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This study aims to develop a novel intraperitoneal two- or three-layered patch with immunomodulatory property for treatment of hernia, regeneration of abdominal wall and prevention of intraperitoneal adhesions. Polypropylene (PP) mesh, middle layer, was intended to provide mechanical support whereas pullulan (PUL) hydrogel coating layer was designed to prevent intraperitoneal adhesions. Fibroin/chitosan oligosaccharide lactate (F/COS) layer electrospun on one side of pullulan was chosen for immunomodulation and abdominal wall regeneration. Physical and mechanical properties and regenerative capacity of intraperitoneal patches were determined. Immunomodulatory property of electrospun layer and whole patch was studied by determining nitric oxide amount produced by RAW 264.7 macrophages. 25 % (w/v) PUL hydrogel and F/COS with 90:10 (w/w) ratio yielded optimal results. Here, we report that fabricated intraperitoneal patches successfully prevented cell adhesion on one side and increased cell viability and proliferation on other side, along with immunomodulation, in vitro., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Surgery to the abdominal wall is ubiquitous worldwide and hernia treatment is challenging and expensive, posing a critical need to tailor treatment to individual patient risk-factors. In this systematic review, we consider specific systemic factors with potential as biomarkers of hernia formation., Methods: A healthcare database-assisted search, following PRISMA guidelines, identified journal articles for inclusion and analysis., Results: 14 biomarker studies were selected, comparing hernia patients and hernia-free controls, focusing on markers of extracellular matrix (ECM) remodelling and collagen turnover. Matrix metalloproteinase-2 was increased in patients with inguinal hernia. Markers of type IV collagen synthesis were increased in patients with abdominal wall hernia; while markers of fibrillar collagen synthesis were reduced. Additional other ECM signalling proteins differ significantly within published studies., Conclusion: We identify a lack of high-quality evidence of systemic biomarkers in tailoring treatment strategies relative to patient-specific risks, but recognise the potential held within biomarker-based diagnostic studies to improve management of hernia pathogeneses., Competing Interests: Declaration of competing interest The authors have no potential competing interests that readers or editors might consider relevant to this publication., (Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.)

The engineering of multifunctional surgical bactericidal nanofibers with inherent suitable mechanical and biological properties, through facile and cheap fabrication technology, is a great challenge. Moreover, hernia, which is when organ is pushed through an opening in the muscle or adjacent tissue due to damage of tissue structure or function, is a dire clinical challenge that currently needs surgery for recovery. Nevertheless, post-surgical hernia complications, like infection, fibrosis, tissue adhesions, scaffold rejection, inflammation, and recurrence still remain important clinical problems. Herein, through an integrated electrospinning, plasma treatment and direct surface modification strategy, multifunctional bactericidal nanofibers were engineered showing optimal properties for hernia repair. The nanofibers displayed good bactericidal activity, low inflammatory response, good biodegradation, as well as optimal collagen-, stress fiber- and blood vessel formation and associated tissue ingrowth in vivo. The disclosed engineering strategy serves as a prominent platform for the design of other multifunctional materials for various biomedical challenges.

Analyze the biometric parameters and the size (area) of abdominal wall defect (AWD) in fetuses with gastroschisis and omphaloceles and correlate them with the herniated internal organs. We studied 22 fetuses (11 with AWDs and 11 without anomalies). In all fetuses we evaluated the xiphopubic distance (XPD) and iliac crest distance (ICD). In fetuses with AWDs we dissected the abdominal wall and measured the width and length of the defect for calculating its area and studying the correlation between the size of the defect with the organs that were herniated. For statistical analysis, the Anova and Tukey post-test were used (p < 0.05). The XPD in the control group had mean of 4.2 mm (2.3-5.9; SD ± 1.11), while in the AWDs it was 4.2 mm (2.9-5.5; SD ± 0.98) (p = 0.4366). The ICD had mean values of 2.5 mm (1.6-3.4; SD ± 0.58) in the control group, and 2.3 mm (1.2-3.0; SD ± 0.56) in AWDs fetuses (p = 0.6963). The number of herniate organs do not have significant correlation with the area of the defect (r 2  = 0.2504, p = 0.5068). There is no correlation between the size (area) of abdominal wall defects and the number of the internal organs that herniated. Therefore, the hole size is not a predictor of the severity of the gastroschisis or omphalocele.

Background: Our aim was to investigate the pathologies in the hernia sac in adults, and the frequency of malignancy as well as to confirm the necessity of maintaining the current applications in histological examination of the hernia sac., Methods: Patients who were operated for hernia in our clinic from 2013 to 2019 were included in the study. Patient data were evaluated retrospectively. We divided the patients into four groups, according to the type of hernia. We evaluated the demographic characteristics of the patients, the pathologies within the hernia sac, histopathological examination outcomes of the hernia sac and clinical features of malignancy in patients with malignancy., Results: A total number of 556 adult patients underwent inguinal, femoral, umbilical or incisional hernia repair in our hospital. Nine patients (0.61%) had malignancy in the hernia sac. Three out of nine patients (33%) had no preoperative diagnosis of malignancy. Six patients (67%) had a known history of malignancy. Two tumors were located in the inguinal (22.0%), six tumors in the incisional (67%), and one in the umbilical (11%) hernia sacs. Among these, 56% were of gastrointestinal, 22% of gynecological, 11% of breast and 11% of epididymis origin. Most of the other pathologies found in the hernia sac were herniated bowel segments, lipomas and omentum., Conclusion: Since the hernia sac might be the first clue for an underlying cancer, if abnormal pathological findings are detected during surgery, histopathological examination should be performed to exclude malignancy. The purpose of histological examination is to detect a hidden malignancy., (© 2019 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Epigastric hernia involving the falciform ligament is exceptionally rare. Most reported cases are incisional hernia secondary to prior abdominal surgery. We report a case of primary falciform ligament herniation into the epigastric region repaired by the laparoscopic preperitoneal approach. In this case, an accompanying vessel along the herniated falciform ligament was identified. This finding provides a basis for the hypothesis of a perforating vessel piercing the linea alba and thereby creating a weak point for hernia protrusion (Moschowitz theory). The patient had an uneventful recovery and was discharged home on the postoperative day two. A laparoscopic preperitoneal approach is feasible for the repair of primary falciform ligament herniation. The magnified endoscopic view enables surgeons to achieve definite repair without missing occult defects.

Background: Meckel's diverticulum is a remnant of the omphalomesenteric duct. It can lead to intestinal perforation, obstruction and gastrointestinal bleeding. While the internal hernia caused by Meckel's diverticulum is rarely reported., Case Presentation: We report a case of a 45-year old female patient who presented with intestinal obstruction and on laparotomy was found to have Meckel's diverticulum with internal hernia causing intestinal gangrene. Segmental bowel resection was performed and the patient had uneventful recovery., Conclusions: In patients with acute intestinal obstruction without previous abdominal surgery, Meckel's diverticulum and its complications should be suspected.

A 7-year-old boy presents at the Emergency Department with an abdominal swelling after an accident with a space scooter. He was diagnosed with a traumatic anterior abdominal wall hernia, for which he underwent surgical correction.

Open abdomen and fascial dehiscence after intestinal transplantation increase morbidity. This study aims to identify recipient and donor factors associated with failure to achieve sustained primary closure (failed-SPC) of the abdomen after intestinal transplant. We conducted a single-center retrospective study of 96 intestinal transplants between 2013 and 2018. Thirty-eight (40%) were adult patients, and 58 were pediatric patients. Median age at transplantation was 36.0 and 5.8 years, respectively. Failed-SPC occurred in 31 (32%) patients. Identified risk factors of failed-SPC included preexisting enterocutaneous fistula (OR: 6.8, CI: 2.4-19.6, P = .0003), isolated intestinal graft (OR: 3.4, CI: 1.24-9.47, P = .02), male sex in adults (OR: 3.93, CI: 1.43-10.8, P = .009), and age over four years (OR: 6.22, CI: 1.7-22.7, P = .004). There was no association with primary diagnosis and prior transplant with failed-SPC. Donor-to-recipient size ratios did not predict failed-SPC. There was an association between failed-SPC and extended median hospital stay (100 vs 57 days, P = .007) and increased time to enteral autonomy in pediatric patients. There is a relationship between failed-SPC and a higher rate of laparotomy (OR: 21.4, CI: 2.78-178.2, P = .0003) and fistula formation posttransplant (OR: 11.4, CI: 2.83-45.84, P = .0005) in pediatric patients. Given inferior outcomes with failed-SPC, high-risk recipients require careful evaluation., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

This study involves the design, development and evaluation of a new multifunctional prosthetic mesh for treatment of abdominal wall defects without complications. The developed prosthetic mesh is a hybrid platform of both synthetic and natural materials with its backbone consisting of a synthetic commercial polyester fabric (CPF) to provide the required mechanical integrity. The CPF mesh was coated by a natural biodegradable, biocompatible and antimicrobial layer of chitosan (CS) incorporating phenytoin (PH)-loaded pluronic nanomicelles for healing promotion, and ciprofloxacin (CPX)-alginate polyelectrolyte complex-based microparticles as antibacterial agent. The prosthetic mesh was optimized and evaluated in-vitro and in-vivo. The optimum PH-loaded micelles had particle size of 95.42 nm, polydispersity index of 0.41, zeta potential of -18 and entrapment efficiency of 89.4%, while the optimum CPX microcomplexes had particle size of 1292.0 nm, polydispersity index of 0.8, zeta potential of -20.1, complexation efficiency of 81.1%, and minimum inhibitory concentration of 0.25 μg/ml and 0.125 μg/ml against Staphylococcus aureus and Pseudomonas aeruginosa, respectively. In-vivo study on abdominal wall defect dog model was conducted, followed by implantation of the proposed prosthetic meshes. The developed mesh depicted an efficient healing with excellent biocompatibility, and could be an ideal and feasible alternative prosthesis with many advantages such as low cost, inertness, mechanical stability, pliability, low infection rate, limited modification by body tissues, sterilizability, non-carcinogenicity, limited inflammatory reaction, hypoallergenic as well as minimal complications., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Foramen of Winslow hernias is a rare and challenging diagnosis as signs and symptoms are usually non-specific. CT imaging has become the method of choice in diagnosing such conditions preoperatively. Traditionally managed via laparotomy, there has been an increase in the use of the minimally invasive technique in recent times, though experience remains sparse. This is a case of a 73-year-old woman with hepatic flexure herniation through the foramen of Winslow who was managed by the traditional laparotomy approach. A review of the literature was performed to learn key techniques in the use of laparoscopy to manage future cases., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: In Roux-en-Y reconstructions, choledocholithiasis could represent a really challenging condition to treat which can be treated by a surgical-assisted ERCP. Only six cases of transjejunal laparoscopic-assisted ERCP (LAERCP) can be found in literature to date and no large series are present., Methods: A young woman who had undergone a laparoscopic Roux-en-Y gastric bypass 2 years earlier came complaining recurrent abdominal pain. Radiologic exams found stones in the common bile duct and no signs of internal hernia. We therefore decided to perform a transjejunal LAERCP finding a concomitant internal hernia in the Petersen's space which was repaired at the same time., Results: The post-operative course was uneventful., Conclusion: Transjejunal LAERCP is a feasible technique to deal with choledocholithiasis, and it allows at the same time to identify and treat concomitant conditions like internal hernias.

Internal abdominal hernia, defined as protrusion of viscera through a defect of the mesentery, has been considered a rare clinical entity. Recent clinical reviews reported a wide range of onset age (from newborns to the elderly) and symptoms (from minimal abdominal symptoms to severe acute abdomen). Sudden and unexpected death due to internal abdominal hernia is rare in infants or toddlers, and only 4 autopsy cases had been reported previously. We report the case of a 3-month-old Japanese boy who unexpectedly died 4 h after first vomiting. Autopsy showed a wide bowel obstruction with necrosis through a congenital mesenteric defect. The larynx was filled with gastric content (milky white viscous muddy material). In the cross section of both lungs, the same material was found to be expressed from the bronchioles. We diagnosed the cause of death as asphyxiation by viscous milk/vomitus aspiration caused by bowel obstruction due to an internal abdominal hernia. In case of sudden and unexpected death of an infant, autopsy is crucial to determine the cause of death. During autopsy, it is helpful to determine the character and distribution of gastric and airway contents to confirm milk or vomitus aspiration., (Copyright © 2019 Elsevier B.V. All rights reserved.)

A three-year-old boy with mild symptoms of an upper respiratory tract infection and recent onset vomiting collapsed at home. Resuscitative attempts in hospital were eventually unsuccessful. At autopsy an obstruction of the small intestine, with ischemia, was identified. It had been caused by strangulation of the small intestine through a congenital mesenteric defect. Moderate mesenteric lymphadenopathy, with enlarged lymph nodes in the region of the herniated small intestine, were associated with positive testing for human metapneumovirus and enterovirus. Transmesenteric hernias are a very rare form of internal herniation that have the highest risk of strangulation. Unfortunately in children the presentation may be relatively nonspecific with a precipitate decline towards the end. In the reported case it is possible that mesenteric lymphadenopathy may have contributed to intestinal entrapment by preventing spontaneous reduction.

We present the case of a 57-year-old woman with a large (7 x 5 cm), asymptomatic lumbar swelling. A lumbar MRI scan revealed a hernia of the superior lumbar triangle (Grynfeltt-Lesshaft hernia). Thus far, 300 cases have been described in the literature. Therapeutic options include surgical and conservative treatment.

A 38-year-old female, intact yellow-naped Amazon parrot ( Amazona auropalliata ) presented with an acute swelling along the ventrocaudal body wall, hematochezia, and tenesmus. Physical examination identified a defect in the ventral body wall. Bimodal pain management was initiated at presentation and hematochezia and tenesmus resolved. Radiographic imaging and contrast fluoroscopy identified a partial cloacal strangulation. An exploratory celiotomy was performed. Adhesions to the body wall were identified and broken down, the cloacal position was corrected, and the abdominal musculature repaired. Contrast fluoroscopy performed 72 hours after surgery confirmed normal positioning of the cloaca. Follow-up examinations documented proper postoperative healing of the hernia repair and maintenance of visibly normal passage of droppings. Although various abdominal hernias have been described in birds, this case demonstrates an unreported variation involving partial cloacal strangulation in a parrot., (© 2018 by the Association of Avian Veterinarians.)

Internal hernias are defined as the protrusion of abdominal viscera through an aperture in the intraperitoneal recesses, they are considered as a rare cause of intestinal obstruction. The paraduodenal hernias are the most common type of congenital hernia especially the left-sided ones. We report a case of a 46 year-old man presenting a left paraduodenal hernia with acute small bowel obstruction, which was firstly (preoperatively) assigned to a tumoral cause., Competing Interests: The authors declare no conflict of interests.

We have read with great interest the case report recently published in Acta Dermatovenerologica Croatica by Boer and Mihajlovic (1), which describes a 33-year-old woman with an 18-year history of classic hidradenitis suppurativa (HS) who developed HS-like lesions at the position of the bra strap. We agree with Boer and Mihajlovic: according to our clinical experience, we are convinced that mechanical stress may contribute or, in some cases, result in the development of HS. In this regard, we will describe the case of a patient with a monster hernia who presented HS-like lesions on his abdomen corresponding to the perihernial skin area, suggesting that mechanical stress was an important pathogenic factor for HS development. A 54-year-old man without any previous history of HS developed chronic, recurrent, inflammatory nodules, cysts, and depressed scars at the location of a giant abdominal hernia (Figure 1). The lesions occurred four years ago, six months after the hernia had reached its current size. Cultures from skin swabs showed commensal skin flora and moderate mixed anaerobic bacteria, as would be expected in HS lesions. No lesions occurred in other inverse areas generally affected by HS, such as the axillary and anogenito-crural regions. It is likely that the mechanical stress in the abdominal region was greater than the one occurring at the other folds due to the pressure of the trousers and belt. In fact, there are many kinds of mechanical stress: friction, pressure, pulling, tension, and pinching. Friction can be defined as the resistance to motion in the direction of the common boundary of the two surfaces. The body areas which are at greater risk for such frictional forces are mainly the skin folds, such as axillae, groins, and buttocks. There is a substantial difference between frictional and pressor stress: pressure is defined as the force per unit exerted parallel to the plane of interest. Pressure on the skin can be caused by tight dressings (2). Frictional and pressor forces can act concurrently and synergistically, starting the series of events that lead to clinical onset of HS, as most likely happened in our patient at the abdomen right below the hernia, where the trousers and belt are tightened. It is believed today that the primary event in HS is follicular inflammation: in predisposed subjects, folliculitis can develop into HS. Follicular enlargement has been observed in HS skin. It has been hypothesized that constant mechanical forces, such as pressure and friction, may lead to follicular occlusion, dilatation, microtears, and ruptures with ensuing abscesses (1-6). This case report corroborates observations from the last three decades: HS is a disease of the follicular epithelium rather than the apocrine glands (7,8), and mechanical stress, friction, and pressure may have an important role in its pathogenesis.

We present a cadaveric case study of an 88-year-old woman with an unusual posterior perineal hernia containing small bowel, rectum, and mesentery. Dissection revealed several loops of the small bowel occupying the presacral space and displacement of the rectum into a large perineal evagination. The intestinal mucosa appeared to have been healthy at the time of death, and we did not find any indication of rectal prolapse. There was also no evidence of past surgery, suggestive of a primary hernia. We conclude this patient had a posterior enterorectal perineal hernia. Suggestions for surgical repair are described.

Abdominal wall repair frequently utilizes either nondegradable or biodegradable meshes, which are found to stimulate undesirable biological tissue responses or which possess suboptimal degradation rate. In this study, a biologic mesh prototype made from carbodiimide cross-linked cholecyst-derived extracellular matrix (EDCxCEM) was compared with small intestinal submucosa (Surgisis ® ), cross-linked bovine pericardium (Peri-Guard ® ), and polypropylene (Prolene ® ) meshes in an in vivo rabbit model. The macroscopic appearance and stereological parameters of the meshes were evaluated. Tailoring the degradation of the EDCxCEM mesh prevents untimely degradation, while allowing cellular infiltration and mesh remodeling to take place in a slower but predictable manner. The results suggest that the cross-linked biodegradable cholecyst-derived biologic mesh results in no seroma formation, low adhesion, and moderate stretching of the mesh. In contrast to Surgisis, Peri-Guard, and Prolene meshes, the EDCxCEM mesh showed a statistically significant increase in the volume fraction (V v ) of collagen (from 34% to 52.1%) in the central fibrous tissue region at both day 28 and 56. The statistically high length density (L v ), of blood vessels for the EDCxCEM mesh at 28 days was reflected also by the higher cellular activity (high V v of fibroblast and moderate V v of nuclei) indicating remodeling of this region in the vicinity of a slowly degrading EDCxCEM mesh. The lack of mesh area stretching/shrinkage in the EDCxCEM mesh showed that the remodeled tissue was adequate to prevent hernia formation. The stereo-histological assays suggest that the EDCxCEM delayed degradation profile supports host wound healing processes including collagen formation, cellular infiltration, and angiogenesis. The use of cross-linked CEM for abdominal wall repair is promising.

Due to the rarity of Grynfelt hernia, there is no standardized surgical technique.From April 2010 to September 2017, 12 cases of primary superior lumbar hernia (Grynfelt hernia) were identified through medical records reviewing and included in our study. Perioperative data, surgical outcomes, and long-term follow-up results were retrospectively analysed.Male/female ratio of patients was 1:1, with age 69.5 (62, 74.5) [median (25 percentile, 75 percentile)] years old. Right/left side ratio of lumbar hernia was 9/3. The in-hospital duration was 7 (5, 8) days. The surgical duration was 35 (30, 50) minutes. The defect size was 2.1 (1.5, 3) cm in diameter. The discharge of the patient was on 3 (2, 4) post-operative day (POD). The meshes used were: MK5816 (10), MK5810 (1), and UHS (1). There was only 1 case of postoperative complication where the patient was admitted in intensive care unit (ICU) due to hypoxemia. Morbidity, mortality, and recurrence cases were null.Our study indicates that open surgery with mesh implantation is a reliable way for the management of primary superior lumbar hernia.

Herpes zoster is caused by the reactivation of latent varicella-zoster virus from dorsal root ganglia. Although infrequent, simultaneous damage to the anterior horn cells or anterior nerve roots at the same level may result in motor neuropathy. When motor involvement is localized in the abdominal wall, a pseudohernia may be the clinical presentation. We report a case of abdominal wall post-herpetic pseudohernia, with clinical, ultrasound and MRI correlation. MRI demonstrated increased T2/STIR signal intensity in the abdominal wall muscles, suggesting acute denervation. To our knowledge, this is the first case report of postherpetic pseudohernia with acute denervation demonstrated on MRI., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Experimental trials were done on five dogs to explore if an anterior abdominal wall defect could be repaired using wet (99.9%), compact BNC membranes produced by the Мedusomyces gisevii Sa-12 symbiotic culture. The abdominal wall defect was simulated by middle-midline laparotomy, and a BNC membrane was then fixed to open aponeurotic edges with blanket suture (Prolene 4-0, Ethicon). A comparative study was also done to reinforce the aponeurotic defect with both the BNC membrane and polypropylene mesh (PPM) (Ultrapro, Ethicon). The materials were harvested at 14 and 60 days postoperative to visually evaluate their location in the abdominal tissues and evaluate the presence of BNC and PPM adhesions to the intestinal loops, followed by histologic examination of the tissue response to these prosthetics. The BNC exhibited good fixation to the anterior abdominal wall to form on the 14th day a capsule of loose fibrin around the BNC. Active reparative processes were observed at the BNC site at 60 days post-surgery to generate new, stable connective-tissue elements (macrophages, giant cells, fibroblasts, fibrin) and neocapillaries. Negligible intraperitoneal adhesions were detected between the BNC and the intestinal loops as compared to the case of PPM. There were no suppurative complications throughout the postsurgical period. We noticed on the 60 th day after the BNC placement that collagenous elements and new capillary vessels were actively formed in the abdominal wall tissues, generating a dense postoperative cicatrix whose intraperitoneal adhesions to the intestinal loops were insignificant compared to the PPM graft.

We present a case of an intact 14-year-old male dog with a prostate B-cell lymphoma recognized in the contents of an irreducible perineal hernia. The enlarged prostate was replaced after reducing its size by partial excision, and the perineal hernia was repaired using the tunica vaginalis communis. However, the pelvic cavity was largely occupied by the replaced prostate, and urinary retention developed. The prostate was resected on the next day via abdominal median incision, and a bladder-urethra anastomosis was performed. Lymphoma has rarely been demonstrated to develop in the prostate, with the lesion comprising the hernia contents. The present study suggests the necessity of early treatment for perineal hernias and the possibility that lymphoma may be present in the hernia contents.

Surgical meshes are effective and frequently used to reinforce soft tissues. Fibrin glue (FG) has been widely used for mesh fixation and is also considered an optimal vehicle for stem cell delivery. The aim of this preclinical study was to evaluate the therapeutic effect of MSCs and their exosomes combined with FG for the treatment of incisional hernia. A murine incisional hernia model was used to implant surgical meshes and different treatments with FG, MSCs and exo-MSCs were applied. The implanted meshes were evaluated at day 7 by anatomopathology, cellular analysis of infiltrating leukocytes and gene expression analysis of TH1/TH2 cytokines, MMPs, TIMPs and collagens. Our results demonstrated a significant increase of anti-inflammatory M2 macrophages and TH2 cytokines when MSCs or exo-MSCs were used. Moreover, the analysis of MMPs, TIMPs and collagen exerted significant differences in the extracellular matrix and in the remodeling process. Our in vivo study suggests that the fixation of surgical meshes with FG and MSCs or exo-MSCs will have a beneficial effect for the treatment of incisional hernia in terms of improved outcomes of damaged tissue, and especially, in the modulation of inflammatory responses towards a less aggressive and pro-regenerative profile., Statement of Significance: The implantation of surgical meshes is the standard procedure to reinforce tissue defects such as hernias. However, an exacerbated and persistent inflammatory response secondary to this implantation is frequently observed, leading to a strong discomfort and chronic pain in the patients. In many cases, an additional surgical intervention is needed to remove the mesh. This study shows that mesenchymal stem cells and their exosomes, combined with a fibrin sealant, can be used for the successful fixation of these meshes. This new therapeutic approach, assayed in a murine model of incisional hernia, favors the modulation of the inflammatory response towards a less aggressive and pro-regenerative profile., (Copyright © 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

We here report two cases of acute bowel obstruction. Emergency intervention showed left obstructive paraduodenal hernia causing volvulus with necrosis of the incarcerated intestinal loops in one patient who underwent one-time anastomosis resection and suffering but viable small bowel in the second patient treated by incarcerated intestinal loop reduction and obturation of the orifice of the hernial canal. We here highlight the diagnostic and therapeutic features of this rare condition.

Background: Reconstruction of muscle defects remains a challenge. Our work assessed the potential of an engineered construct made of a human acellular collagen matrix (HACM) seeded with porcine mesenchymal stem cells (MSCs) to reconstruct abdominal wall muscle defects in a rodent model., Methods: This study compared 2 sources of MSCs (bone-marrow, BMSCs, and adipose, ASCs) in vitro and in vivo for parietal defect reconstruction. Cellular viability and growth factor release (VEGF, FGF-Beta, HGF, IGF-1, TGF-Beta) were investigated under normoxic/hypoxic culture conditions. Processed and recellularized HACMs were mechanically assessed. The construct was tested in vivo in full thickness abdominal wall defect treated with HACM alone vs. HACM+ASCs or BMSCs (n=14). Tissue remodeling was studied at day 30 for neo-angiogenesis and muscular reconstruction., Results: A significantly lower secretion of IGF was observed with ASCs vs. BMSCs under hypoxic conditions (-97.6%, p<0.005) whereas significantly higher VEGF/FGF secretions were found with ASCs (+92%, p<0.001 and +72%, p<0.05, respectively). Processing and recellularization did not impair the mechanical properties of the HACM. In vivo, angiogenesis and muscle healing were significantly improved by the HACM+ASCs in comparison to BMSCs (p<0.05) at day 30., Conclusion: A composite graft made of an HACM seeded with ASCs can improve muscle repair by specific growth factor release in hypoxic conditions and by in vivo remodeling (neo-angiogenesis/graft integration) while maintaining mechanical properties., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Lateral approaches to the spine are increasing in popularity. However, details of the innervation pattern of the abdominal oblique muscles with the initial dissection have not been well studied., Methods: Ten adult fresh-frozen cadavers (20 sides) were placed in the lateral position. On each side, the region in which transpsoas approaches are performed, between the iliac crest and the 12th rib, was dissected. The nerves, their course, and their muscular supply were studied., Results: The subcostal nerve is the predominant nerve supply for the anterolateral abdominal muscle innervation. It is larger and has a wider field of distribution and more branches (8 on average) compared with the L1 (4 on average) and 11th intercostal nerves (2 on average 2). The proximal 6-10 cm of each nerve has few if any branches. The subcostal nerve is often (75%) located up to 5 cm inferior to the 12th rib in its initial course. The area of least concentration ("safe zone") is located at an approximate midpoint between the lower edge of the 12th rib and the superior-most aspect of the iliac crest. A previously undescribed branch of the subcostal nerve was found traveling posterior to the quadratus lumborum and joining the remaining subcostal nerve in an anastomosis at or near the lateral position., Conclusions: Knowledge of the innervation and nerve dominance patterns might help decrease postoperative complications such as sensory deficits or abdominal wall hernias. The subcostal nerve is the dominant nerve in both size and innervation of the oblique muscles in the lateral position, transpsoas approach., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Congenital abdominal wall defects occur when normal embryonic development is interrupted and most commonly results in gastroschisis or omphalocele. Other entities, such as ruptured omphalocele, vanishing gastroschisis, and patent omphalomesenteric ducts with prolapse, have also been described and can create a confusing picture. This case of a newborn with a midline abdominal defect and a mass that was intestine-like and arose from the bowel cannot be classified, and no similar reports were found. This suggests a previously undescribed abdominal wall defect with an aberrant colonic appendage.

Preoperative progressive pneumoperitoneum and botulinum toxin type A are useful tools in the preparation of patients with loss of domain hernias. Both procedures are complementary in the surgical repair, especially with the use of prosthetic techniques without tension, that allow a integral management of these patients. The aim of this paper is to update concepts related to both procedures, emphasizing the advantages that take place in the preoperative management of loss of domain hernias., (Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: A pseudohernia is an abdominal wall bulge that may be mistaken for a hernia but that lacks the disruption of the abdominal wall that characterizes a hernia. Thus, the natural history and treatment of this condition differ from those of a hernia. This is the first report of a pseudohernia due to cough-associated rib fracture., Case Presentation: A case of pseudohernia due to fractures of the 10 th and 11 th ribs in a 68-year-old white woman is presented. The patient suffered from a major coughing episode 1 year prior to her presentation, after which she noted a progressively enlarging bulge in her left flank. Computed tomography demonstrated a bulge in the abdominal wall containing bowel and spleen but with all muscle and fascial layers intact; in addition, lateral 10 th rib and posterior 11 th rib fractures were noted., Conclusions: As there was no defect in muscle or fascia, we diagnosed a pseudohernia, likely due to a denervation injury from the fractured ribs. Symptomatic treatment was recommended, including wearing a corset and referral to a pain management clinic. Symptomatic treatment is thought to be the mainstay of therapy for pseudohernias, as surgical intervention is unlikely to be of benefit.

Post traumatic anterior abdominal wall hernia can be ignored in emergency settings. We here report the case of a 32-year-old patient with a BMI of 30 kg/m 2 , suffering from anterior abdominal wall hernia as a result of a road accident. This lesion wasn't detected during clinical examination. Abdominal tomodensitometry showed a defect of 8 cm in the anterior abdominal wall. The patient underwent surgery during which a musculoaponeurotic defect of 12 cm was detected. The repair was carried out using interrupted suture. The postoperative course was marked by a secondarily infected skin necrosis. The evolution was satisfactory after directed cicatrization. At 3 months postoperatively the patient was doing well with a healed wound and a strong abdominal wall., Competing Interests: Conflits d’intérêts Les auteurs ne déclarent aucun conflit d’intérêts.

Background: Cyanoacrylate(CA)-based tissue adhesives, although not widely used, are a feasible option to fix a mesh during abdominal hernia repair, due to its fast action and great bond strength. Their main disadvantage, toxicity, can be mitigated by increasing the length of their alkyl chain. The objective was to assess the in vitro cytotoxicity and in vivo biocompatibility in hernia repair of CAs currently used in clinical practice (Glubran(n-butyl) and Ifabond(n-hexyl)) and a longer-chain CA (OCA(n-octyl)), that has never been used in the medical field., Methods: Formaldehyde release and cytotoxicity of unpolymerized(UCAs) and polymerized CAs(PCAs) were evaluated by macroscopic visual assessment, flow cytometry and Alamar Blue assays. In the preclinical evaluation, partial defects were created in the rabbit abdominal wall and repaired by fixing polypropylene prostheses using the CAs. At 14 days post-surgery, animals were euthanized for morphology, macrophage response and cell damage analyses., Results: Formaldehyde release was lower as the molecular weight of the monomer increased. The longest side-chain CA(OCA) showed the highest cytotoxicity in the UCA condition. However, after polymerization, was the one that showed better behavior on most occasions. In vivo, all CAs promoted optimal mesh fixation without displacements or detachments. Seroma was evident with the use of Glubran, (four of six animals: 4/6) and Ifabond (2/6), but it was reduced with the use of OCA (1/6). Significantly greater macrophage responses were observed in groups where Glubran and Ifabond were used vs. sutures and OCA. TUNEL-positive cells were significantly higher in the Glubran and OCA groups vs. the suture group., Conclusions: Although mild formaldehyde release occurred, OCA was the most cytotoxic during polymerization but the least once cured. The CAs promoted proper mesh fixation and have potential to replace traditional suturing techniques in hernia repair; the CAs exhibited good tissue integration and effective short-term biocompatibility, with the slightest seroma and macrophage response induced by OCA.

Background: Gender differences are expected to influence the pattern and outcome of management of abdominal wall hernias. Some of these are left to speculations with few published articles on hernias in females., Objectives: To describe the clinical pattern of abdominal wall hernias in females., Method: A 5 year retrospective review., Result: There were 181 female patients with 184 hernias representing 27.9% of the total number of hernia patients operated. Mean age was 41.66±24.46 years with a bimodal peak in the 1(st) and 7(th) decades. Inguinal hernia accounted for majority (50.5%) but incisional hernia predominated in the 30-49 age group, while only inguinal and umbilical hernias were seen in the first two decades (p=0.04). There was no side predilection in the cases of inguinal hernia. There were 12 (6.6%) emergency presentations, most of which occurred in the 6th decade and above and none below 30 years (p=0.02). Umbilical (4 cases) and femoral hernias (3cases) accounted for most of these cases. Incisional hernia was the commonest cause of recurrent hernias., Conclusion: Inguinal hernia is the commonest hernia type in females followed by incisional hernias which also accounteds for most recurrent cases. Age appears to be a risk factor for developing complications.

The results of investigation of the inflammatory processes dynamics in operative wounds in 238 patients after surgical intervention, performed for noncomplicated hernias of anterior abdominal wall of various localization, as well as the impact of polarized light on correction of the vegetative nervous system disorders, for prophylaxis of infiltrative-purulent complications were analyzed.

Results of diagnosis and treatment of 48 patients, suffering an acute adhesiv eileus of small intestine, were analyzed. In 22 (45.8%) patients conservative therapy have appeared effective, in 26 (54.2%) — operative interventions were performed. Тransabdominal ultrasonographic investigation — noninvasive, available, highly informative diagnostic method — permits to differentiate various forms of an acute ileus precisely, and, comparing with roentgenological method, it is more secure and simple, which may be used even in a severely ill patients. The method permits to diagnose an acute adhesive small intestinal ileus in a shorter terms, and to determine severity of changes not in intestine only, but in adjacent abdominal organs as well.

Purpose: To validate the need of continuing the current practice of histologic examination of hernia sacs (HS)., Methods: All HS received by our laboratory over 15 years were reviewed for any pathological findings. Cases harboring these results were selectively re-examined histologically by a pathologist and their charts were reviewed by a surgeon checking for clinical significance. Moreover, previous studies were analyzed to reach a final conclusion., Results: Pathological findings were noted in only 13.7 and 12.8% of adults and kids HS, respectively. None of these had significant impact on patient care., Conclusions: Serious pathologies reported in HS in the literature are rare. This, coupled with our data, suggest that the current practice of routine microscopic examination of HS is not justified. Criteria are proposed for categorizing cases as eligible for histologic evaluation. This will significantly reduce the workload and contain the cost.

Results of morphological investigation of musculo-aponeurotic structures of anterior abdominal wall were presented in the morbid obesity patients. The role of obesity as a primary cause for morphofunctional insufficience of musculo-aponeurotic structures was established.

Purpose: This study aimed to analyze the clinical features of lumbar hernia reported in South Korea and compare these features with those reported in foreign literature., Methods: From January 1968 through December 2013, 13 cases reported in South Korea were included in the study. The variables compared were age, sex, main symptoms at hospital visit, etiology, location, herniated contents, lateralization, defect size, diagnostic methods, surgical methods, surgical opinions, and recurrence., Results: In the South Korean cases, women outnumbered men (3.3:1) and no significant differences were found in the herniated side (left:right, 1.1:1). In contrast, in the foreign cases, men outnumbered women (3:1) and left-sided hernia was dominant (2:1). Moreover, in most of the foreign cases, patients were aged 50-70 years, whereas in the South Korean cases, none of the patients were in their 50 s. However, no substantial differences were found in etiology, anatomical locations, symptoms, and herniated contents., Conclusion: This research revealed that few clinical features of lumbar hernias in South Korea differ from those reported in foreign literature. Thirteen cases were analyzed in the present study, and results obtained from such a small sample size cannot be generalized with certainty. Therefore, more cases should be collected for a definitive analysis. Despite this limitation, this study is important because it is the first attempt to collect and analyze the clinical features of lumbar hernia in South Korea. This study will serve as a basis for future studies investigating the clinical features of lumbar hernia cases in South Korea.

A 16-year-old spayed female domestic shorthair cat with no history of trauma was presented to the Western College of Veterinary Medicine for assessment of urinary incontinence. Diagnostic investigation revealed herniation of the urinary bladder through a caudoventral abdominal wall defect. Clinical signs resolved after surgical reduction of the bladder.

Background: It remains unclear to what extent midgut rotation determines human intestinal topography and pathology. We reinvestigated the midgut during its looping and herniation phases of development, using novel 3D visualization techniques., Results: We distinguished 3 generations of midgut loops. The topography of primary and secondary loops was constant, but that of tertiary loops not. The orientation of the primary loop changed from sagittal to transverse due to the descent of ventral structures in a body with a still helical body axis. The 1st secondary loop (duodenum, proximal jejunum) developed intraabdominally towards a left-sided position. The 2nd secondary loop (distal jejunum) assumed a left-sided position inside the hernia before returning, while the 3rd and 4th secondary loops retained near-midline positions. Intestinal return into the abdomen resembled a backward sliding movement. Only after return, the 4th secondary loop (distal ileum, cecum) rapidly "slid" into the right lower abdomen. The seemingly random position of the tertiary small-intestinal loops may have a biomechanical origin., Conclusions: The interpretation of "intestinal rotation" as a mechanistic rather than a descriptive concept underlies much of the confusion accompanying the physiological herniation. We argue, instead, that the concept of "en-bloc rotation" of the developing midgut is a fallacy of schematic drawings. Primary, secondary and tertiary loops arise in a hierarchical fashion. The predictable position and growth of secondary loops is pre-patterned and determines adult intestinal topography. We hypothesize based on published accounts that malrotations result from stunted development of secondary loops.