Bone mesh fixation for the treatment of suprailiac hernia. Report of two cases.

Hernias of the lateral abdominal wall are a rare entity. In most cases, they occur after surgery or trauma. We present two cases of lumbar hernia: the first one after iliac bone grafting and the second one after muscular tearing by the seatbelt during a car accident. Both cases were successfully repaired using a propylene mesh with bone fixation.

Las eventraciones de la pared lateral del abdomen son poco frecuentes. Pueden ser posquirúrgicas o causadas por agentes traumáticos. Se presentan dos casos de eventración lumbar: el primero tras una resección ósea por autoinjerto de cresta ilíaca y el segundo por desinserción muscular por cinturón de seguridad secundaria a un accidente en la vía pública. Ambos fueron resueltos quirúrgicamente con colocación de una malla de polipropileno fijada a hueso.

Abdominal computed tomography scans in the selection of patients with malignant peritoneal mesothelioma for comprehensive treatment with cytoreductive surgery and perioperative intraperitoneal chemotherapy.

BACKGROUND: Malignant peritoneal mesothelioma is a rare and fatal disease. Until recently, the treatment options were very limited and ineffective. The new comprehensive approach of cytoreductive surgery with perioperative intraperitoneal chemotherapy offers improved survival rates at a cost of considerable morbidity and mortality as in other peritoneal surface malignancies. The outcome after these treatments is predominantly dependent on adequate cytoreduction. The aim of the current study was to identify computed tomography (CT) scan images that are useful in patient selection for this comprehensive approach. METHODS: An analysis of the preoperative CT scans of 30 patients with peritoneal mesothelioma treated with cytoreductive surgery and perioperative intraperitoneal chemotherapy at a single institution was performed. Based on the size of residual tumor nodules after cytoreductive surgery, patients were divided into 2 groups: those with residual lesions2.5 cm (suboptimal cytoreduction). The CT scans for each patient were evaluated by a standardized scoring system with the reader blinded to the operative findings. Thirty-nine CT scan parameters were obtained and statistically analyzed to determine their association with the study outcome variables, namely, adequacy of cytoreduction. RESULTS: Seven patients (64%) in the suboptimal cytoreduction group and 2 patients (11%) in the adequate cytoreduction group had a >5-cm tumor mass in the epigastric region (P=0.004). Nine patients (82%) in the suboptimal group and 2 patients (11%) in the adequate cytoreduction group had CT scans that showed loss of normal architecture of the small bowel and its mesentery (P<0.001). In a composite analysis of these 2 radiologic features, none of the patients with a >5-cm tumor mass in the epigastric region and loss of normal architecture of the small bowel and its mesentery had an adequate cytoreduction. Patients who lacked these two preoperative CT scan findings had a 94% probability of an adequate cytoreduction. CONCLUSIONS: CT scans effectively identified large peritoneal mesothelioma tumors at crucial anatomic sites. Because adequate cytoreduction is necessary to achieve prolonged survival, CT scans became an accurate prognostic radiologic test for patient selection for comprehensive treatment.