Management of complex hernias with loss of domain using daily and fractioned preoperative progressive pneumoperitoneum: a retrospective single-center cohort study.

PURPOSE: The incidence of complex hernias with loss of domain (CHLD) has been increasing and the treatment of these cases may require auxiliary techniques in addition to surgery. This study aims to refine the progressive preoperative pneumoperitonium (PPP) in patients with CHLD, to achieve an increased in wall dimensions. METHODS: Patients presented with a CHLD undergoing PPP protocol were analyzed between May 2017 and May 2019. Our PPP protocol was to use two daily insufflations of 1000 ml of ambient air during a period of 14 days. We compared the abdominal cavity volume (ACV), the hernial sac volume (HSV) and the volume ratio (VR), before and after our refined PPP. RESULTS: During our evaluation period, the protocol was performed on 16 patients. The mean age was 55.73 (± 12.87), and the mean BMI was 31.35 (± 7.33). The median of HSV was 2104.53 ml; Mean ACV was 6722.36 ml, and median of VR was 29.97% (27.46-34.38 IIQ). The averages were: daily volume of gas ± 1526.66 ml, total volume ± 17,350 ml, and the PPP period of ± 10.7 days. The increase in post-PPP ACV was 52.13% (p < 0.0001), and the VR decreased to 26.9% (p < 0.609). All patients' symptoms and complications were mild (according Clavien-Dindo grades I and II), and there were no loop injuries, no catheter complications, or any surgical re-interventions. CONCLUSION: The study suggests that the use of this method results in a significant increase in ACV, and reduction of the herniated content in a safe and efficient manner, with mild complications.

Importância anatomocirúrgica das características macroscópicas, localização e suprimento vascular das glândulas paratireóides cervicais / Anatomic and surgical importance of macroscopic characteristics, location and vascular supply of cervical parathyroid glands

OBJETIVOS: A importância anatômica e cirúrgica das glândulas paratireóides, notadamente, no curso das tireoidectomias continua viva e despertando interesse científico. Por outro lado, são raros os trabalhos científicos sobre a investigação da anatomia das paratireóides. Dessa forma, o objetivo deste trabalho é contribuir para estabelecer essa ponte anatomocirúrgica. MÉTODO: Estudo macro e microscópico das glândulas paratireóides dissecadas nas peças anatômicas de dezenove cadáveres, todos do sexo masculino e com idade entre 20 e 60 anos. Na abordagem do suprimento vascular foi utilizada a técnica de corrosão para identificar a vascularização e a glândula tireóide adotada como referência espacial na localização das paratireóides. RESULTADOS: Foram identificadas na macro e microscopia 76 glândulas paratireóides cervicais. Trinta e quatro (44,73 por cento) possuíam a coloração vermelho-amarelada, 26 (34,21 por cento) a cor preto-acinzentada e dezesseis (21,06 por cento) a cor castanho-amarelada. O tamanho encontrado ficou entre 3 e 15mm, prevalecendo o intervalo de 4 a 6,9mm em 43 (56,58 por cento) glândulas. Foram encontradas de duas a seis paratireóides por cadáver, prevalecendo o número de quatro (47,37 por cento) em nove necrópsias. Quarenta e duas (55,26 por cento) glândulas localizavam- se superior à tireóide e 34 (47,74 por cento) inferiormente. Os moldes da vascularização das paratireóides após a corrosão demonstraram que os capilares provenientes das artérias tireóideas superiores e inferiores se unem próximo à glândula. CONCLUSÕES: Com forte influência no curso das tireoidectomias, o estudo evidenciou que as glândulas paratireóides cervicais superiores e inferiores podem ser encontradas em diferentes posições frente à tireóide com maior ou menor intimidade em relação à cápsula tireóidea e que a irrigação vascular de uma paratireóide não é proveniente apenas de uma artéria.

OBJECTIVES: The anatomic and surgical importance of the parathyroid glands, notably in the course of thyroidectomy still continues alive and awaking scientific interests. On the other hand, there are scarce scientific studies about the investigation of parathyroid glands anatomy. The main objective of this study is to contribute to establish these anatomic and surgical connections. METHODS: The macro and microscopic studies of the parathyroid glands dissected in anatomic parts from nineteen corpses, all male between 20 and 60 years old. To approach the vascular supply, it was used an erosion technique to identify the blood vessels and the thyroid gland adopted as a space reference in the parathyroid glands location. RESULTS: There were identified in macro and microscopy 76 cervical parathyroid glands. Thirty-four (44.73 percent) had a yellow-red colouring, 26 (34.21 percent) a grey-black colouring and sixteen (21.06 percent) a yellow-tan colouring. The size was between 3 to 15 mm, prevailing the interval of 4 to 6.9 mm in 43 (56.58 percent) glands. There were found from two to six parathyroid glands per corpse, prevailing the number of four in nine (47.37 percent) necropsies. Forty-two (55.26 percent) parathyroid glands were from the upper and 34 (47.74 percent) from the lower thyroid gland. Blood vessels moulds of parathyroid glands after the erosion technique, demonstrated that capillaries prevailing from the upper and lower thyroid arteries join together next to the gland. CONCLUSION: With strong influence in the course of thyroidectomies, the study showed up that upper and lower cervical parathyroid glands can be found in different positions face to thyroid gland, with greater or smaller intimacy gland is not prevailing of a unique artery.