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Objective: This study aimed to investigate growth among neonates with gastrointestinal disorders., Study Design: Inclusion criteria included neonates with gastroschisis, omphalocele, intestinal atresia, tracheoesophageal fistula, Hirschsprung's disease, malabsorption disorders, congenital diaphragmatic hernia, and imperforate anus born between 2010 and 2018. Anthropometrics were collected for the first 30 months, and a subgroup analysis was performed for gastroschisis infants., Results: In 61 subjects, 13% developed severe growth failure within the first month. One-, four-, and nine-month weight and length z -scores were less than birth weight in all infants ( p  < 0.05). In infants with gastroschisis, a similar pattern was observed for weight z -scores only ( p  < 0.05). From birth to 15 months, head circumference z -score increased over time in all infants ( p  = 0.001), while in gastroschisis infants, weight, length, and head circumference z -scores increased over time ( p  < 0.05)., Conclusion: In a cohort of infants with gastrointestinal disorders, growth failure was followed by catch-up growth., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: With the widespread use of advanced imaging there is a need to quantify the prevalence and impact of hernias. We aimed to determine the prevalence of abdominal wall hernias among patients undergoing computed tomography (CT) scans and their impact on abdominal wall quality of life (AW-QOL)., Methods: Patients undergoing elective CT abdomen/pelvis scans were enrolled. Standardized physical examinations were performed by surgeons blinded to the CT scan results. AW-QOL was measured through the modified Activities Assessment Scale. On this scale, 1 is poor AW-QOL, 100 is perfect, and a change of 7 is the minimum clinically important difference. Three surgeons reviewed the CT scans for the presence of ventral or groin hernias. The number of patients and the median AW-QOL scores were determined for three groups: no hernia, hernias only seen on imaging (occult hernias), and clinically apparent hernias., Results: A total of 246 patients were enrolled. Physical examination detected 62 (25.2%) patients with a hernia while CT scan revealed 107 (43.5%) with occult hernias. The median (interquartile range) AW-QOL of patients per group was no hernia = 84 (46), occult hernia = 77 (57), and clinically apparent hernia = 62 (55)., Conclusions: One-fourth of individuals undergoing CT abdomen/pelvis scans have a clinical hernia, whereas nearly half have an occult hernia. Compared with individuals with no hernias, patients with clinically apparent or occult hernias have a lower AW-QOL (by 22 and seven points, respectively). Further studies are needed to determine natural history of AW-QOL and best treatment strategies for patients with occult hernias., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Internal hernias (IH) are a recognized problem in laparoscopic Roux-en-Y gastric bypass (LRYGB) that can cause intestinal obstruction. The routine closure of the mesenteric defects (MDs) to prevent IH in the LRYGB remains controversial., Objectives: The main objective of our study was to evaluate the risk of reopening at the level of both MDs, the Petersen space, and the intermesenteric gap., Setting: University hospital., Methods: Prospective cohort of patients with a history of LRYGB, all with closure of both MDs, and in whom another intra-abdominal surgery was performed after the LRYGB, between January 2013 and December 2018. The status of both MDs was recorded. All analyses were performed with Stata version 15 software with a level of significance of .05., Results: A total of 76 patients were included. The average time that elapsed between the LRYGB and the surgery that evaluated the state of the MDs was 22.8 months. The patients lost on average 34.7 kg, with a minimum of 8 kg and a maximum of 76 kg. The indications for the interventions were cholelithiasis (68.3%), recurrent abdominal pain (13.2%), intestinal obstruction (11.8%), malabsorption syndrome (7.3%), and bilateral inguinal hernia (2.4%). At the time of surgery, 52 patients (68.4%) had a completely closed Petersen space; 58 patients (76.3%) had a completely closed intermesenteric defect. Both MDs were closed in 36 patients (47.4%), and 33 patients (43.4%) had at least 1 of the MDs open., Conclusion: The closure of MDs eliminated the risk of IH in half of the operated patients of LRYGB in this series., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background and Objective: Abdominal hernia repair is one of the most often performed surgical procedures worldwide. Numerical simulations of the abdominal wall mechanics can be a valuable tool to devise actions aimed at preventing hernia formation. A first step towards this goal is the development of consistent constitutive models for the tissues that form the human abdominal wall. In this study we propose, for each of the tissues involved, a new formulation of the so-called transversely isotropic hyperelastic model (TIHM)., Methods: We propose a new TIHM for the human abdominal wall tissues and we present a systemic view of the methodology that we have implemented in the present study. First we consider the mathematical background of the TIHM. The novelty of our formulation is that both the isotropic and the fiber contributions to the strain energy function are characterized exclusively by polynomial convex functions of certain invariant quantities. Then, we provide a detailed description on how the constitutive model is implemented into an open source finite element (FE) software. In our approach we use the specific interface provided by the MFront software to incorporate our TIHM formulation into the Code Aster FE solver. For each of the tissues considered, the values of the TIHM constants are adjusted by means of a numerical simulation of previous experimental data from tensile tests., Results: We studied the following abdominal wall tissues: linea alba, rectus sheath, external oblique muscle, internal oblique muscle, transversus abdominis muscle and rectus abdominis muscle. Our formulation closely reproduces tensile test data for each tissue in the corresponding FE numerical simulation., Conclusions: The new TIHM formulation is suitable for a future numerical investigation of the abdominal wall, which will in turn help us to assess the best zone to practice a colostomy. The methodology implemented in the present study can be easily extended in the future to develop and implement a TIHM for active muscles and/or a different type of constitutive model which might be suitable to characterize other tissues of biomedical interest., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Abdominal pain is the most frequent cause of hospital admission after Roux-en-y gastric bypass (RYGB). Among numerous possible underlying causes, internal hernias represent one of the most peculiar and insidious conditions, setting challenging diagnostic and therapeutic problems for the surgeon. The aim of this study is to analyze aspecific abdominal pain incidence and characteristics after RYGB, discriminating peculiar aspects suggestive of internal hernias., Methods: 13 patients submitted to internal hernia repair after laparoscopic antecolic RYGB and a group of 49 controls (non-complicated RYGB) have been assessed using a specific questionnaire. Overall aspecific abdominal pain incidence and characteristics have been analysed. Typical pain traits and predisposing conditions for internal hernias have been investigated., Results: 33% of controls reported aspecific abdominal pain after RYGB, mainly early postprandial, deep, remittent, colicky, located in the upper left abdomen. 77% of the case patients reported prodromal episodes of pain similar to the controls. The only significant differences between prodromal and acute episodes were pain intensity and quality (continuous). Excess weight lost at 3 months significantly correlated with internal hernia occurrence (p: 0.002)., Conclusions: Based on abdominal pain characteristics, we can reasonably postulate the presence of remittent bowel torsions (remittent internal hernia) in many patients after antecolic RYGB, only occasionally complicating. Therapeutic management of these cases remains controversial, being laparoscopic exploration a reasonable option when symptomatology is suggestive.

Acquired abdominal intercostal hernia (AAIH) is an infrequent occurrence whereby intra-abdominal contents herniate into intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. These hernias are difficult to diagnose and should always be suspected when a chest wall swelling occur after major or minor trauma. Surgical repair is warranted in symptomatic patients. The majority of AAIHs are repaired through an open approach using tension-free mesh, with significant recurrence risk. Recently, laparoscopic and robot-assisted repairs have been proposed. We discuss a 49-year-old man presented through outpatient setting with a 5-year history of ongoing left subcostal discomfort and a reducible lump. His history included a workplace accident 5 years ago. Contrast-enhanced abdominal CT confirmed AAIH with omentum herniation into the sac. A successful laparoscopic repair with intraperitoneal onlay mesh technique using composite mesh was performed., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Open abdominal surgery is frequently complicated by the subsequent development of an incisional hernia. Consequently, more than 400,000 incisional hernia repairs are performed each year, adding over $15 billion per year to U.S. health-care expenditures. While the vast majority of studies have focused on improved surgical techniques or prosthetic materials, we examined the use of metallic silver microparticles to prevent incisional hernia formation through enhanced wound healing., Materials and Methods: A rodent incisional hernia model was used. Eighty-two rats were randomly placed into two control groups (saline alone and silver microparticles alone), and three experimental groups (0 mg/cm, 2.5 mg/cm, and 25 mg/cm of silver microparticles applied with a fibrin sealant). Incisional hernia incidence and size, tensile strength, and tissue histology were assessed after 28 days., Results: A significant reduction of both incisional hernia incidence and hernia size was observed between the control groups and 2.5 mg/cm group, and between the control and 25 mg/cm group by nearly 60% and 90%, respectively (P < 0.05). Histological samples showed a noticeable increase in new fibrosis in the treated animals as compared with the controls, whereas the tensile strength between the groups did not differ., Conclusions: The novel approach of using silver microparticles to enhance wound healing appears to be a safe and effective method to prevent incisional hernias from developing and could herald a new era of medicinal silver use., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Management of abdominal pain in a pregnant patient with a history of Roux-en-Y gastric bypass presents unique challenges. A misdiagnosis or delay in management can result in lethal maternal-fetal outcomes. We present a 30-year-old woman at 21 weeks of pregnancy presented with abdominal pain. She had a history of laparoscopic Roux-en-Y gastric bypass performed 3 years earlier. The clinical examination was remarkable for epigastric pain and tenderness. The vital signs and laboratory examinations were unremarkable. The CT scan was suggestive of an internal hernia. On an exploratory laparoscopy, the distal common small bowel was found to be herniating through the jejunojejunostomy mesenteric defect, causing intestinal obstruction with dilatation of the Roux limb and the biliopancreatic limb. The internal hernia was reduced, and no bowel resection was required. The mesenteric defect was closed with 3-0 silk sutures in a continuous fashion. The patient was discharged after 3 days and delivered a healthy baby at 40 weeks of gestation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Hernia repairs still exhibit clinical complications, i.e. recurrence, discomfort and pain and mesh features are thought to be highly influent. The aim of this study is to evaluate the impact of the defect size and mesh type in an herniated abdominal wall using numerical models., Methods: To do so, we have started from a FE model based on a real human abdomen geometry obtained by MRI, where we have provoked an incisional hernia of three different sizes. The surgical procedure was simulated by covering the hernia with a prostheses, and three surgical meshes with distinct mechanical properties were used for the hernia repair: an isotropic heavy-weight mesh (Surgipro @ ), a slightly anisotropic light-weight mesh (Optilene @ ) and a highly anisotropic medium-weight mesh (Infinit @ ). The mechanical response of the wall to a high intraabdominal pressure (corresponding to a coughing motion) was analyzed here., Results: Our findings suggest that the anisotropy of the mesh becomes more relevant with the increase of the defect size. Additionally, according to our results Optilene @ showed the closest deformation to the natural distensibility of the abdomen while Infinit @ should be carefully used due to its excessive compliance.

Pelvic floor dysfunction, specifically genital prolapse (GP) and stress urinary inconsistency (SUI) presumably co-occur with other connective tissue disorders such as hernia, hemorrhoids, and varicose veins. Observations on non-random coexistence of these disorders have never been summarized in a meta-analysis. The performed meta-analysis demonstrated that varicose veins and hernia are associated with GP. Disease connections on the molecular level may be partially based on shared genetic susceptibility. A unique opportunity to estimate shared genetic susceptibility to disorders is provided by a PheWAS (phenome-wide association study) designed to utilize GWAS data concurrently to many phenotypes. We searched the PheWAS Catalog, which includes the results of the PheWAS study with P value < 0.05, for genes associated with GP, SUI, abdominal hernia, varicose veins and hemorrhoids. We found pronounced signals for the associations of the SLC2A9 gene with SUI (P = 6.0e-05) and the MYH9 gene with varicose veins of lower extremity (P = 0.0001) and hemorrhoids (P = 0.0007). The comparison of the PheWAS Catalog and the NHGRI Catalog data revealed enrichment of genes associated with bone mineral density in GP and with activated partial thromboplastin time in varicose veins of lower extremity. In cross-phenotype associations, genes responsible for peripheral nerve functions seem to predominate. This study not only established novel biologically plausible associations that may warrant further studies but also exemplified an effective use of the PheWAS Catalog data.

Purpose: High pressure peaks might be a risk factor for the development of abdominal hernia. The course of abdominal pressure during extubation remains unclear. This preliminary study assessed the impact of two established extubation techniques., Methods: Twenty-four consecutive patients suffering from abdominal wall hernia with the indication for surgical treatment were included. Twelve patients were extubated directly after the intravenous anaesthesia was stopped, before they had spontaneous breathing (deep extubation). The other 12 were extubated after they had spontaneous breathing (awake extubation). Intra-abdominal pressure (IAP) was measured via bladder catheter continuously., Results: The highest value during extubation as well as the main increase in IAP was significantly lower in patients who underwent deep extubation (p < 0.001)., Conclusions: Therefore, this extubation technique might improve the outcome of hernia repair.

An incisional hernia is a common complication after abdominal surgery. Complaints of dyspnea in this population may be attributed to cardiopulmonary dysfunction or deconditioning. Large abdominal incisional hernias, however, may cause diaphragm dysfunction and result in dyspnea, which is more pronounced when standing (platypnea). The use of an abdominal binder may alleviate platypnea in this population. We discuss the link between diaphragm dysfunction and the lack of abdominal wall integrity and how abdominal wall support partially restores diaphragm function., (Copyright © 2015 the American Physiological Society.)

Background: Most surgical innovations require extensive preclinical testing before employment in the operative environment. There is currently no way to develop and test innovations for abdominal wall surgery that is cheap, repeatable and easy to use. In hernia repair, the required mesh overlap relative to defect size is not established. The aims of this study were to develop a biomechanical model of the abdominal wall based on in vivo pressure measurements, and to apply this to study mesh overlap in hernia repair., Methods: An observational study of intra-abdominal pressure (IAP) levels throughout abdominal surgery was conducted to identify the peak perioperative IAP in vivo. This was then applied in the development of a surrogate abdominal wall model. An in vitro study of mesh overlap for various defect sizes was then conducted using this clinically relevant surrogate abdomen model., Results: The mean peak perioperative IAP recorded in the clinical study was 1740 Pa, and occurred during awakening from anaesthesia. This was reproduced in the surrogate abdomen model, which was also able to replicate incisional hernia formation. Using this model, the mesh overlap necessary to prevent hernia formation up to 20 kPa was found, independent of anatomical variations, to be 2 × (defect diameter) + 25 mm., Conclusion: This study demonstrated that a surgically relevant surrogate abdominal wall model is a useful translational tool in the study of hernia repair. Surgical relevance This study examined the mesh overlap requirements for hernia repair, evaluated in a biomechanical model of the abdomen. Currently, mesh size is selected based on empirical evidence and may underpredict the requirement for large meshes. The study proposes a relationship between the defect size and mesh size to select the appropriate mesh size. Following further trials and investigations, this could be used in clinical practice to reduce the incidence of hernia recurrence., (© 2015 BJS Society Ltd. Published by John Wiley & Sons Ltd.)

The results of laparoscopic cholecystectomy, conducted in 71 patients, suffering cholelithiasis, were analyzed. In early postoperative period an acute cholangitis have occurred in 2 (2.8%) patients, an acute pancreatitis--in 1 (1.4%), postoperative infiltrate--in 14(19.7%), suppuration of postoperative cicatrix--in 6 (8.4%); late compli- cations as a kind of postcholecystectomy syndrome was observed in 29 (40.8%) patients, and abdominal hernia--in 3 (4.2%).

Parastomal hernia continues to be a common and distressing problem for stoma patients. But are they preventable? In 2005 and again in 2007, Thompson and Trainor reported that by introducing a simple prevention programme that advised the wearing of support garments for heavy lifting for 1 year after stoma surgery, they significantly reduced the incidence of parastomal hernias. They also found that most of the hernias occurred in the early months after stoma surgery (their intervention programme started 3 months after surgery). The current study builds on Thompson and Trainor's work by introducing an intervention programme at a much earlier stage, with specific advice to wear a lightweight support garment on discharge from hospital in place of normal underwear. Advice was also given about lifting and participants were started on an abdominal exercise programme. Quality of life was monitored at discharge, 3 months, 6 months and 1 year. The results show reduced hernia rates and an increased quality of life for these patients. The aim was to improve on the results of Thompson and Trainor in reducing parastomal hernias, improving quality of life and reducing costs to the NHS through fewer complications associated with hernias, and wasted prescriptions for unused, inappropriate or ill-fitting support wear.

A postoperative complication after Altemeier operation, so far never reported, is described in a 42 years old mentally disabled patient with external full thickness rectal prolapse who usually had prolonged straining at defecation. After 6 d from perineal rectosigmoidectomy, the patient, was discharged free of complications. Four days later he was readmitted in emergency for strangulated perineal trans-anastomotic ileal hernia that occurred at home during efforts to defecate. The clinical feature required an emergency operation for repositioning the ileal loops into the abdomen, resection of the necrotic ileum, and end colostomy. The outcome of the second operation was free of complication and the patient was discharged on the 6(th) postoperative day. In conclusion, after Altemeier operation prolonged straining at defecation should be carefully avoided.

Better mechanical knowledge of the abdominal wall is requested to further develop and validate numerical models. The aim of this study was to characterize the passive behaviour of the abdominal wall under three configurations: intact, after creating a defect simulating an incisional hernia, and after a repair with a mesh implanted intraperitonally. For each configuration, controlled boundary conditions were applied (air pressure and then contact loading) to the abdominal wall. 3D local strain fields were determined by digital image correlation. Local strains measured on the internal and external surfaces of the intact abdominal wall showed different patterns. The air pressure and the force applied to the abdominal wall during contact loading were measured and used to determine stiffness. The presence of a defect resulted in a significant decrease of the global stiffness compared to the intact abdominal wall (about 25%). In addition, the presence of the mesh enabled to restore the stiffness to values that were not significantly different from those of the intact wall. These results suggest that intraperitoneal mesh seems to restore the global biomechanics of the abdomen., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Problems of the groin and genitalia are a common presenting complaint in both pediatrician's offices and emergency departments. The authors endeavor to provide a comprehensive review of the most common inguinal and genital anomalies encountered by the pediatrician, with a special focus on examination and management., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Routine hernia repair surgery involves the implant of synthetic mesh. However, this type of procedure may give rise to pain and bowel incarceration and strangulation, causing considerable patient disability. The purpose of this study was to compare the long-term behaviour of three commercial meshes used to repair the partially herniated abdomen in New Zealand White rabbits: the heavyweight (HW) mesh, Surgipro(®) and lightweight (LW) mesh, Optilene(®), both made of polypropylene (PP), and a mediumweight (MW) mesh, Infinit(®), made of polytetrafluoroethylene (PTFE). The implanted meshes were mechanical and histological assessed at 14, 90 and 180 days post-implant. This behaviour was compared to the anisotropic mechanical behaviour of the unrepaired abdominal wall in control non-operated rabbits. Both uniaxial mechanical tests conducted in craneo-caudal and perpendicular directions and histological findings revealed substantial collagen growth over the repaired hernial defects causing stiffness in the repair zone, and thus a change in the original properties of the meshes. The mechanical behaviour of the healthy tissue in the craneo-caudal direction was not reproduced by any of the implanted meshes after 14 days or 90 days of implant, whereas in the perpendicular direction, SUR and OPT achieved similar behaviour. From a mechanical standpoint, the anisotropic PP-lightweight meshes may be considered a good choice in the long run, which correlates with the structure of the regenerated tissue., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: The atraumatic fixation of meshes by fibrin sealant (FS) has been established for both open and laparoscopic techniques of hernia repair. This study was performed to evaluate the use of FS in hernia mesh fixation with different polymerization speed (thrombin concentrations), using commercial hernia meshes, and in two techniques, transabdominal preperitoneal mesh placement (TAPP) and intraperitoneal mesh placement (IPOM)., Materials and Methods: A median laparotomy was performed in a pig model and hernia meshes were placed in IPOM and TAPP techniques. After mesh fixation with FS using thrombin concentrations of 4 and 500 IU/mL, maximum shear force before failure was measured at 5, 60, and 120 min., Results: At both thrombin concentrations and in all meshes in which the technique was used, the TAPP method tended to show higher maximum force levels at failure than did the IPOM method. In both TAPP and IPOM techniques and in all meshes, the 4 IU/mL thrombin concentration FS was superior to the 500 IU/mL thrombin concentration sealant., Conclusions: Although both thrombin concentrations are suitable for mesh fixation, lower concentrations allow slower polymerization and better sealant diffusion leading to higher maximum force levels at failure. The TAPP method was biomechanically superior to the IPOM method. There were no major differences between mesh products., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Lysostaphin (LS), a naturally occurring Staphylococcal endopeptidase, has the ability to penetrate biofilm, and has been identified as a potential antimicrobial to prevent mesh infection. The goals of this study were to determine if LS adhered to porcine mesh (PM) can impact host survival, reduce the risk of long-term PM infection, and to analyze lysostaphin bound PM (LS-PM) mesh-fascial interface in an infected field., Methods: Abdominal onlay PMs measuring 3×3 cm were implanted in select groups of rats (n=75). Group assignments were based on bacterial inoculum and presence of LS on mesh. Explantation occurred at 60 d. Bacterial growth and mesh-fascial interface tensile strength were analyzed. Standard statistical analysis was performed., Results: Only one out of 30 rats with bacterial inoculum not treated with LS survived. All 30 LS treated rats survived and had normal appearing mesh, including 20 rats with a bacterial inoculum (10(6) and 10(8) CFU). Mean tensile strength for controls and LS and no inoculum samples was 3.47±0.86 N versus 5.0±1.0 N (P=0.008). LS groups inoculated with 10(6) and 10(8) CFU exhibited mean tensile strengths of 4.9±1.5 N and 6.7±1.6 N, respectively (P=0.019 and P<0.001 compared with controls)., Conclusion: Rats inoculated with S. aureus and not treated with LS had a mortality of 97%. By comparison, LS treated animals completely cleared S. aureus when challenged with bacterial concentrations of 1×10(6) and 1×10(8) with maintenance of mesh integrity at 60 d. These findings strongly suggest the clinical use of LS-treated porcine mesh in contaminated fields may translate into more durable hernia repair., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The management of complex abdominal wall defects is challenging and often requires an individualized strategy with additional measures to minimize morbidity and recurrence. We retrospectively reviewed all patients who underwent reconstruction of complex abdominal wall defects at Emory Hospital by the senior author over a 7-year period. Abdominal hernia defects were categorized into primary, secondary, and tertiary hernias; infection; composite tumor defects; and dehiscence. Charts were queried for comorbidities, surgical technique, and outcome measures such as complications and recurrence. A total of 165 patients included in the series, with an average age of 52 years, and an average body mass index of 38 kg/m. Mesh was used in 81.8% of cases, 77% of those (mesh) being acellular dermal matrices (ADM). Component separation was performed in 75 patients (45.4%). The overall complication rate was 23.6% (39/165) including infection, delayed healing, skin necrosis, and fistulae, and was higher in patients with 2 or more comorbidities and those who required synthetic mesh reconstruction. The hernia recurrence or bulge was observed in 20.6% (34/165), and 29.4% of these patients required an additional, equally complex procedure. Hernia recurrence was significantly associated with a history of previous recurrent hernia, and hypertension (P < 0.04 and P = 0.001, respectively). Recurrence was higher in patients with 2 or more comorbidities (26% vs. 14%, P = 0.022). The recurrence rate was similar for synthetic and ADM reconstructions; however, the complication rates were higher when synthetic mesh was used. Attention to surgical technique, optimization of comorbidities, and the increased use of biologic meshes will minimize the need for operative intervention of complications following reconstruction of complex abdominal wall defects. Components separation and ADM have been very useful additions to the surgical management in these high-risk patients.

Background: Mammary reconstruction by using the transverse myocutaneous flap of the abdominal straight muscle (TRAM) is still an option well accepted in many parts of the world. However, bipedicled TRAM flaps are associated with greater morbidity of the abdominal donor area. The aim of this study was to describe an efficient technique for correcting the delayed defects of the abdominal wall following mammary reconstruction carried out with bipedicled TRAM flaps by using two polypropylene prostheses overlapped in different anatomical planes., Methods: At Hospital Estadual Sumaré at Universidade Estadual de Campinas, 18 women who underwent unilateral mammary reconstruction with bipedicled TRAM flaps and immediate fixation of two rectangular flaps of polypropylene mesh on the donor area were assessed. Later on, three patients (16.7%) presented with deformity of the anterolateral abdominal wall in the donor area. Each of these herniations was corrected by fixing two polypropylene meshes in different anatomical planes: the first mesh, which was bigger and preperitoneal, was fixed from the costal borders until the pubis; the second mesh was fixed from the external oblique muscle to the contralateral external oblique muscle, remaking the median line., Results: All patients were followed up for at least 18 months, without any signs of relapse, abdominal asymmetry, or chronic pain and with satisfactory functional results., Conclusion: The correction of delayed deformities of the abdominal wall after mammary reconstruction with bipedicled TRAM flaps using double mesh was carried out in an effective and secure way, providing an interesting surgical option for mastologists and plastic and general surgeons.

The treatment results of 1540 patients with the incarcerated hernias of various localization were analyzed. It was revealed, that treatment results depend not only of the patient's age and concomitant diseases and operating time but the choice of surgical access and the type of intestinal anastomosis. The main postoperative negative factor proved to be the increase of the intraabdominal pressure, which severely impairs the lung ventilation. The factor can be excluded by using the prosthetic methods of hernioplasty, though.

The used foreign endoprostheses have redundant strength, and great number and stiffness of implanted material might be a cause of complications and result in patients' discomfort associated with decreased mobility of the anterior abdominal wall. Less material consumption of endoprostheses results in increased porosity and less thickness facilitating rapid integration of the grid into the elastic and strong connective tissue scar. Company "Lintex" has developed and produced endoprostheses from polypropylene and polyvinylenfluoride monothreads in heavy, standard and light version, which allows their choice with a glance to the particular surgical situation.

Abdominal and groin injuries are common problems encountered by athletes across a wide variety of sports. They range from benign but annoying, such as exercise-related transient abdominal pain (ETAP), to the activity-limiting and possibly career-ending condition of athletic hernia. This article covers ETAP, rectus abdominus injuries, osteitis pubis, athletic hernia, and abdominal/groin hernias to provide an update on the current pathophysiology and treatment of common abdominal and pelvic conditions in the athlete.

Background: Over the years, reticular prostheses have undergone changes in their structure and composition to give rise to today's partially absorbable lightweight meshes. This study was designed to assess the biological and biomechanical behavior of these prostheses to establish whether they offer any advantages over nonabsorbable lightweight polypropylene prostheses., Materials and Methods: 7 x 5 cm defects were created in the anterior abdominal wall of New Zealand White rabbits and repaired by securing different prostheses to the edges of the defect with a running 4/0 polypropylene suture. The lightweight biomaterials compared were two nonabsorbable meshes: Parietene and Optilene elastic, and two partially absorbable prostheses: Vypro II and Ultrapro. At 14 and 90 days postimplant, tissue/prosthesis specimens were subjected to histological, immunohistochemical, shrinkage, and biomechanical analyses., Results: Adhesion formation on the peritoneum-facing surface of the meshes was significantly less extensive in the meshes with absorbable components at 90 days postimplant. The newly formed tissue around the prosthetic filaments was comprised of collagen fibers, fibroblasts, blood vessels, and macrophages. The partially absorbable meshes showed higher macrophage proportions (due to remnants of absorbable material and their structure) than the nonabsorbable meshes at 90 days, although differences were not significant. At 90 days postimplant, similar tensile strengths were recorded for all the implants., Conclusions: All the prosthetic materials induced good host tissue ingrowth, with no significant differences in tensile strength observed. Our findings suggest that partially absorbable lightweight prostheses could offer advantages over nonabsorbable lightweight meshes since less foreign material persists in the recipient, improving abdominal wall compliance.

Background: Attempts to limit the impact of autogenous breast reconstruction on the abdominal wall have led to the use of the muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM), the deep inferior epigastric artery perforator (DIEP), and the superficial inferior epigastric artery (SIEA) flaps. The purpose of this study was to compare the SIEA flap with the muscle-sparing free TRAM flap to determine whether gains in abdominal wall function are offset by flap-related complications., Methods: Seventy-two consecutive SIEA flaps were compared with 569 consecutive muscle-sparing free TRAM flaps. Outcomes included arterial and venous thrombosis, reoperation, abdominal hernia/bulge, seroma, hematoma, fat necrosis, delayed wound healing, infection, partial flap loss, and total flap loss. Chi-square and Fisher's exact tests were used to determine significant differences., Results: In the SIEA group, there was a higher percentage of overweight patients (p = 0.0001), bilateral cases (p = 0.0001), and smokers (p = 0.0003). Among SIEA flaps, there were two total flap losses (2.9 percent) and no abdominal morbidity. In the muscle-sparing free TRAM flap group, there was one total flap loss (0.18 percent), and a hernia/bulge rate of 1.9 percent (n = 11). The difference in flap loss rate was significant (p = 0.03). There was a higher incidence of vessel thrombosis requiring anastomotic revision in the SIEA group, 17.4 percent (n = 12), compared with the free TRAM group, 6.0 percent (n = 34) (p = 0.0005)., Conclusions: The SIEA flap has a lower rate of hernia/bulge and a higher rate of thrombotic complications. Because of the emotional and financial cost of these complications, the SIEA flap should be undertaken only if strict criteria are met.

A transmesocolic hernia is an uncommon type of internal hernia. We present a case of an internal hernia, through a congenital defect of the sigmoid mesocolon in a 3-year-old girl referred to our hospital with acute pain in the left abdominal region and vomiting. Because of the progressive worsening of her clinical status, an early laparotomy was performed and the intraoperative findings were consistent with a transmesosigmoid hernia. The hernia's sac contained gangrenous ileum loops, which were resected, and the defect was closed. Postoperative outcome was uneventful and the patient was discharged on the 10th postoperative day.

Based on anatomical background authors review the current knowledge on mechanisms and anatomical predisposes causing abdominal herniations. They are giving a brief summary of limitations of potential spaces involved into dislocation of abdominal visceral through natural spaces. Authors try to join anatomical knowledge with clinical information what might be useful in understanding of the patomechanism of these surgical disorders.

Objectives: To evaluate internal herniation as a rare cause of intestinal obstruction., Materials and Methods: Files of 18 cases, operated due to internal herniation between 2000 and 2006 at Selcuk University, Meram School of Medicine, General Surgery Department, were reviewed retrospectively. Sixteen patients (88.8%) were male (mean age: 58.2 years; range: 42-67) and 2 were female (mean age: 56.5 years; range: 52-61).Cases were grouped according to the location of internal herniation, and the clinical findings and applied treatment strategies were evaluated., Results: All patients were taken into surgical operation after preoperative preparations were completed. Findings were as follows: 6 cases of paraduodenal internal herniation, 4 of internal herniation through a defect in the terminal mesoileum, 2 of herniation through a defect in the falciform ligament, 2 of herniation through a defect in the omentum majus, 1 of herniation to the recessus over the bladder, 2 of herniation through a defect in the transverse mesocolon and 1 iatrogenically caused internal herniation through a defect in the mesojejunum., Conclusion: In an adult patient with findings of intestinal obstruction, diagnosis is difficult. Most cases presented to date are incidental findings during laparotomy, and surgical treatment is necessary., ((c) 2008 S. Karger AG, Basel.)

Incisional hernias occur in up to 11 per cent of patients undergoing abdominal surgery. Up to 50 per cent of these patients with hernias will require repeat operative procedures. Management of these hernias have focused primarily on tensile strength of the mesh material, have not addressed currently used materials, and have not compared the strength of these repairs with each other. Forty-nine adult Sprague-Dawley rats had an incisional hernia created by removing a portion of their abdominal wall that was then repaired primarily, using either a composite mesh, Dual mesh (Gore-Tex), or polypropylene mesh. Six weeks after the repair, the rats were euthanized. Hydrostatic distension of the abdominal cavity was performed to compare bursting strength of each repair. Wound tensile strength was assessed and compared. Tissue samples were also taken to compare repair types for incorporation of prosthetic materials. The gross weight of the animals subjected to hydrostatic distention was equivalent between groups, as was the volume required prior to failure of the repair. There was a trend toward improved tensile strength of the Prolene mesh repair, which had a lower average inflammatory and fibrosis score on histology. Overall, the type of mesh used for repair does not seem to impact significantly the strength of the repair when assessed 6 weeks postoperatively. Choice of prosthetic material to repair the hernia should be made based on economics and handling characteristics alone. Prolene mesh has satisfactory strength with the least amount of inflammation and fibrosis.

Background: Internal hernias are rare. Their occurrence through the broad ligament is one of the rarest forms. We present a report of a 45 year Nigerian female with acute on chronic intestinal obstruction due to an internal hernia of the broad ligament., Methods: Patients case notes and a review of relevant literature using manual library and Medline search was used., Results: A 45-year-old multiparous woman presented with a ten-year history of features of partial intestinal obstruction, and no previous abdominal surgery. Examination revealed right iliac fossa tenderness and a plain abdominal radiograph showed air fluid levels. Conservative management was not successful and laparatomy confirmed an internal hernia of the right broad ligament which was repaired with satisfactory outcome., Conclusion: This report is to highlight the fact that though rare, internal hernia should be considered in the differential diagnosis of intestinal obstruction.

Background: Spigelian hernia is a rare partial abdominal wall defect in the transversus abdominus aponeurosis or Spigelian fascia. We here report the case of a patient with incarcerated greater omentum in a Spigelian hernia., Case Report: The patient presented with a six-hour history of nausea, constant abdominal pain, and a palpable mass in the left lower quadrant. Abdominal computed tomography revealed that omentum was strangulated in a Spigelian hernia that was successfully treated by plug and mesh repair. No recurrence has been observed during three-year follow-up., Conclusions: In our case, plug and mesh repair was a safe and effective method of repairing an incarcerated Spigelian hernia with durability through three years of follow-up.

A 49-year-old female with morbid obesity (BMI 42) underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP). 10 months after the operation, she presented to the hospital with intermittent mid-abdominal pain. An internal hernia of the sigmoid colon through a mesenteric defect of the jejuno-jejunostomy was found. Although small bowel internal herniation has been widely documented, the finding of large bowel internal herniation has not been previously reported. Maintaining a high index of suspicion and a low threshold for urgent intervention are required when evaluating patients with vague abdominal complaints after LRYGBP.

Hypothesis: A number of risk factors for incisional hernia have been identified, but the pathogenesis remains unclear. Based on previous findings of smoking as a risk factor for wound complications and recurrence of groin hernia, we studied whether smoking is associated with incisional hernia., Design: Cohort study. Clinical follow-up study for incisional hernia 33 to 57 months following laparotomy for gastrointestinal disease. Variables predictive for incisional hernia were assessed by multiple regression analysis., Setting: Department of Surgery, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark., Patients: All 916 patients undergoing laparotomy from 1997 through 1998. Surgeons performed clinical examination in 310 patients; patients who failed to meet for examination, died, or were lost to follow-up were excluded., Main Outcome Measures: Thirty-four variables related to patient history, preoperative clinical condition, operative severity and findings, and the surgeon's training., Results: The incidence of incisional hernia was 26% (81/310). Smokers had a 4-fold higher risk of incisional hernia (odds ratio [OR], 3.93 [95% confidence interval (CI), 1.82-8.49]) independent of other risk factors and confounders. Relaparotomy was the strongest factor associated with hernia (OR, 5.89 [95% CI, 1.78-19.48]). Other risk factors were postoperative wound complications (OR, 3.91 [95% CI, 1.99-7.66]), age (OR, 1.04 [95% CI, 1.02-1.06]), and male sex (OR, 2.17 [95% CI, 1.21-3.91])., Conclusion: Smoking is a significant risk factor for incisional hernia in line with relaparotomy, postoperative wound complications, older age, and male sex.

Background: Because of the socioeconomic conditions existing today in Argentina, I decided to operate on hernias and incisional hernias among the poorest population in their living environment., Methods: To achieve this, I organized a group of 19 people, including resident surgeons and technicians, transferring everything in order to set up three surgical rooms in an old house, in the worst surgical environment, in the middle of the woodlands in the northeast tropical part of our country. It was like war-trench surgery but in peacetime. We successfully operated on 83 cases with different techniques in 4 days, in a trip that lasted a week., Results: After 18 months, there is not even one complication or recurrence., Conclusions: Because of this experience, I must remark that the patients' immunity-cicatricial condition is essential to success.

The lower esophagus is intra-abdominal and exposed to intra-abdominal pressure (IAP) variations that may lead to gastroesophageal reflux (GER). We investigated the hypothesis that the lower esophageal sphincter (LES) undergoes phasic contraction on IAP increase, with a resulting inhibition of the stress GER. The study comprised 17 subjects (age 42.3 +/- 8.7 SD yr, 10 men, 7 women) who were scheduled for surgical repair of abdominal hernia. The patients had no swallowing problems. The electromyographic (EMG) activity of the LES and pressure within the LES were recorded at rest and during increased IAP (coughing, straining). The recording was repeated after LES anesthetization or saline infiltration. The LES EMG at rest showed regular slow waves (SWs), superimposed on or followed by random action potentials (APs). Coughing or straining induced increase of the SWs parameters and also of the APs; although the increase with straining was less than with coughing, the difference was insignificant. Coughing or straining increased the LES pressure significantly (p < .05, p < .05, respectively). Ten minutes after LES anesthetization, coughing or straining did not produce significant LES EMG or pressure changes, while saline infiltration of LES caused LES response similar to preinjection. Thus, coughing and straining effected an increase of the LES EMG activity and pressure, an action presumably mediated through a reflex that we call the "straining-esophageal reflex." This reflex seems to be evoked during increased intra-abdominal pressure and to effect LES contraction, thus, sharing with other factors in prevention of gastroesophageal reflux.