Reparação da parede abdominal com membranas acelulares de pericárdio bovino - Parte II - Análises histológicas e morfométricas / Repair of the abdominal wall with acellular bovine pericardial membranes - Part II - Histological and morphometric analyses

Introdução: Análise histológica é a principal ferramenta de avaliação de biopróteses acelulares, em sua maioria em caráter experimental. O objetivo é analisar histologicamente a matriz acelular de pericárdio bovino em reparações de parede abdominal implantada em humanos. Método: De uma série de 30 reparações com a membrana, 3 pacientes foram submetidas a revisão cirúrgica não relacionada aos implantes, aos 13, 22 e 23 meses de pós-operatório, obtendo-se biópsias das áreas previamente implantadas. Além da avaliação dos aspectos básicos de biocompatibilidade e neoformação tecidual, as lâminas foram digitalizadas e submetidas a análise computadorizada com o software ImageJ para quantificação da cinética de degradação das membranas, associada à análise da dimensão fractal das amostras. Os valores obtidos para porcentagens de membrana residual tiveram suas médias comparadas por análise de variância (ANOVA) e pelo teste T de Student não pareado, também utilizado para os valores da quantificação da dimensão fractal. Resultados: Foi demonstrada a biocompatibilidade do material, com neoformação tecidual, deposição de colágeno e tecido celularizado de aspecto normal, sem reações locais importantes. Fragmentos residuais da membrana foram quantificados em 40%±7% aos 13 meses, em 20%±6% aos 22 meses e em 17%±6% aos 23 meses de pós-operatório, com a análise da dimensão fractal indicando uma progressiva degradação dos implantes, com significância estatística entre 13 meses e as amostras tardias. Conclusão: Os resultados atestaram a funcionalidade do pericárdio bovino acelular sob diferentes níveis de estresse mecânico nas reparações da parede abdominal em humanos.

Introduction: Histological analysis is the main tool for evaluating acellular bioprostheses, mostly on an experimental basis. The objective is to histologically analyze the acellular matrix of bovine pericardium in abdominal wall repairs implanted in humans. Method: From a series of 30 repairs with the membrane, 3 patients underwent surgical revision unrelated to the implants at 13, 22, and 23 months postoperatively, obtaining biopsies of the previously implanted areas. In addition to evaluating the basic aspects of biocompatibility and tissue neoformation, the slides were digitalized and subjected to computerized analysis with the ImageJ software to quantify the kinetics of membrane degradation associated with the analysis of the fractal dimension of the samples. The values obtained for percentages of residual membrane had their means compared by analysis of variance (ANOVA) and the unpaired Student's T test, also used for the fractal dimension quantification values. Results: The biocompatibility of the material was demonstrated, with tissue neoformation, collagen deposition, and cellularized tissue with a normal appearance without important local reactions. Residual fragments of the membrane were quantified at 40%±7% at 13 months, at 20%±6% at 22 months, and at 17%±6% at 23 months postoperatively, with the analysis of the fractal dimension indicating a progressive degradation of implants, with statistical significance between 13 months and late samples. Conclusion: The results confirmed the functionality of the acellular bovine pericardium under different levels of mechanical stress in abdominal wall repairs in humans.

Divertículo de Meckel en el hiato de Winslow como causa extraordinaria de oclusión intestinal / Meckel's diverticulum in the foramen of Winslow as a rare cause of small bowel obstruction

RESUMEN El divertículo de Meckel es la malformación congénita más frecuente del tracto gastrointestinal. Puede permanecer completamente oculto sin dar síntomas o puede ser causa de abdomen agudo quirúrgico en donde se debe descartar patología inflamatoria, infecciosa y/o mecánica. Se presenta un caso excepcional de una obstrucción intestinal producido por una hernia interna generada por un divertículo de Meckel en el hiato de Winslow.

ABSTRACT Meckel's diverticulum is the most common congenital defect of the gastrointestinal tract. It may remain asymptomatic or may cause acute abdomen requiring surgery due to inflammation, infection or mechanical obstruction. We report case of small bowel obstruction produced by an internal hernia generated by a Meckel's diverticulum in the foramen of Winslow.

Experiencia del tratamiento de la hernia incisional en un hospital de tercer nivel en Colombia / Experience of the treatment of incisional hernia in a third level hospital in Colombia

Introducción. El manejo de las hernias se ha instaurado como un problema quirúrgico común, estimándose su aumento en los próximos años. El objetivo del presente trabajo fue describir el curso clínico, los aspectos del tratamiento quirúrgico y factores asociados a la presencia de complicaciones en pacientes intervenidos por hernia incisional. Métodos. Estudio descriptivo en el que se analizaron las características de una cohorte de pacientes llevados a corrección quirúrgica de hernia incisional en el Hospital Universitario Hernando Moncaleano Perdomo, un centro de alta complejidad en Neiva, Colombia, entre 2012 y 2019. Los datos fueron recolectados en programa Microsoft Excel® y analizados en SPSSTM, versión 21. Resultados. Se realizaron 133 correcciones de hernias incisionales, 69,9 % en mujeres y la mayoría ubicadas en la línea media (84,2 %). La edad media de los pacientes al momento de la intervención fue de 52 años ±14,6. Las comorbilidades más frecuentes fueron obesidad, hipertensión y diabetes. La causa más frecuente de la hernia fue traumática (61,7 %). La frecuencia de complicaciones fue superior al 50 %, en su mayoría menores; se encontró asociación con obesidad para la presencia de seroma. La mortalidad fue del 2,3 %. Conclusión.La hernia incisional es un problema de salud pública. Consideramos que la obesidad y el uso de malla pueden ser factores de riesgo asociados con la presentación de complicaciones postoperatorias, así como el aumento de los gastos relacionados con días de hospitalización

Introduction. Hernias management has become a common surgical problem, with an estimated increase in the coming years. The objective of this study was to describe the clinical course, aspects of surgical treatment and factors associated with the presence of complications in patients operated on for incisional hernia. Methods. Descriptive study, in which the characteristics of a cohort of patients taken to surgical correction of incisional hernia at the Hospital Universitario Hernando Moncaleano Perdomo, a high complexity medical center located in Neiva, Colombia, between 2012 and 2019 were analyzed, whose data were collected in Microsoft Excel® software and analyzed in SPSSTM, version 21. Results. One-hundred-thirty-three incisional hernia corrections were performed. The mean age at the intervention was 52 years ±14.6. The most frequent comorbidities were weight disorders, hypertension and diabetes. Only one laparoscopy was performed, the first etiology of the hernia was traumatic (61.7%) and midline (84.2%). The frequency of complications was greater than 50%, mostly minors. An association with obesity was found for the presence of seroma. Mortality was 2.3%. Conclusion. Incisional hernia is a public health problem. We consider that obesity and the use of mesh are a risk factor associated with the presentation of postoperative complications as well as the increase in costs related to days of hospitalization

Caracterización de un grupo de pacientes sometidos a herniorrafia lateral con malla retromuscular en un centro de tercer nivel de 2015 a 2019 / Characterization of a group of patients who underwent lateral herniorrhaphy with retromuscular mesh in a third level center from 2015 to 2019

Introducción. El objetivo de este estudio fue describir las características de la población y determinar las principales complicaciones de los pacientes que son llevados a cirugía por hernia lateral en el abdomen. Métodos. Estudio observacional retrospectivo, que incluyó a los pacientes sometidos a herniorrafia lateral, entre 2015 y 2019 en un centro de tercer nivel. La información se obtuvo del registro de historias clínicas. Las variables analizadas se clasificaron según las características sociodemográficas de los pacientes, clínicas y quirúrgicas. Se hizo una caracterización de acuerdo con los resultados encontrados. Resultados. Se incluyeron 51 pacientes con hernia lateral, 29 de ellos mujeres, con un promedio de edad de 59 años y de índice de masa corporal de 28 kg/m2. El 60 % tenía comorbilidades de base, siendo la hipertensión arterial la más frecuente. La mayoría se clasificaron como ASA II. En cuanto a la localización, la L3 fue la más común (37,2 %). Se presentaron complicaciones postquirúrgicas en el 27,4 % de los pacientes, siendo las más frecuentes seromas, hematomas e infecciones de sitio operatorio. Ningún paciente requirió reintervención para el manejo de las complicaciones. Conclusión. Conocer la población y determinar cuáles son las principales complicaciones postquirúrgicas de un procedimiento permite tomar medidas para disminuir su frecuencia, pero en este caso, se necesitan estudios adicionales para determinar cuáles son los mayores factores asociados a las complicaciones

Introduction. To describe the characteristics of the population and to determine the main complications of patients who undergo surgery for lateral hernia. Methods. We performed a retrospective observational study, including patients who underwent lateral herniorrhaphy between 2015 and 2019 in a third-level medical center, obtaining information through the registration of medical records. The analyzed variables were classified according to the patients' clinical, surgical and sociodemographic characteristics, performing a characterization according to the results found. Results. Fifty-one patients due to lateral hernia were included, 29 of them were women, with a mean age of 59 years and a body mass index of 28 Kg/m2. Of those, 60% presented basic comorbidities, being arterial hypertension the most frequent. Most were classified as ASA II. Regarding the location, the L3 was the most commonly presented hernia, referring to 37.2%. Postoperative complications occurred in 27.4% of the patients, with seromas being the most frequent, followed by hematomas and surgical site infections. No patient required reintervention for the management of complications. Conclusion. By knowing the population and determining which are the main complications, measures can be taken to reduce their incidence. Additional studies are needed to determine which are the main factors associated with complications

Congenital Paraduodenal Hernia: A Case Report

Paraduodenal hernia is a rare congenital anomaly that arises from an alteration in the midgut rotation during embryogenesis. Consequently, the small intestine becomes trapped in a sac of the posterior mesentery of the colon. This entity can compromise the intestinal segment's viability and the patient's life. Its diagnosis is difficult, rarely suspected, and often confused with other causes of abdominal pain. We present the case of a 29-year-old male patient with a documented paraduodenal hernia during surgery, its correction, and follow-up, in which no complications were reported.

La hernia paraduodenal es una anomalía congénita poco frecuente que surge de una alteración en la rotación del intestino medio durante la embriogénesis. En consecuencia, el intestino delgado queda atrapado en un saco del mesenterio colónico posterior. Dicha entidad puede comprometer la viabilidad del segmento intestinal y la vida del paciente. Su diagnóstico es difícil, pocas veces sospechado y muchas veces confundido con otras causas de dolor abdominal. Presentamos el caso de un paciente de 29 años con una hernia paraduodenal documentada durante la cirugía, su corrección y seguimiento, en el cual no se documentaron complicaciones.

Hernies pariétales au CHU Souro Sanou de Bobo Dioulasso: profil sociodémographique, diagnostique et thérapeutique / Parietal hernias at the CHU Souro Sanou in Bobo Dioulasso: sociodemographic, diagnostic and therapeutic profile

But : étudier le profil sociodémographique, diagnostique et thérapeutique des hernies pariétales au Centre Hospitalier Universitaire Sourô Sanou. Patients et méthodes Il s'est agi d'une étude transversale descriptive allant du 1ier janvier au 31 décembre 2022. Les patients opérés pour une hernie pariétale ont été inclus. Résultats Il s'agissait de 101 patients d'un âge moyen de 45,6 ans avec un sex-ratio de 2,1. Parmi les patients avec une activité physique intense, les cultivateurs étaient au nombre de 34 (32,7%), les ouvriers au nombre de 10 (9,9%) et les militaires au nombre de 10 (9,9%). Il y'avait 104 cas de hernie selon le siège. Trois patients étaient porteurs d'une hernie inguinale bilatérale. La hernie était congénitale dans 23 (22%) cas. Il s'agissait d'une récidive après cure chirurgicale sans prothèse dans 16 (15,4%) cas. Le siège de la hernie était inguinal dans 65 (62,5%) cas, la ligne blanche 24 (23,1%) cas, ombilical dans 12 (11,5%) cas, crural dans 3 (2,9%) cas. La hernie était étranglée dans 39 (37,5%) cas. L'anesthésie était générale chez 73 (72,3%) patients et on avait une rachianesthésie chez 28 (27,7%) patients. Quatre résections intestinales ont été réalisées. La cure herniaire était une plastie prothétique dans 15 (14,4%) cas. Sept (6,9%) patients ont présenté une complication dont cinq (4,9%) infections du site opératoire et deux (2%) hématomes scrotaux. Aucun décès n'a été enregistré. Conclusion Les hernies pariétales étaient fréquentes et de siège inguinal, compliquées d'étranglement, avec la présence de cas de récidive. Les prothèses herniaires étaient peu utilisées.

Introduction Objective: to study the sociodemographic, diagnostic and therapeutic profile of parietal hernias at the Sourô Sanou University Teaching Hospital. Patients and methods This was a descriptive cross-sectional study lasting one year from January 1 to December 31, 2022. Patients operated on for a parietal hernia were included. Results There were 101 patients with an average age of 45.6 years and a sex-ratio of 2.1. Among the patients with intense physical activity, the farmers were 34 (32.7%), the workers 10 (9.9%) and the military 10 (9.9%). There were 104 cases of hernia depending on the site. Three patients had a bilateral inguinal hernia. The hernia was congenital in 23 (22%) cases. It was a recurrence after surgical treatment without prosthesis in 16 (15.4%) cases. The site of the hernia was inguinal in 65 (62.5%) cases, the linea alba in 24 (23.1%) cases, umbilical in 12 (11.5%) cases, crural in 3 (2.9%) . The hernia was strangulated in 39 (37.5%) cases. The anesthesia was general in 73 (72.3%) patients and there was spinal anesthesia in 28 (27.7%) patients. Four bowel resections were performed. The hernia cure was a prosthetic plasty in 15 (14.4%) cases. Seven (6.9%) patients presented a complication including five (4.9%) surgical site infection and two (2%) scrotal hematomas. No deaths have been recorded. Conclusion Parietal hernias were frequent and inguinal in location, complicated by strangulation, with the presence of cases of recurrence. Hernial prostheses were rarely used.

A preliminary study on reducing the formation of intra-abdominal hernia and postoperative intestinal obstruction in laparoscopic Bricker operation / 现代泌尿外科杂志

【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.

Hernias traumáticas de la pared abdominal en pediatría: serie de tres casos / Traumatic hernias of the abdominal wall in pediatrics: Series of three cases

Introducción. Las hernias traumáticas de la pared abdominal son una entidad de muy rara ocurrencia en niños, con pocos casos descritos. Son lesiones causadas por trauma cerrado cuando las fuerzas resultantes del trauma no tienen la suficiente energía para romper la piel, pero son suficientes para producir una disrupción de las fibras musculares y la fascia. Métodos. Se presentan tres casos clínicos de niños con hernias traumáticas, el primero tipo I y los otros dos, tipo II, cuyo diagnóstico y tratamiento quirúrgico se llevaron a cabo por el servicio de cirugía pediátrica en un hospital de alto nivel de atención en Colombia. Resultados. Los tres pacientes fueron llevados a manejo quirúrgico sin prótesis, el primero por abordaje abierto y los otros dos por cirugía videoasistida, con buena evolución y sin recidivas en el seguimiento. Discusión. Las hernias traumáticas de la pared abdominal son más frecuentes en varones, como en nuestros casos, y del lado derecho. El diagnóstico de este tipo de hernias es clínico y se apoya en imágenes, teniendo en cuenta que no hay antecedente de hernia en la región afectada. El tratamiento es quirúrgico, pero es controversial el momento del mismo y el uso de materiales protésicos, puesto que existe la posibilidad de recidiva en los primeros meses en los casos de reparo primario. Conclusión. A pesar de la rareza de esta entidad, presentamos tres pacientes pediátricos a quienes se les realizó diagnóstico y manejo quirúrgico tempranos, con buena evolución y seguimiento a más de tres años.

Introduction. Traumatic hernias of the abdominal wall in children are a very rare entity, with few cases described. They are injuries caused by blunt trauma when the forces resulting from low-energy trauma to break the skin, but enough to produce a disruption of the muscle fibers and fascia. Methods. Three clinical cases of traumatic hernias in children are presented, one type I and the other two type II, whose diagnosis and surgical treatment were carried out by the pediatric surgery service in a high-level hospital in Colombia. Results. The three patients underwent surgical management without prosthesis, one by open approach and the other two by video-assisted surgery, with good evolution and no recurrence during follow-up. Discussion. Traumatic hernias of the abdominal wall are more common in male patients as in our cases, and on the right side of the abdomen. The diagnosis of this type of hernia is clinical and based on images, taking into account that there is no history of hernia in the affected region. The treatment is surgical, but its timing and the use of prosthetic materials are controversial, since there is the possibility of recurrence in the first few months in cases of primary repair. Conclusion. Despite the rarity of this entity, we present three pediatric patients who underwent early diagnosis and surgical management, with good evolution and follow-up for more than three years.

Abdominal Wall Hernias: different types of classifications and complications / Hernias de la Pared abdominal: diferentes tipos de clasificaciones y complicaciones

Abdominal hernias are defects due to loss of continuity of the fasciae and/or muscles with the protrusion of abdominal structures. They are the third most prevalent and incident abdominal pathology worldwide and the second pathology of consultation in general surgery in patients of age limits. There are various factors that contribute to their formation, but within the scientific community there are various types of classifications, which differ according to the professional training school and their decision-making. This bibliographic review aims to expose the most used abdominal hernia classification systems such as the European one that has a morphological vision, the Ventral Hernia Working Group that proposes its aspect on recurrence together with the modified one that exposes comorbidity and the staging system of ventral hernia that provides a comprehensive approach to classification and management. In addition to the most common complications of the same.

Las hernias abdominales son defectos por pérdida de continuidad de las fascias y/o músculos con la protrusión de estructuras abdominales. Son la tercera patología abdominal más prevalente e incidente a nivel mundial y la segunda patología de consulta en cirugía general en pacientes en límites de edades. Existen diversos factores que contribuyen a su formación, pero dentro de la comunidad científica existe diversos tipos de clasificaciones, las cuales difieren de acuerdo a la escuela de formación de los profesionales y su toma de decisiones. La presente revisión bibliográfica pretende exponer los sistemas de clasificación de hernias abdominales más utilizados como la Europea que tiene una visión morfológica, el Grupo de Trabajo de Hernia Ventral que propone su aspecto sobre la recurrencia junto con el modificado que expone comorbilidad y el sistema de estadificación de hernia ventral que brinda un enfoque integral para clasificación y manejo. Además de las complicaciones más habituales de las mismas.

Incisional hernia repair in rats: description of the sublay technique under videomagnification system

Purpose: To describe the technique of sublay correction of incisional hernia in Wistar rats under videomagnification system. Methods: Five male rats of the species Rattus norvegicus, of the Wistar lineage, with body weight between 250­350 g and 60 days old were used. Incisional hernia was inducted in all animals. After that, the incisional hernia was immediately corrected by the sublay method. Results: There were no cases of recurrence of the incisional hernia after placement of the polypropylene mesh using the sublay technique. No postoperative complications were observed. Conclusions: The technique is suitable for execution in Wistar rats.

Manejo quirúrgico de la hernia perineal primaria / Surgical management of primary perineal hernia

Las hernias perineales presentan una incidencia variable entre el 0,3-6 %. El abordaje quirúrgico se puede realizar por vía perineal o por vía laparoscópica. Se presentan las imágenes de una paciente con una hernia perineal adquirida primaria, tratada exitosamente mediante un abordaje mixto.

Perineal hernias present a variable incidence between 0.3-6%. The surgical approach can be performed perineally or laparoscopically. Images of a patient with a primary acquired perineal hernia, successfully treated using a mixed approach, are presented.

Síndrome lumbocostovertebral. Reporte de un caso / Lumbocostovertebral syndrome. A case report

Introducción. El síndrome lumbocostovertebral es una anomalía poco frecuente, que afecta a los cuerpos vertebrales, las costillas y músculos de la pared abdominal, y puede estar asociada a múltiples anomalías congénitas. Requiere un manejo multidisciplinario y tratamiento quirúrgico temprano para evitar complicaciones. Caso clínico. Se reporta el caso de un neonato masculino de 10 días de edad, que presentó desde el nacimiento 2 tumoraciones lumbares derechas, una que aumentaba de tamaño con el llanto, correspondió a una hernia lumbar, y la otra, a mielomeningocele. En estudios complementarios se evidenció fusión de costillas, fusión de cuerpos vertebrales lumbares, sacros (hemivértebras) y defecto de pared abdominal con protrusión de contenido intestinal. Se realizó cierre de la hernia lumbar con refuerzo protésico de pericardio bovino, sin complicaciones. Conclusión. En defectos extensos, como el que se reporta en este paciente, puede ser recomendable emplear material protésico. El pericardio bovino aparece como una opción segura, bien tolerada y eficaz para estos pacientes en particular. Este síndrome es una entidad rara, que amerita un equipo multidisciplinario para la resolución quirúrgica temprana y con ello evitar complicaciones.

Introduction. Lumbocostovertebral syndrome is a rare anomaly that affects the vertebral bodies, ribs and muscles of the abdominal wall, and can be associated with multiple congenital abnormalities. It requires multidisciplinary management and early surgical treatment to avoid complications. Clinical case. The case of a 10-day-old male neonate is reported, who presented from birth 2 right lumbar tumors, one that increased in size with crying, corresponded to a lumbar hernia, and the other, to myelomeningocele. In complementary studies, rib fusion, fusion of lumbar and sacral vertebral bodies (hemivertebrae), and abdominal wall defect with protrusion of intestinal contents were evidenced. The lumbar hernia was closed with prosthetic reinforcement with a bovine pericardium, without complications. Conclusion. In extensive defects, such as the one reported in this patient, it may be advisable to use prosthetic material. The bovine pericardium appears as a safe, well tolerated and effective option for these patients in particular. This syndrome is a rare entity, which requires a multidisciplinary team for early surgical resolution and thus avoid complications.

Between prolene®, ultrapro® and bard soft® meshes which presents the best performance in the repair of the abdominal wall? / Dentre as telas prolene®, ultrapro® ebard soft® qual apresenta melhor desempenho no reparo da parede abdominal?

ABSTRACT Background: In the definition of the mesh to be used to correct hernias, porosity, amount of absorbable material and polypropylene should be considered in the different stages of healing process. Aim: To evaluate the inflammatory reaction in the use of macro and microporous meshes of high and low weight in the repair of defects in the abdominal wall of rats. Methods: Ninety Wistar rats (Rattus norvegicus albinus) were used. The animals were submitted to similar surgical procedures, with lesion of the ventral abdominal wall, maintaining the integrity of the parietal peritoneum and correction using the studied meshes (Prolene®, Ultrapro® and Bard Soft®). Euthanasia was performed at 30, 60 and 120 days after surgery. The abdominal wall segments were submitted to histological analysis using H&E, Masson's trichrome, immunohistochemistry, picrosirius red and tensiometric evaluation. Results: On the 120th day, the tensiometric analysis was superior with Ultrapro® macroporous mesh. The inflammatory process score showed a significant prevalence of subacute process at the beginning and at the end of the study. Microporous meshes showed block encapsulation and in macroporous predominance of filamentous encapsulation. Conclusion: The Ultrapro® mesh showed better performance than the others in healing process of the abdominal wall.

RESUMO Racional: Na definição da tela a ser utilizada na correção das hérnias deve-se considerar a porosidade, quantidade de material absorvível e polipropileno ou inabsorvível nas diversas fases da cicatrização. Objetivo: Avaliar a reação inflamatória das telas macro e microporosas de alta e baixa gramatura no reparo de defeito da parede abdominal de ratos. Método: Foram utilizados 90 ratos da raça Wistar (Rattus norvegicus albinus). Os animais foram submetidos a procedimentos cirúrgicos semelhantes, com lesão da parede abdominal ventral, mantendo a integridade do peritônio parietal e correção utilizando as telas Prolene®, Ultrapro® e Bard Soft®. Realizou-se a eutanásia aos 30, 60 e 120 dias de pós-operatório. Os segmentos da parede abdominal foram submetidos à análise histológica com H&E, tricômio de Masson, imunoistoquímica, picrosirius red e análise tensiométrica. Resultado: No 120º dia a análise tensiométrica mostrou superioridade da tela macroporosa Ultrapro®. O escore do processo inflamatório demonstrou prevalência significativa de processo subagudo no início e no final do estudo. As telas microporosas mostraram encapsulamento em bloco e as macroporosas encapsulamento predominantemente filamentar. Conclusão: A tela Ultrapro® mostrou melhor desempenho em relação às demais na cicatrização da parede abdominal.

Tratamiento de eventraciones gigantes con cirugía de separación de componentes más turn over flap aponeurótico / Giant ventral hernia treatment with components separation technique and aponeurotic turn over flap

Resumen Objetivo: Demostrar la anatomía y aplicación de la vaina anterior de los rectos para la reparación de defectos herniarios gigantes de la línea media abdominal mediante la cirugía de separación de componentes más la aplicación de un colgajo aponeurótico tipo turn over. Materiales y Método: Disección anatómica con descripción vascular y dinámica de la vaina anterior de los rectos. Posterior aplicación de la técnica en pacientes con hernias gigantes de la línea media. Seguimiento clínico de recidiva y complicaciones locales como sistémicas. Resultados: 8 pacientes fueron seleccionados. La edad promedio fue de 58,6 años y el tamaño del defecto hemiario 19,6 cm. En todos los pacientes se pudo aplicar la técnica sin inconvenientes. Sólo 1 paciente presentó una complicación local (dehiscencia y necrosis parcial del colgajo cutáneo) que se manejó con resección y reavance sin incidentes. No se describen complicaciones sistémicas ni mortalidad. Discusión: Las hernias abdominales gigantes y con pérdida a derecho de domicilio son un desafío quirúrgico. Se han desarrollado importantes avances con abordajes quirúrgicos innovadores. Nuevos materiales biológicos y sintéticos se han convertido en una parte integral del arsenal quirúrgico, sin embargo, involucran muchas veces asumir grandes costos y complicaciones propias a los materiales utilizados, además, de no cumplir con la adaptación dinámica adecuada de la pared requerida. Conclusión: Esta modificación técnica es segura, útil y accesible para los pacientes con eventraciones gigantes. La tasa de complicaciones es baja y está dada principalmente por problemas relacionados al sufrimiento de los colgajos cutáneos.

Aim: To demonstrate the anatomy and application of the anterior rectus sheet in the repair of giant abdominal wall hernias through a classic component surgery plus a turn over flap. Materials and Method: Anatomic dissection with vascular and dynamic description of the anterior rectus sheet. Posterior application of the technique in patients with giant abdominal wall hernias. Clinical follow up of recurrence, local and systemic complications. Results: 8 patients were selected. The average age was 58.6 years old and the abdominal wall defect 19.6 cm wide. The technique could be applied in every patient without inconveniences. Only 1 patient had a complication (dehiscence and partial skin flap necrosis) that was successfully treated with resection and readvancement. No systemic complications nor mortality was described. Discussion: Giant abdominal wall hernias are a surgical challenge. Great and innovative advances have been made. New biological and synthetic materials have been developed, nevertheless they frequently involve great costs and complications related to them. Also, they do not adapt adequately to the dynamic required for the abdominal wall. Conclusion: This technical modification is useful, safe and accessible for the patients who present giant wall hernias. The complication rate is low and it's principally given from problems related to skin flap blood flow.

A rare case of bilateral drain site abdominal hernia: a case report and review of literature

Use of abdominal drain is a tradition used since a long time. These is generally done to prevent or drain any post-operative intra-abdominal collection aiming to reduce morbidity and mortality and early recovery of patient. But drain has its own complication such as drain site infection, drain site hernia. We encountered a case of bilateral drain site hernia in a 55 year old female who was previously operated for perforation peritonitis. Both herniae were repaired successfully with onlay meshplasty. Drain placement has various complications like drain site infection, adhesion's, intestinal erosion, bleeding, anastamotic rupture and drain site hernia. There is greater risk of hernia in patient with poor nutritional status, obesity, ascitis, severe abdominal infection or with persistent cough. It is better to avoid unnecessary placement of drain. If a drain is placed, its removal should be done as early as possible. It is better to close the defect after removal of drain.

Hernia lumbar del espacio de Grynfelt. A propósito de un caso / Lumbar hernia of the Grynfelt space. Apropos of a case

RESUMEN La hernia lumbar del espacio de Grynfelt, pese a que es la más frecuente de los dos tipos de hernias lumbares, es un defecto raro de la pared abdominal posterior. Su diagnóstico se hace difícil por su relativa poca frecuencia. Los médicos no piensan seriamente en esta variedad de hernia, aunque constituye una patología en la que el diagnóstico, al igual que el resto de las hernias de la pared abdominal, es esencialmente clínico. Se presentó un caso tipo de hernia poco frecuente. Una paciente de 32 años con antecedentes de salud, que hacía 3 meses comenzó a quejarse de dolor en la región lumbar y notó la presencia de una masa pequeña en esa misma región. Acudió a la consulta de Cirugía por este motivo y posterior a los estudios correspondientes se le realizó hernioplastia lumbar (AU).

ABSTRACT Lumbar hernia of the Grynfelt space, although it is the most frequent of the two kinds of lumbar hernias, is a rare posterior abdominal wall defect. Its diagnosis is difficult because of its low frequency. Doctors do not think about this illness because it is very infrequent, though it is a disease that, like the rest of abdominal wall hernia, is mainly clinically diagnosed. The authors presented a typically infrequent case of hernia. A female patient, aged 32 years, with health antecedents, referred that three months ago she began to feel pain in the lumbar region and noticed the presence of a little mass in that region. For that reason she assisted the consultation of Surgery and, after being correspondently studied, she underwent a lumbar hernioplasty (AU).

Hernia paracecal, reto diagnóstico y quirúrgico: reporte de caso y revisión de la literatura / Paracecal hernia, diagnostic and surgical challenge: case report and literature review

Introducción. La hernia paracecal es una entidad rara que corresponde al 13 % de todas las hernias internas. Aunque algunas pueden ser adquiridas, pero la mayoría son congénitas y se originan en los recesos creados durante la adherencia y fusión de los repliegues peritoneales alrededor de la región ileocecal. Caso clínico. Se trata de un hombre de 42 años de edad a quien se le diagnosticó una apendicitis aguda. La in-tervención quirúrgica se inició con una incisión para apendicectomía localizada; no obstante, por los hallazgos intraoperatorios, se decidió la conversión a laparotomía y se produjo el hallazgo incidental de una hernia paracecal.Resultados. El paciente fue hospitalizado y, en el quinto día postoperatorio, presentó obstrucción intestinal por lo cual fue intervenido nuevamente; se encontró escaso líquido de reacción peritoneal y adherencias. Se le dio el egreso hospitalario cuatro días después de su segundo procedimiento quirúrgico y continuaba asintomático hasta su último control.Discusión. Las hernias paracecales son hernias internas que se describen como la protrusión de una víscera hueca por una apertura mesentérica o peritoneal. Sus manifestaciones clínicas son variadas y se puede presentar sin síntomas, con dolor abdominal localizado o hasta con obstrucción intestinal. El tratamiento quirúrgico se basa en liberar y examinar el segmento intestinal herniado y, de requerirse, proceder a la resección con anastomosis; se debe resecar el saco herniario cuando sea evidente, valorar los vasos mesentéricos y cerrar el defecto herniario. Se trata de una enfermedad poco común y es importante conocer su manejo con la finalidad de evitar complicaciones, ya que continúa siendo un reto diagnóstico para el cirujano.

Introduction: Paracecal hernia is a rare entity that represents 13% of all internal hernias. Although some may be acquired, most are congenital and originate in the recesses created during the adhesion and fusion of peritoneal folds around the ileocecal region.Clinical case: This is a 42-year-old man who was diagnosed with acute appendicitis. The surgical intervention began with an incision for localized appendectomy; however, due to intraoperative findings, conversion to laparotomy was decided and the incidental finding of a paracecal hernia occurred. The patient was hospitalized and, on fifth postoperative day presented intestinal obstruction, for which he was reoperated; little peritoneal reaction fluid and adhesions were found. He was discharged four days after his last surgical procedure and remained asymptomatic until his last control.Discussion: Paracecal hernias are internal hernias that are described as the protrusion of a hollow viscera throu-gh a mesenteric or peritoneal opening. Its clinical manifestation are varied and can present without symptoms, with localized abdominal pain or even intestinal obstruction. Surgical management is based on releasing and examining the herniated intestinal segment and, if required, proceed with resection with anastomosis. The hernia sac should be resected when evident, assess the mesenteric vessels and close the hernia defect. It is a rare pathology and it is important to know its management in order to avoid complications, as it continues to be a diagnostic challenge for the surgeon

Hernia de Littré estrangulada. Presentación de un caso / Hernia of Littré strangled. Presentation of a case / A hérnia de littréé estrangulada. Arquivando um caso

RESUMEN La hernia de Littré es la presencia de un divertículo de Meckel en cualquier hernia de la pared abdominal. Se encuentran pocos reportes en la literatura médica por su baja incidencia. Su sospecha clínica es infrecuente, por lo que su diagnóstico es intraoperatorio. Se presenta un caso de un paciente de 39 años de edad que acude al servicio de urgencias del Hospital Misionario de Vouga. Cunhinga, Bié. República de Angola, con dolor abdominal agudo, y no expulsión de gases. Al examen físico encontramos dolor abdominal, ligera defensa abdominal y tumor doloroso e irreductible en región inguinal derecha. Se ingresa con el diagnóstico de hernia inguinal derecha estrangulada. Es intervenido quirúrgicamente de urgencia con hallazgo transoperatorio de hernia de Littré estrangulada. Se realiza quelotomia más resección intestinal del segmento de íleo que contiene el divertículo y anastomosis término terminal, por los signos de isquemia y necrosis presentes más herniorrafia inguinal derecha. El paciente fue dado de alta a los 10 días con evolución favorable.

ABSTRACT The Littré hernia is the presence of a Meckel diverticulum in any hernia of the abdominal wall. There are few reports in the medical literature due to its low incidence. His clinical suspicion is infrequent, so his diagnosis is intraoperative. We present a case of a 39-year-old patient who goes to the emergency service of the Hospital Misionario de Vouga. Cunhinga, Bié. Republic of Angola, with acute abdominal pain, and no expulsion of gases. Upon physical examination we found abdominal pain, slight abdominal defense and a painful and irreducible tumor in the right inguinal region. The patient is admitted with the diagnosis of strangulated right inguinal hernia. He underwent emergency surgery with a strangulated Littr hernia. We performed kelootomy plus intestinal resection of the ileus segment that contains the end-stage diverticulum and anastomosis, due to signs of ischemia and necrosis plus right inguinal herniorrhaphy. The patient was discharged after 10 days with favorable evolution.

RESUMO A hérnia de Littré é a presença de um divertículo de Meckel em toda a parede abdominal herniated. Poucos relatos são encontrados na literatura médica por causa de sua baixa incidência. Sua suspeita clínica é rara, assim que seu diagnóstico é intraoperativo. Há um caso de um paciente de 39 anos indo ao departamento de emergência do hospital missionário Vouga. Cunhinga, Bié. República de Angola, com dor abdominal aguda e sem ejeção de gás. O exame físico encontrou dor abdominal, discreta defesa abdominal e tumor doloroso e irredutível na região inguinal direita. É entrado com o diagnóstico da hérnia ardor direita. É cirurgicamente cirùrgica cirùrgica urgente com encontrar transoperatório de littré' hérnia de s estrangulada. É realizada quelotomia mais ressecção intestinal do segmento de íleo contendo o divertículo e anastomose terminal a termo, pelos sinais de isquemia e necrose apresentam herniorrafia inguinal mais direita. O paciente foi descarregado em 10 dias com evolução favorável.

Hernia de Spiegel: presentación de un caso / Spigelian hernia: case report

RESUMEN Fundamento: La hernia de Spiegel es un defecto de la pared abdominal generalmente mal diagnosticado; en la experiencia de los cirujanos, las hernias de la pared abdominal constituyen una enfermedad cuyo diagnóstico es esencialmente clínico. Sin embargo, la hernia de Spiegel por su infrecuente presentación (0.1 - 2 %) pasa fácilmente inadvertida. Objetivo: Describir el caso de un paciente con una hernia de Spiegel. Presentación del caso: En este artículo presentamos un paciente masculino de 37 años que fue hospitalizado por presentar dolor abdominal de un mes y medio de evolución, al que se le diagnosticó una hernia de Spiegel. Conclusiones: Por las dificultades diagnósticas que presenta esta enfermedad es importante realizar una correcta anamnesis y examen físico, sin dejar de lado estudios de imagen. El tratamiento definitivo de la hernia de Spiegel es el quirúrgico.

ABSTRACT Background: Spigelian hernia is a defect of the abdominal wall that is generally misdiagnosed. In the experience of surgeons, the diagnosis of the abdominal wall hernias is usually clinical. However, because of their presentation is infrequent (0.1 - 2 %) Spigelian hernias often fail to be noticed. Objective: To describe the case of a patient with a Spigelian hernia. Case report: In this article, we present a 37-year-old male patient who was hospitalized due to abdominal pain during a month and a half of evolution, who was diagnosed with a Spigelian hernia. Conclusions: Due to the diagnostic difficulties this disease presents it is important to accomplish a correct anamnesis and physical examination, without putting aside studies of image. The definite treatment of Spigelian hernia is surgery.