ABSTRACT
SUMMARY: Gluteal augmentation is one of the most requested cosmetic procedures. This article describes the surgical technique and early results of an innovative minimally invasive video-assisted submuscular gluteal augmentation with implants. The authors aimed to perform a technique that would reduce complications and surgical time. Fourteen healthy non-obese women with no relevant pathologic background who requested gluteal augmentation with implants as a single procedure were included. The procedure was performed through bilateral parasacral 5 cm incisions at cutaneous and subcutaneous planes as far as the gluteus maximus muscle fascia. Through a 1 cm incision in the fascia and muscle, the index finger was introduced under the gluteus maximus and a submuscular space was created by blunt dissection towards the greater trochanter to avoid a sciatic nerve injury, until the middle gluteus level was reached. Next, the balloon shaft of a Herloon trocar (Aesculap® - B. Brawn®) was introduced in the dissected space. Balloon dilatation in this submuscular space was performed as required. The balloon shaft was replaced by the trocar, through which a 30° 10-mm laparoscope was introduced. Submuscular pocket anatomic structures were observed, and while the laparoscope was being retrieved, hemostasis was verified. The submuscular plane collapsed, leaving the pocket for the implant to be placed. There were no intraoperative complications. The only complication was a self-limited seroma in one patient (7.1 percent). This innovative technique has shown ease and safety, allowing direct visualization and hemostasis, with a short surgical time, low complication rate and an excellent degree of satisfaction.
ABSTRACT
BACKGROUND: The celiac artery, celiac axis or celiac trunk is the first major abdominal branch of the aorta. Anatomic variations and accessory vessels have been reported with variable percentages. The purpose of this study was to report the pattern of the celiac trunk and its anatomic variations in a sample of Mexican population. METHODS: Celiac trunk dissection was performed in 140 fresh cadavers. Cadavers of Mexican subjects aged 18 years and older were included. Cadavers with previous upper abdominal surgery, abdominal trauma, disease process that distorted the arterial anatomy or signs of putrefaction were excluded. Celiac trunk variations and external diameter, accessory vessels, and vertebral level of origin were described. Celiac trunk patterns were reported according to the Panagouli classification. This study was reviewed and approved by the Ethics Committee of our Hospital. RESULTS: The celiac trunk derived in a common hepatic artery, a left gastric artery and a splenic artery (type I) in 43.6% of dissections. A true tripod was found in 7.1% and a false tripod in 36.4%. Celiac trunk bifurcation (type II) was found in 7.1%. Additional branches (type III) were observed in 47.9%. One or both phrenic arteries originated from the celiac trunk in 41.4% of dissections. Celiac trunk tetrafurcation was observed in 12.9%, pentafurcation in 12.9%, hexafurcation in 1.4%, and heptafurcation in 0.7%. The mean diameter of the celiac trunk ranged from 6 to 12 mm, with a mean diameter of 7.2 mm (SD = 1.39 mm). No significant difference was found between the diameters of the different types of celiac trunk (P > 0.05). The celiac trunk originated between the 12th thoracic and first lumbar vertebral bodies in 90% of dissections. CONCLUSIONS: Trifurcation of the celiac trunk was lower than previously reported. A high proportion of cases with additional vessels were found.
ABSTRACT
BACKGROUND: Abdominal wall hernia repair after open abdomen management represents a surgical challenge, particularly due to muscle tension and lateral retraction. This study was designed to propose the use of Botulinum Toxin Type A (BTA) before abdominal wall hernia repair. METHODS: A prospective study of patients with abdominal wall hernia after open abdomen management was undertaken between September 2007 and January 2009. Bilateral BTA application was performed under electromyographic guidance at the abdominal wall. Transverse abdominal wall defect measurement was practiced at weekly intervals: clinically, in the first two patients, and with CT scan in the following 10 patients. Surgical closure was scheduled if no further hernia defect reduction was noted. Patients were followed at monthly hospital visits. RESULTS: In the first two patients, a hernia defect reduction of 50 and 47.2%, respectively, was documented by the third week after BTA application, with no further reduction. In the 10 patients under CT scan hernia defect measurement, when comparing the initial mean transverse defect measure and at 4 weeks after BTA application (13.85 +/- 1.49 cm vs. 8.6 +/- 2.07 cm), an overall mean reduction of 5.25 +/- 2.32 cm was observed (p < 0.001; 95% confidence interval, 3.59-6.91). Hernia repair was performed, with no recurrences at a mean follow-up of 9.08 months. CONCLUSIONS: BTA application before abdominal wall hernia repair seems to be useful. The lateral muscles paralysis achieved and transverse hernia defect reduction allows a minimal tension closure. To our knowledge, this is the first report of BTA application before abdominal wall hernia reconstruction.
