Hérnia umbilical primária: melhor manejo operatório no adulto / Primary umbilical hernia: Best surgical management in adults

RESUMO: Modelo do estudo: Revisão sistemática. Objetivo: Avaliar se é facultativo ou imprescindível o uso de malha cirúrgica no reparo das pequenas hérnias umbilicais primárias, com orifício menor que 2 cm, a fim de oferecer melhores evidências aos cirurgiões e, assim, aprimorar o método cirúrgico e o seu desfecho. Métodos: Trata-se de uma revisão da literatura, cuja busca foi direcionada aos artigos que abordassem o manejo operatório das hérnias abdominais, sobretudo das hérnias umbilicais de pequeno tamanho. A pesquisa foi realizada nas bases de dados primárias PubMed, LILACS, Cochrane Library e Periódicos CAPES. Resultados: No total, foram incluídos quatro es-tudos. Foram avaliadas as taxas de recorrência, bem como as de complicações pós-operatórias após a correção da hérnia umbilical com e sem o uso de tela, observando-se o tamanho do defeito abdominal. Foi observada diminuição da recorrência das hérnias após o reparo com tela. No entanto, complicações, como infecção da ferida operatória, foram mais comumente observadas com o uso da prótese. Não houve consenso quanto ao uso da tela em hérnias menores que 1 cm. Conclusão: O uso de próteses pode vir a ser o tratamento de escolha no reparo das hérnias umbilicais primárias. Contudo, mais estudos são necessários para avaliar o papel dessa estratégia no manejo das hérnias menores que 1 cm (AU)

ABSTRACT: Study design: Systematic review. Objective: Evaluate whether surgical mesh is optional or essential for the repair small primary umbilical hernias, with an orifice smaller than 2 cm, in order to provide better evidence for surgeons, thus enhancing surgical method and its outcomes. Methods: This is a literature review, whose search was directed towards papers that depicted surgical management of abdominal hernias, especially small umbilical hernias. The research was carried out in the primary the primary databases PubMed, LILACS, Cochrane Library, and Periódicos CAPES. Results: A total of four studies were included. Recurrence rates, as well as postoperative complications, were assessed after an umbilical hernia was corrected with or without the use of a mesh, observing the size of the abdominal defect. A reduction in the re-occurrence of hernias was observed when using a mesh. However, complications, such as surgical site infection, were more commonly noticed with the use of the prosthe-sis. There was no consensus regarding the use of the mesh in hernias smaller than 1 cm. Conclusion: The use of surgical mesh may prove to be the treatment of choice for the repair of primary umbilical hernias. However, more studies are needed to evaluate the role of this strategy in the management of hernias smaller than 1 cm. (AU)

Abordagem cirúrgica em bezerros com onfalite / Surgical approach in calves with omphalitis

Pathological changes in the umbilical region are common in calves. Among such alterations, omphalitis is included. This term is used to define inflammation and infection of the external structures of the umbilicus. According to the affected structures, it can be subclassified into omphalophlebitis, omphaloarteritis, omphalourachitis and panvasculitis. These inflammations are usually associated with bacterial infections. There are predisposing conditions that include inadequate handling such as poor hygiene and neglect of primary care. Omphalitis can affect the animal in a multisystemic way, compromising its well-being and bringing economic losses. In treatment, the use of antimicrobials does not always solve the problem. Thus, surgical treatment can be used, which has good results and should be the choice in the disease. The objective of this work is to report 30 cases of omphalitis in calves, submitted to surgical or conservative treatment. Thirty cases of omphalitis in calves treated in the routine of the Veterinary Hospital of the Paranaense University was analyzed. On physical examination, the animals presented fever, apathy, hyporexia or anorexia and increase of umbilical volume, usually with purulent secretion. Some animals had sepsis and arthritis. In animals with sepsis, hyperemia of the episcleral vessels, dehydration and severe apathy were observed. In calves with arthritis, increased joint volume, pain on palpation and lameness were observed. In animals where the owners did not authorize the surgery, treatment was instituted with sulfadoxine and flunixim meglumine. In dehydrated calves, fluid therapy was used. Animals that were surgically treated received the same clinical treatment protocol as non-operated animals. The surgical procedure was performed under general anesthesia and consisted of resection of the affected umbilical structures. Omphalophlebitis was the most common illness. The most frequent complication was sepsis. Calves treated surgically had a higher survival rate (86.66%) than those treated clinically (46.67%). The clinical signs presented by all animals converged with the literature, allowing for clinical diagnosis. Clinical examination is essential for diagnosis in omphalitis cases. Complementary methods include ultrasound, thermography and laparoscopy, which are important to identify changes in intra-abdominal umbilical structures. Accurate diagnosis of the involved structures was only possible in animals surgically, as well as alterations in organs such as the liver and bladder. There is great variability related to the umbilical structures involved, according to initial care, breeds, seasonality or even the method of conception. Unlike what is observed in the literature, in the present study, there was a higher prevalence of omphalophlebitis, demonstrating variability in relation to the umbilical structures involved. Sepsis, observed in 16.7% of cases, results from bacterial ascension of the umbilical structures. Lameness due to polyarthritis was found in 10% of animals. Meningoencephalitis was observed in 3.3%. Hepatic and retroperitoneal abscedation were observed in 6.7% and 3.3% of cases, respectively. Conservative treatment with antibiotics and local antiseptics has a limited effect on this type of condition, which was proven in the present study, since the survival rate was statistically higher in animals surgically treated.(AU)

Description and early clinical outcome of patients with omphalocele admitted to a tertiary hospital in Kigali, Rwanda over a three-year period ­ a cross-sectional study

BACKGROUND: Studies suggest that patients with omphalocele have poor outcomes which are associated with the high rate of associated congenital abnormalities. A variety of surgical management techniques have been described, with some requiring equipment not available in resource-limited countries. OBJECTIVES: This study aimed to describe associated abnormalities, management and early hospital outcomes of patients with omphalocele.METHODS: A retrospective study of newborns diagnosed with omphalocele hospitalized from January 2014 to December 2016 at a tertiary level facility, the University Hospital of Kigali (CHUK) in Kigali, Rwanda. Case-file review of included newborns and analysis of the data collected was performed with SPSS version 16.0. RESULTS: Thirty-one patients were hospitalized with omphalocele during the three-year study period. A limited number of investigations were done to diagnose possible associated congenital abnormalities. Three patients (9.7%) were found to have cardiac abnormalities, nine (27.0%) had suspected genetic abnormalities including Trisomy 13, 18 and Beckwith Wiedemann Syndrome. In terms of management, ten patients (32.3%) underwent primary closure. Sixteen patients (51.6%) developed sepsis during hospitalization. Of the thirty-one patients hospitalized, nine (27.0%) died in the hospital. The only factor found to be associated with increased mortality was the size of the omphalocele, with small omphaloceles associated with lower mortality than large omphaloceles (OR 0.909, P-value 0.028).CONCLUSION: Mortality of these patients is significant and slightly higher in patients with larger omphalocele. Newborns with omphalocele should receive appropriate investigations to diagnose associated congenital abnormalities and have early recognition and prompt management of complications, especially sepsis. The results are limited by the small sample size and limited investigations performed to detect associated abnormalities

Hernia umbilical en pacientes cirróticos con ascitis: ¿tratamiento conservador o quirúrgico? / Umbilical hernia in liver cirrhosis with ascites: conservative or surgical treatment?

Resumen La ascitis es la complicación más común en los pacientes con cirrosis hepática. Las hernias umbilicales (HU) ocurren en 20% de estos pacientes y 40% en aquellos con ascitis severa. La HU ocurre debido al aumento de presión intraabdominal, al debilitamiento de la fascia abdominal y la pérdida de masa muscular. Además, tienen tendencia a aumentar rápidamente y presentar alto riesgo de complicaciones que amenazan la vida del paciente. El tratamiento de la HU no complicada es controversial, tanto el manejo quirúrgico (herniorrafia) como el manejo conservador (control de ascitis) presentan alta tasa de complicaciones, en consecuencia incrementa la morbimortalidad. Actualmente, se recomienda herniorrafia umbilical con previo control de la ascitis en el manejo de HU no complicada, reduce el riesgo de infección de herida operatoria, evisceración, drenaje de ascitis, peritonitis y reduce hasta 41% la recidiva de HU. El éxito de este enfoque también depende del grado de disfunción hepática. El tratamiento de la HU complicada es quirúrgico (herniorrafia sin malla), con menor tasa de mortalidad respecto al manejo conservador. Estudios revelan ventajas de la herniorrafia umbilical laparoscópica (mínimamente invasiva y sin tensión) en comparación a la cirugía abierta, sin embargo, aún no hay evidencia al respecto.

Ascites is the most common complication in patients with liver cirrhosis. Umbilical hernias (HU) occur in 20% of these patients and 40% in those with severe ascites. HU occurs due to increased intra-abdominal pressure, weakening of the abdominal fascia and loss of muscle mass. In addition, they have a tendency to enlarge rapidly and present high risk of complications that threaten the patient's life. The treatment of the uncomplicated HU is controversial, both the surgical management (herniorrhaphy) and the conservative management (control of ascites) present high rate of complications, consequently high morbidity and mortality. Currently, umbilical herniorrhaphy is recommended with prior control of ascites in uncomplicated HU management, it reduces the risk of surgical wound infection, evisceration, ascites drainage, peritonitis, and it reduces up to 41% of HU recurrence. The success of this approach also depends on the degree of liver dysfunction. The treatment of complicated HU is surgical (herniorrhaphy without mesh), with lower mortality rate compared to conservative management. Studies reveal advantages of umbilical herniorrhaphy laparoscopy (minimally invasive and stress-free) compared to open surgery; however there is still no evidence about it.

Celio-mesenteric trunk associated with giant omphalocele: surgical consequences / Tronco celíaco-mesentérico asociado con onfalocele gigante: consecuencias quirúrgicas

We report the first case of a newborn presenting with a celio-mesenteric trunk variation associated with a giant omphalocele. The celio-mesenteric trunk was unexpected and unseen during the staged surgical closure. After partial reintegration of the liver, the newborn presented refractory hypovolemia with anuria, leading to redo surgery. This procedure revealed ischemia of the liver and necrosis of the entire gastrointestinal tract except the colon. Despite treatment, including liver externalization, the infant did not survive. The autopsy revealed a celio-mesenteric trunk, a rare anomaly characterized by a common origin of the celiac axis and the superior mesenteric artery from the aorta. This association may explain the dramatic consequences of the staged closure procedure. Awareness of the association of celio-mesenteric trunk and omphalocele would allow the surgeon to take extra care during this delicate surgery.

Presentamos el primer caso de un recién nacido que presenta una variación del tronco celíaco-mesentérico asociada con un onfalocele gigante. El tronco celíaco-mesentérico fue inesperado y no se vio durante las etapas del cierre quirúrgico. Después de la reintegración parcial del hígado, el recién nacido presentó hipovolemia refractaria con anuria, lo que condujo a la repetición de la cirugía. Este procedimiento reveló isquemia del hígado y necrosis de todo el tracto gastrointestinal excepto el colon. A pesar del tratamiento, incluyendo la externalización hepática, el bebé no sobrevivió. La autopsia reveló un tronco celíaco-mesentérico, una rara anomalía caracterizada por un origen común del tronco celíaco y la arteria mesentérica superior, a partir de la aorta. Esta asociación puede explicar las dramáticas consecuencias del procedimiento durante las etapas del cierre. El conocimiento de la asociación de tronco celíaco-mesentérico y onfalocele permitiría al cirujano tomar especial cuidado durante esta delicada cirugía.

Reparación protésica en una paciente con hernia incisional catastrófica / Prosthetic repair in a patient with catastrophic incisional hernia

Se presenta el caso clínico de una paciente de 66 años de edad, blanca, con antecedentes de hipertensión arterial, diabetes mellitus de tipo II y sobrepeso, quien fue operada en el Hospital General Universitario Dr Juan Bruno Zayas Alfonso de Santiago de Cuba por presentar una eventración gigante en la pared abdominal anterior, que no le permitía deambular sin apoyo. Se realizó la reparación protésica que resultó eficaz y segura, con 13 años sin recurrencia

The case report of a 66 years white patient with a history of hypertension, type II diabetes mellitus and overweight is presented, who was operated on at Dr Juan Bruno Zayas Alfonso University General Hospital in Santiago de Cuba due to a considerable eventration in the front abdominal wall that didn't allow her wandering around without support. The prosthetic repair which was effective and safe, was carried out with no recurrence during 13 years

Reparación endoscopica de diastasis derecto y defectos de la línea media / Endoscopic approach of rectus diastasis and abdominal midline defects

La Diástasis de los rectos (DR) consiste en la separación existente entre los músculos recto anterior del abdomen, no es considerado un defecto herniario sino una alteración de la línea alba. Se la relaciona con edad, la multiparidad, el aumento de peso y clínicamente se manifiesta con un abombamiento en la línea media y suele acompañar a otros defectos dela línea media (hernia umbilical y epigástrica). Reportamos el caso de una paciente de 40 años de edad portadora de Diastasis de los rectos de 4 cm que fue sometida a reparación por abordaje endoscópico supraaponeurótico y con refuerzo protésico.

Rectus diastasis (RD) consists of the separation between the rectus abdominis anterior muscles, it is not considered a hernia defect but an alteration of the alba line. It is associated with age, multiparity, weight gain and clinically manifests with a bulging of the midline and usually accompanies other midline defects (umbilical and epigastric hernia). We report the case of a 40-year-old female patient with a 4 cm rectus diastasis who underwent repair by supraaponeurotic endoscopic approach and with prosthetic reinforcement.

Neo-onfaloplastia com enxerto cutâneo / Neoomphaloplasty with cutaneous graft

Introdução: A cicatriz umbilical é decorrente da queda do coto umbilical, que ocorre alguns dias após o nascimento. Sua presença, formato e localização na parede abdominal fornecem ao indivíduo uma conotação estética e sensual. Métodos: Estudo primário, prospectivo, de intervenção. A casuística foi de conveniência, no período de fevereiro de 2006 a junho de 2016, incluindo pacientes de ambos os gêneros, alocados do ambulatório do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE) e clínica privada. Os critérios de inclusão foram pacientes com indicação de abdominoplastia e que apresentavam um comprometimento da irrigação da pele da região umbilical e periumbilical devido a defeitos herniários da região. O estudo seguiu os critérios de Helsinki e os pacientes assinaram o Termo de Consentimento Livre e Esclarecido. Resultados: Foram operados 28 pacientes, sendo observada uma boa integração da pele enxertada, resultando em uma cicatriz umbilical de aparência natural e sem complicações. Conclusões: A neo-onfaloplastia com enxerto cutâneo é de fácil execução e que, a longo prazo, tem demonstrado um bom resultado estético, principalmente nos retalhos abdominais espessos, demonstrando ser mais uma opção técnica na realização de neo-onfaloplastias.

Introduction: The umbilical scar is due to the fall of the umbilical stump that occurs a few days after birth. Its presence, shape, and location on the abdominal wall provide the individual with an aesthetic and sensual connotation. Methods: A primary prospective interventional study. The sample was of convenience, from February 2006 to June 2016, and included patients of both sexes attending the outpatient clinic of the Hospital das Clínicas of the Federal University of Pernambuco (HC-UFPE), a private clinic . The inclusion criteria were patients with abdominoplasty indications presenting with compromised circulation to the skin of the umbilical and periumbilical region caused by hernia defects in this area. The study followed the criteria of Helsinki and the patients signed an Informed Consent Form. Results: Twenty-eight patients underwent surgery and good integration of the grafted skin was observed. This resulted in an umbilical scar with a natural appearance and without complications. Conclusions: Neoomphaloplasty with a cutaneous graft is easy to perform and, in the long term, has shown to provide good aesthetic results, especially in thick abdominal flaps, thus proving to be an additional technical option for neoomphaloplasty procedures.

Mucopolisacaridosis (síndrome de Hunter) / Mucopolysaccharidosis (Hunter syndrome)

Se realiza una presentación de un caso interesante, no comúnmente visto en la práctica médica, de unos de los tipos de mucopolisacaridosis, específicamente de un síndrome de Hunter. Se hace esta presentación con el objetivo de dar a conocer a estudiantes y profesionales de la salud, mediante fotos, las características físicas del paciente con dicho sídrome, quien llegó desnutrido al hospital; se le operó de la hernia umbilical y se mejoró su estado nutricional al compensarse su hepatopatía. Se le da el alta médica en mejores condiciones(AU)

We present here an interesting case of mucopolysaccharidoses, which is not commonly seen in medical practice, specifically a Hunter syndrome. This presentation is done in order to make known to students and health professionals, through photos, the physical characteristics of the patient with such syndrome. This patient arrived malnourished at the hospital, he was operated on the umbilical hernia and improved his nutritional status by compensating for his liver disease. This patient had medical discharge in better conditions(AU)

Avaliação estética da cicatriz umbilical em duas técnicas de onfaloplastia / Aesthetic evaluation of two omphaloplasty techniques

Introdução: O tratamento da cicatriz umbilical é um tempo muito importante na plástica abdominal. Existem várias técnicas descritas de onfaloplastia na literatura. Objetivo: Este trabalho tem com objetivo comparar o resultado estético de onfaloplastias com as técnicas em estrela e losango. Método: Foram avaliados os resultados de 20 pacientes, por meio de pontuação, utilizando cinco critérios: formato, localização, cicatriz, tamanho e profundidade. Resultado: As pacientes apresentaram somatória significativamente maior de pontos no critério que avaliou o formato da onfaloplastia, sendo utilizada a técnica em estrela 15,8± 2,05, quando comparada com a técnica de onfaloplastia em losango 12,6± 3,65 com p=0,03. Nos demais critérios de localização, tamanho, profundidade e cicatriz não houve diferenças significantes. Conclusão: O estudo demonstrou que a técnica em estrela apresentou melhores resultados estéticos no critério de formato do que a técnica em losango.

Introduction: The treatment of umbilical scarring is important in abdominoplasty, and many omphaloplasty techniques are described in the literature. Objetive: The objective of this work is to compare the aesthetic result of omphaloplasty with the star technique and the diamond technique. Method: Twenty patients were evaluated through scoring, by using five criteria: shape, location, scar, size, and depth. Result: The patients showed significantly higher scores when evaluating the shape criterion during an omphaloplasty; the star technique scored, on average, 15.8 ± 2.05, whereas the diamond technique scored 12.6 ± 3.65 (p = 0.03). No significant difference was found in all other criteria (location, size, depth, and scar). Conclusion: This study demonstrates that the star technique produces better aesthetic results than the diamond technique.

Onfaloplastia secundária: descrição de uma nova proposição / Secondary omphaloplasty: description of a new proposal

Introdução: O umbigo é um componente essencial à estética do abdome. Sequelas de onfaloplastia podem comprometer o resultado final de uma dermolipectomia abdominal. Objetivo do trabalho é propor um procedimento alternativo, de fácil execução, com resultado estético favorável e bem aceito pelas pacientes. Métodos: Fizemos o levantamento dos casos de dermolipectomia abdominal operados no serviço de ensino e na clínica privada nos últimos cinco anos (433 casos) Resultados: Encontramos 30 casos (6,9%) com sequelas, assim distribuídos: 14 casos (3,2%) na cicatriz hipogástrica, e 16 casos de sequelas de umbigo (3,8%), assim caracterizados: sete casos (1,6%) constrição de umbigo e nove casos (2,07%) hipertrofia cicatricial. Conclusão: Analisamos os resultados da técnica de onfaloplastia secundária proposta quanto ao pós-operatório imediato (até 30 dias) e tardio (um ano).

Introduction: The navel is an essential component of abdominal aesthetics. Omphaloplasty sequelae can compromise the result of an abdominal abdominoplasty. The purpose of this article was to propose an alternative procedure that is simple to perform and well accepted by patients, with favorable cosmetic results. Methods: We surveyed cases of abdominal dermolipectomy in teaching hospitals and in private practice in the last 5 years (433 cases). Results: We found 30 cases (6.9%) of sequelae distributed as follows: 14 cases (3.2%) in the hypogastric scar and 16 cases in the umbilicus (3.8%). They are characterized as follows: 7 cases (1.6%) of constriction of the navel and 9 cases (2.07%) of scar hypertrophy. Conclusion: We analyzed the results of the proposed technique of secondary omphaloplasty in the immediate (up to 30 days) and late (1-year) postoperative periods.

Traitement chirurgical des omphaloceles au CHU de Yaounde

But : l'objectif de ce travail etait d'analyser les methodes de prise en charge des omphaloceles dans une formation hospitaliere africaine ne disposant pas de service de chirurgie neonatale. Patients et methode : il s'agit d'une etude retrospective descriptive qui a inclus 10 nouveau- nes presentant une omphalocele et admis au Centre Hospitalier et Universitaire de Yaounde entre Janvier 2005 et Decembre 2010. Resultat : il n'y a eu aucun patient avec un diagnostic en prenatal. Aucun patient n'a presente de malformation associee. Les formes cliniques etaient reparties en 60 de type I et 40 type II selon la classification de Aitken. Neuf enfants ont beneficie d'une prise en charge medicale pre-operatoire. Un traitement chirurgical avec fermeture parietale en un temps a ete realise chez 7 patients (78). Deux patients (22) ont ete traites avec une fermeture parietale en un temps a l'aide d'une prothese de polyester. Un enfant est decede en postoperatoire immediat sans traitement. Le taux de mortalite dans cette serie etait de 20Conclusion : le diagnostic antenatal doit etre encourage afin d'ameliorer le pronostic de ces patients dans notre contexte. La fermeture parietale en un temps semble le traitement de choix dans les omphaloceles de type I. La fermeture parietale immediate avec prothese devrait etre progressivement indiquee dans le traitement des omphaloceles en Afrique pour les omphaloceles de type II chaque fois qu'il est possible d'assurer a l'enfant la securite anesthesique et chirurgicale

Uso del pericardio porcino tratado con gluteraldehido en el tratamiento de los defectos de la pared abdominal: estudio experimental en ratas / Using porcine pericardio gluteraldehyde treated in the treatment of abdominal wall defects: an experimental study in rats

Introducción: El tratamiento quirúrgico del onfalocele y gastrosquísis gigante, plantea un tratamiento complementario con parches protésicos sintéticos que son eliminados a los siete a doce días de haberse aplicado Objetivos: El objetivo del presente trabajo fue determinar la utilidad de un parche de pericardio porcino tratada con glutaraldehido 1%, aplicado quirúrgicamente sobre un defecto de la pared abdominal. Material y Métodos: El estudio de tipo experimental se llevó a cabo en el Servicio de Cirugía Experimental del Instituto Nacional de Salud del El pericardio porcino obtenido en forma estéril y fue tratado con gluteraldehido al 1 %. Los animales fueron anestesiados con una combinación de ketamina 50mg /kilo y Xilascina a razón de 12 mgs /kilo IM Atropina 0.2 mgs / Kilo IM. Usando una técnica quirúrgica aséptica. Se les resecó, de 1x 3 cms de pared, en la zona media del abdomen, aplicándoles luego un parche de pericardio 1,5 cm. por 3 cm. la cual, se fijó a los bordes del defecto. Resultados: Cuatro animales murieron y 26 sobrevivieron hasta los 30 días. Se observó Cierre de la herida en primera intención en 22 ratas (84,65 % ), integración del parche a la pared abdominal. Hubieron 4 evisceraciones (13,3 %) y 2 eventraciones (6,6 %) Conclusiones: El parche de porcino tratado con glutaraldehido al 1 %, ha tenido un efecto curativo de los efectos de la pared abdominal en ratas, caracterizado por cierre de la herida en primera intención, integración del parche a la pared abdominal y escasas complicaciones.

Introduction: In the Surgical treatment of giant omphalocele and gastroschisis and recommended the complementary treatment with prosthetic synthetic patch in order to prevent the compartmental syndrome. But this prosthetic materials are get out seven a twelve days post surgery. Objectives: This study has the goal to determinate the usefulness of a porcine pericardium treated with 1 % glutaraldehyde , surgically applied on a defect in the abdominal wall. Matrial and method: The study was carry on in Experimental Surgery Unit at the National Child Hospital , we've had 30 rats Holtzmann with weights between 200 and 300 grams. The porcine pericardium sterile obtained was treated with 1% glutaraldehyde. The animals were anesthesied with ketamine 50 mg/ kg and Xilascina 12 mgs/kg IM Atropine 0.2 mgs/Kilo IM. Using sterile surgical technical a rectangular area of 3 x 1 centimeter of the abdominal wall was resected. A similar patch of the porcine pericardium was fixed on the defect with vycril5 (0). Later the skin was sutured on the pericardium..The rats remain lives during 30 days. Results: We had 4 animals death for due evisceration 26 rats survived. In 22 animals, the chirurgical wound was close in first intention 100 % of live animals was observed permanence of the pericardium and the integration of the patch to the abdominal wall. Conclusion: The porcine pericardical patch was curative effect on the abdominal wall defect of the experimental animals. With some mild complications.

Pentalogía de Cantrell: presentación de un caso clínico / Pentalogy of Cantrell: clinical case

La pentalogía de Cantrell es una enfermedad poco frecuente que resulta de alteraciones embriológicas del mesodermo, caracterizada por defecto en la porción baja esternal, defecto de la pared abdominal supraumbilical, defecto diafragmático anterior, defecto del pericardio diafragmático y anomalía cardiaca. Caso clínico: Se presenta el caso de un neonato de sexo masculino con diagnóstico prenatal de defecto de la pared abdominal, en quien posteriormente se realizó el diagnóstico de Pentalogía de Cantrell. Al presentar este caso se destaca la posibilidad diagnóstica en la vida fetal, y el pobre pronóstico de estos pacientes cuando su presentación clínica se asocia a hipoplasia pulmonar severa.

Pentalogy of Cantrell is a rare disease that results from alterations in embryo development. It is characterized by defects of the lower sternum, midline supraumbilical abdominal wall defect, deficiency of the anterior diaphragm, defects in the diaphragmatic pericardium and cardiac anomaly. Case Report: The case of a male neonate with a prenatal diagnosis of abdominal wall defect is presented, who was subsequently diagnosed with Pentalogy of Cantrell. This study emphasizes the prenatal diagnosis possibilities and the poor prognosis for these patients when their clinical presentation is associated with severe lung hypoplasia.

Hernia umbilical eviscerada en pacientes cirróticos: reporte de un caso / Eviscerated umbilical hernia in cirrhotic patients: case report

La evisceración espontánea de las hernias umbilicales en pacientes con cirrosis hepática y ascitis es una complicación rara y potencialmente fatal que ocurre en menos de un 2% de los pacientes con esta patología. Se presenta un caso de un paciente masculino de 58 años de edad conocido con el diagnóstico de cirrosis hepática por alcohol, Child B, con síndrome de hipertensión portal, que consultó por dolor abdominal tipo cólico difuso y salida espontánea de líquido ascítico de color amarillo, no fétido, a través de hernia umbilical, de gran tamaño, con erosiones en su superficie. El citoquímico del líquido ascítico fue compatible con peritonitis bacteriana secundaria. Se manejó conjuntamente con cirugía, de forma conservadora con antibioticoterapia parenteral. Al cuarto día se apreció salida del epiplón a través del saco herniario. Se realizó herniorrafia umbilical sin complicaciones, evolucionando satisfactoriamente. Desde el primer caso reportado en 1901, son pocos los casos registrados en la literatura. Los factores precipitantes descritos son traumatismos y aumento de presión intra-abdominal. El manejo de la hernia umbilical en el paciente cirrótico es controversial, cuando se desarrollan complicaciones como la evisceración, la conducta quirúrgica es urgente

Spontaneous evisceration of umbilical hernias in patients with cirrhosis and ascites is a rare and potentially fatal complication that occurs in less than 2% of patients. We report a case of a 58-year old male patient with Child B alcoholic liver cirrhosis,with portal hypertension, who presented with diffuse crampy abdominal pain and spontaneous leaking of yellow not foul ascitic fluid through a large umbilical hernia with superficial tiny erosions. Cytochemical ascitic fluid analysis was consistent with secondary bacterial peritonitis. Patient was managed conservatively with parenteral antibiotics in conjunction with surgery. On fourth day, the omentum was seen through the hernia sac and surgical repair was performed without complications and the patient did well in the postoperative period. Since the first case reported in 1901, there had been few cases reported in the literature. Trauma and increased intra-abdominal pressure are among the precipitants reported. Management of umbilical hernia in cirrhotic patients is controversial, however when they develop complications, surgical treatment become urgent

Port Site Infection in Laparoscopic Surgeries.

Background/Aims: As the surgeries undertaken by laparoscope are increasing, complications are also increasing. In light of the explosive increase in laparoscopic surgery, there is concern about the effectiveness of sterilizing reusable laparoscopic instruments which might be a potential source of infection if not properly sterilized. Our study explains port site infection, its diagnosis and management with review of literature. Setting and Design: This study was carried out in a tertiary care setting and was an outcome study. Material and Methods: All five patients in the study were operated (April 2008-2010) elsewhere and came to us for management of non healing sinuses. Result: Amongst operated cases of laparoscopic cholecystectomy one healed by irrigation with superoxide, two cases healed with sinus exploration and wound debridement while one case required extensive wound debridement requiring temporary mesh repair of the abdominal wall with removal of the mesh (due to persistence of sinus) six months later following complete healing, no residual hernia. One operated case of laparoscopic incisional hernia repair with laparoscopic Cholecystectomy healed after removal of mesh with sinus exploration. Conclusion: The present study is an attempt to make surgeons aware about the complications which occur due to improper sterilisation of laparoscopic instruments ending into increased morbidity of patients.

Hernie ombilicale de l'enfant : aspects epidemiologiques; cliniques et therapeutiques au complexe pediatrique de Bangui (RCA)

Les objectifs de ce travail sont de decrire les aspects epidemiologiques; cliniques et therapeutiques de la hernie ombilicale. A cet effet; une etude retrospective a ete conduite de juin 2005 a juin 2010 sur 93 cas de hernie ombilicale. Celle-ci representait 12 de toutes les interventions chirurgicales; 33;7 des hernies de l'enfant et 5;2 des cas d'hospitalisation. La population etait masculine avec un sex-ratio de 2;2. L'age moyen etait de 2;3 ans avec des extremes d'un mois et 15 ans. La tranche d'age la plus touchee etait celle des enfants de moins d'un an. Les malades se plaignaient dans 51;3 de douleurs abdominales. L'etranglement etait la complication la plus representee avec 22;6 de cas. 11 engouements etaient observes soit 11;8. Les hernies ombilicales dont le diametre etait superieur a 2 cm etaient les plus representees (57). Le paludisme et la typhoide etaient les principales pathologies associees. La hernie ombilicale; pathologie frequente en pratique pediatrique africaine; a ete rapportee dans la litterature comme nous; et le sexe masculin semble etre un facteur de risque. C'est une affection non douloureuse en general et notre fort taux de douleur pourrait etre lie aux formes compliquees ou pathologies medicales associees. Le traitement chirurgical etait notre seul mode de traitement. Les etranglements herniaires; les engouements et les hernies ombilicales simples persistantes etaient systematiquement operes. Les dernieres categories devraient desormais faire l'objet d'un examen approfondi car une hernie ombilicale simple; souvent associee a une douleur ou autres signes peut cacher une pathologie medicale ou chirurgicale

Técnica de mínimo acceso no videolaparoscópica para hernias umbilicales con defectos múltiples de la línea media / Non-videolaparoscopic minimal access technique to treat umbilical hernia with multiple midline defects

Introducción: un estudio preliminar realizado por el autor sobre hernia umbilical recidivante demostró que los defectos múltiples de la línea media la predisponen, si no se tratan al unísono. El presente trabajo tiene como objetivo demostrar que al aplicar una técnica de mínimo acceso no videolaparoscópica se logra una cura integral para la hernia umbilical y los defectos múltiples de la línea media. Métodos: para su realización, en la etapa del 2006 al 2011, se seleccionaron todos los pacientes herniados (72 en total) que acudieron a la consulta especializada del Hospital Universitario General Calixto García, con hernia umbilical y que además presentaron defectos de la línea media, como diastasia o hernia epigástrica. Se realizó un estudio de intervención para demostrar la utilidad de la técnica quirúrgica, inscrita por el autor en el Centro Nacional de Derecho de Autor, (CENDA), registro: 856-2007. Se colocó una prótesis de polipropileno preperitoneal por incisión transumbilical que protege toda la zona afectada. Se evaluaron complicaciones y grado de satisfacción del paciente. Resultados: predominaron los hombres y los pacientes con hernia umbilical y diastasia, seguidos de los casos con hernia umbilical y epigástrica y por último, los tres defectos. La media del tiempo quirúrgico fue de 45 minutos. La complicación posoperatoria predominante fue el seroma, no hubo infección, rechazo ni muerte. El grado de satisfacción fue excelente en la mayoría de los casos y solo hubo una recidiva. Conclusiones: el método es factible y útil(AU)

Introduction: apreliminary study conducted by the author of this paper on relapsing umbilical hernia showed that the multiple midline defects may predispose a patient to it, if not treated at the same time. The present paper was aimed at demonstrating that the application of a non-videolaparoscopic technique manages to comprehensively cure the umbilical hernia and the multiple midline defects. Methods: from 2006 through 2011, all the herniated patients (72) who went to the specialized service of Calixto García general university hospital and presented with umbilical hernia and midline defects such as dyasthasia or epigastric hernia were selected. An intervention study was conducted to demonstrate the advantages of the surgical technique registered by the author in the National Center of Copyright (CENDA) under the register no. 856-2007. Through a transumbilical incision, a preperitoneal polypropylene prosthesis that protects the affected area was placed. The complications and the level of satisfaction of the patient were evaluated Results: males and patients with umbilical hernia and diasthasia prevailed, followed by cases with umbilical and epigastric hernia and finally the three defects together. The surgical time mean was 45 minutes. The predominant postoperative complication was serome, but there was no infection, rejection or death. The level of satisfaction was considered excellent in most of cases, and just one relapse. Conclusions: this method is feasible and useful(AU)

Spontaneous rupture of umbilical hernia in pregnancy: a case report

A 28 year old woman presented with a spontaneous rupture of an umbilical hernia in her seventh month of pregnancy. She had four previous unsupervised normal deliveries. There was no history of trauma or application of herbal medicine on the hernia. The hernia sac ruptured at the inferior surface where it was attached to the ulcerated and damaged overlying skin. There was a gangrenous eviscerated small bowel. The patient was resuscitated and the gangrenous small bowel was resected and end to end anastomosis done. The hernia sac was excised and the 12 cm defect repaired. Six weeks later, she had spontaneous vaginal delivery of a live baby. We advocate that large umbilical hernias should be routinely repaired when seen in women of child bearing age