed in fetuses with multiple malformations. The overall survival rate was 40.6% for omphalocele and 77.1% for gastroschisis.

The reconstruction of large abdominal wall defects still is a major surgical problem. Many different techniques have been developed for this purpose, most of which appeared to be unsatisfactory. The lack of sufficient tissue requires the insertion of prosthetic material. Non-absorbable prostheses used to reconstruct abdominal wall defects showed the best results . Polypropylene mesh (PPM) and expanded polytetrafluoroethylene (ePTFE) soft-tissue patch are the most frequently used materials for this purpose . However, PPM induces extensive visceral adhesions and erosion of the skin, whereas ePTFE is insufficiently anchored to the adjacent tissue and therefore both materials are not ideal. As a result of own clinical and experimental studies , we constructed a new prosthesis that combines the favourable properties and avoids the drawbacks of PPM and ePTFE and tested it in an experimental study in the rat. The results are promising and warrant future study to find the ideal non -absorbable prosthesis to reconstruct large abdominal wall defects.

The rupture of an omphalocele sac during birth is a well recognized entity. The associated lesions due to vascular compromise can result in necrosis of the bowel with perforation. Spontaneous bowel perforation in an omphalocele at birth is not reported in the literature. We describe a case with bowel perforation at the fundus of an omphalocele in a newborn.

Background The repair of incisional hernias remains a challenge for the general surgeon. Indications for surgery are severe bowel obstruction, as well as aesthetic problems. There are various surgical methods to correct these hernias, with varying results. However, the gold standard has not yet been found. Both laparoscopic repair and the component separation technique (CTS) have proven to be acceptable techniques; however, they are not always suitable for resolving the more complicated abdominal wall defects, i.e. after open-abdomen treatment or fascial necrosis. In our hospital, we developed a new onlay technique which we have evaluated in the following research. Patients and methods During a period of 10 years (1996–2007), 101 patients with an incisional hernia were corrected with the new onlay technique. A Marlex mesh of dimensions at least 10 × 20 cm was used, overlapping the fascia by at least 5 cm on each side. This mesh was stapled onto the fascia with skin staples. Of the 101 patients, there were 45 men and 56 women, with a mean age of 55 years. Nine patients died and 13 were lost during follow-up. Of the remaining 79 patients, eight refused to participate. The mean follow-up time was 64 months (normal distribution, standard deviation [SD] 34 months). This cohort of 101 patients was studied retrospectively. Results Seventy-one of the 101 patients were evaluated at our out-patient clinic. For 24 patients (25%), the operation was for a recurrence after an incisional hernia correction in the past. Twenty-one patients (20%) had an open-abdomen treatment in their medical history. The surgical procedure was technically possible in all patients and the mean operation time was 63 min. The median admission time was 4.5 days (quartiles 3–6.25). The mean follow-up time was 64 months (SD 35 months). A seroma was reported in 27 of 101 patients (27%) and a wound infection in 22 patients (21%), of which seven patients had to be re-operated. Only if a patient was evaluated at our out-patient clinic could reherniation have been scored; this occurred in 11 of 71 patients (16%). Conclusion This technique is an effective and simple procedure to correct incisional hernias with acceptable complication rates and is feasible even in the more complicated hernias.

The purpose of the present study was to analyze the use of autologous dermis compared to non-biological meshes in repair of abdominal wall defects in patients with redundant skin and immunosuppression.Eighteen patients with abdominal wall defects, immunosuppression and with redundant skin were divided into two groups: Group A consisted of 11 patients treated with autologous dermis. In these patients, autologous dermis was isolated from the amount of skin resected from the inferior abdominal region that was used as a reinforcement of fascial margins above the defect. Group B consisted of seven patients treated with non-biological meshes We evaluated the infection rate of these groups.The infection rate was significantly lower in group A patients.The transplantation of autologous dermis as a reinforcement for the reconstruction of abdominal wall defects is reasonable for highly selected patients. The use of the dermis was proven useful and we found a lower rate of infection and recurrence.

Background Previous studies on the mortality rate of omphalocele are limited. The risk of death of non-isolated omphalocele and that of cases of omphalocele that are diagnosed prenatally by ultrasound are unclear. This study aimed to estimate the perinatal mortality of pregnancies with omphalocele. This study also examined the potential risk of death of non-isolated omphalocele and that of cases that are prenatally diagnosed by ultrasound. Methods Data were retrieved from the national birth defects registry in China, for 1996–2006. Multinomial logistic regression was used to calculate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) between perinatal mortality and selected maternal and fetal characteristics. Results Among 827 cases of omphalocele, 309 (37.4%) cases resulted in termination of pregnancy and stillbirth, and 124 (15.0%) cases resulted in death in the first 7 days after delivery, yielding a perinatal mortality rate of 52.4% (95% CI: 49.0–55.8%). The late fetal death rate (LFDR) of omphalocele that was diagnosed prenatally by ultrasound was 15.91-fold (AOR: 15.91, 95% CI: 10.18–24.87) higher than that of postnatally diagnosed cases. The LFDR of non-isolated omphalocele was 2.64-fold (AOR: 2.64, 95% CI: 1.62–4.29) higher than that of isolated cases. For the early neonatal death rate, neonates with non-isolated omphalocele had a 2.96-fold (AOR: 2.96, 95% CI: 1.82–4.81) higher risk than isolated cases, but the difference between prenatal ultrasound diagnosis and postnatal diagnosis was not significant. Conclusions Selected fetal characteristics are significantly associated with the perinatal risk of death from omphalocele. Our findings suggest that improving pregnancy and delivery care, as well as management for omphalocele are important.