Quality of life following transobturator sling surgery for female stress urinary incontinence.

OBJECTIVE: This descriptive study examines quality of life in women undergoing placement of a midurethral sling for stress urinary incontinence. MATERIALS AND METHODS: This was a retrospective cohort study based on data from 51 women consecutively undergoing this procedure at a tertiary hospital in the years 2014 and 2015. The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF) at the time points baseline or presurgery, and 6 months and 5 years postsurgery. Factors associated with treatment failure were determined through binary logistic regression. RESULTS: At 5-year follow up we obtained an absolute reduction of 8.78 points (95% CI 6.43-11.14; p < 0.001) in the ICIQ-IU-SF questionnaire and 4.54 (95% CI 3.25-5.83; p < 0.001) in the Sandvick severity test score, compared to baseline, in the 35 patients that completed follow-up. Out of the 51 patients that were followed, the rate of success in incontinence correction was 86.3% (44/50) with a failure rate of 12% (6/50). Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure. Obesity was associated with a worse treatment outcome. CONCLUSION: Sling treatment for incontinence was successful in 86.3% (44/50) of participants and remained effective 5 years after surgery in terms of quality of life.

Obstrucción intestinal tardía secundaria a migración de cono de polipropileno / Late intestinal obstruction secondary to polypropylene mesh migration

RESUMEN El uso de materiales protésicos sintéticos en el ámbito de las hernioplastias de pared abdominal ha sido aceptado ampliamente en el mundo; es importante señalar que su implantación puede ocasionar serias complicaciones, por ejemplo, reacción a cuerpo extraño, migración y perforación hacia la cavidad peritoneal (existen informes de migración de malla en espacio preperitoneal imitando cáncer de colon1. El propósito de este artículo es referir un caso de obstrucción intestinal secundaria a migración de malla a cavidad peritoneal, en un paciente previamente asintomático sometido a plastia inguinal izquierda 10 años antes de su ingreso.

ABSTRACT The use of meshes for abdominal wall repair has been widely accepted worldwide; however, serious complications may occur, such as foreign body reaction, mesh migration, penetration into the peritoneal cavity and even migration into the preperitoneal space mimicking colorectal cancer. The aim of this paper is to report a case of intestinal obstruction secondary to mesh migration into the peritoneal cavity in a previously asymptomatic patient who underwent left inguinal hernia repair 10 years prior to admission.

Are abbreviations and acronyms to describe hernia repair techniques overused and helpful? A proposal for rationalisation.

Surgeons use abbreviations and acronyms frequently to describe surgical techniques. Recent advances and innovations in repair of abdominal wall hernias, have given rise to a plenitude of novel acronyms. For each small deviation of an existing technique authors have proposed a novel acronym. Since an acronym is most of times not self-explaining it is often hard to understand literature, lectures, symposia programs and discussions in social media. Regularly, we discover different acronyms used for the same procedure and sometimes the same or similar acronyms are used for different techniques. A clear and non-ambivalent description of surgical techniques in the literature is most valuable to summarize scientific evidence in systematic reviews and meta-analyses. We would like to propose a more rational use of abbreviations to describe hernia repair techniques based on the type of access, type of hernia, mesh position, type of mesh used and type of mesh fixation.

Laparoscopic TAPP to treat inguinal hernia. Is the robot preferable? A review and cohort-study on anatomical landmarks of robotic-assisted transabdominal preperitoneal groin hernia repair (r-TAPP).

In this review, the advantages of the robotic platform in rTAPP are presented and discussed. Against the background of the unchanged results of conventional TAPP for decades (approx. 10% chronic pain and approx. 3.5% recurrence), a new anatomy-guided concept for endoscopic inguinal hernia repair with the robot is presented. The focus is on the identification of Hesselbach's ligament. The current results give hope that the results of TAPP can be improved by rTAPP and that rTAPP is not just a more expensive version of conventional TAPP. To support the rationale presented here, we analyzed 132 video recordings of rTAPP's for the anatomical structures depicted therein. The main finding is, that in all cases (132/132 or 100%) Hesselbach's ligament was present and following its lateral continuity with the ileopubic tract offered a safe framework to develop all the critical anatomical structures for clearing the myopectineal orifice, repair the posterior wall of the groin and perform a flawless mesh fixation. Future studies are needed to integrate all the resources of the robotic platform into an rTAPP concept that will lead out of the stalemate of the indisputably high rate of chronic pain and recurrences.

Malla suburetral retropúbica (TVT): experiencia clínica y análisis de datos en el Hospital El Carmen de Maipú / Retropubic suburethral mesh (TVT): clinical experience and data analysis at the Hospital El Carmen de Maipú

La incontinencia urinaria de esfuerzo es la pérdida involuntaria de orina durante una maniobra de esfuerzo físico, ejercicio, estornudo o tos. Afecta aproximadamente al 15% de las mujeres de 30-60 años y su prevalencia es del 30-41%. Aunque existen terapias conservadoras para su manejo, muchas pacientes terminarán necesitando cirugía para su resolución. Las mallas suburetrales son alternativas para el manejo quirúrgico, existiendo dos vías de instalación, la transobturadora (TOT o TVT-O) y la retropúbica (del inglés tension-free vaginal tape o TVT), siendo esta última la que presenta mejores resultados y menos complicaciones posoperatorias. Objetivo: evaluar la tasa de efectividad y las complicaciones de la TVT en la Unidad de Piso Pélvico Femenino del Hospital El Carmen de Maipú entre los años 2015 y 2020. Materiales y Métodos: Se obtuvieron 715 registros de pacientes que fueron sometidas a TVT y se logró contactar telefónicamente con el 60,69% de ellas. Resultados: Los resultados muestran una tasa de efectividad del 94,8% y una tasa de complicaciones del 2,3%. Conclusión: Este estudio aporta evidencia local de los resultados posoperatorios en la IOE en pacientes que requirieron la instalación de una malla suburetal retropúbica, demostrando ser una cirugía altamente efectiva y segura.

Stress urinary incontinence is the involuntary loss of urine during physical exertion, exercise, sneezing, or coughing. It affects approximately 15% of women aged 30-60, with a prevalence of 30-41%. Although there are conservative therapies for its management, many patients will eventually require surgery for resolution. Suburethral sling are considered for surgical management, and there are two installation alternatives, transobturator (TOT or TVT-O) and retropubic (tension-free vaginal tape or TVT), with the latter presenting better results and fewer postoperative complications. Objetive: to evaluate effectiveness rate and complications of the TVT in the Female Pelvic Floor Unit of Hospital El Carmen de Maipú between 2015 and 2020. Materials and Methods: A total of 715 patient records were obtained for those who underwent TVT, and 60.69% of them were successfully contacted by telephone. Results: The results show an effectiveness rate of 94.8% and a complication rate of 2.3%. Conclusion: This study provides local evidence for the results of stress urinary incontinence that required the placement of a retropubic suburethral sling, proving to be a highly effective and safe surgery.

Rectopexia laparoscópica con técnica de Orr-Loygue para el tratamiento del prolapso rectal / Laparoscopic Orr-Loygue rectopexy with mesh for the treatment of rectal prolapse

Introducción: Existen múltiples alternativas para el tratamiento quirúrgico del prolapso rectal mediante procedimientos de fijación, resección o combinados. Si bien el abordaje perineal evita el acceso a la cavidad peritoneal, se acompaña de una tasa de recidiva mayor en relación al abordaje abdominal. Descripción: Se presenta una paciente de 66 años, histerectomizada por vía laparotómica, con un prolapso rectal externo y reductible de 1 año de evolución, sin incontinencia fecal ni constipación. La endoscopia preoperatoria descartó patología colónica asociada. Abordaje laparoscópico en posición de Trendelenburg lateralizado a la derecha. Como es habitual en estos casos se observa la presencia de dolicosigma y fondo de saco de Douglas profundo y se evidencia también la cicatriz de la cesárea. El procedimiento comienza con la apertura peritoneal a nivel del promontorio y la movilización de la unión rectosigmoidea, identificando el uréter izquierdo. Se continua la disección circunferencial tras la apertura de la reflexión peritoneal hasta la altura de la cúpula vaginal. La rectopexia se realiza según la técnica de Orr-Loygue mediante la fijación de la malla por una parte a ambas caras laterales del recto y por otra al promontorio sacro con puntos de polipropileno 2-0, cuidando de no lesionar los vasos ilíacos y los uréteres. Finalmente se cierra la reflexión peritoneal con poliglactina para aislar las mallas protésicas del contenido visceral. La paciente tuvo una buena evolución postoperatoria, otorgándose el alta a las 48 h. Tras 8 meses de seguimiento se encuentra asintomática, con tránsito digestivo y continencia fecal sin alteraciones. Conclusión: El abordaje laparoscópico para el tratamiento del prolapso rectal es seguro y ofrece las ventajas de la cirugía mini-invasiva. La rectopexia con malla protésica es un procedimiento técnicamente desafiante, aunque con mejores resultados alejados. (AU)

Introduction: There are multiple alternatives for the surgical treatment of rectal prolapse through fixation, resection or combined procedures. Although the perineal approach avoids access to the peritoneal cavity, it is associated with a higher recurrence rate than the abdominal approach. Description: The video shows a 66-year-old female patient, hysterectomized by laparotomy, with a 1-year history of reduciblefull-thickness rectal prolapse, without fecal incontinence or constipation. Preoperative endoscopy ruled out associated colonic pathology. The laparoscopic approach is done with the patient placed in Trendelenburg and tilted to the right. As usual in these cases, the presence of dolichosigma and deep Douglas pouch is observed, as well as the cesarean section scar. The procedure begins with the peritoneal opening at the level of the promontory and the mobilization of the rectosigmoid junction, identifying the left ureter. Circumferential dissection is continued after opening the peritoneal reflection up to the level of the vaginal vault. Rectopexy is performed according to the Orr-Loygue technique by fixing the mesh to both lateral aspects of the rectum on one side and to the sacral promontory on the other side with 2-0 polypropylene interrupted sutures, taking care not to injure the iliac vessels and ureters. Finally, the peritoneum is closed with a running suture with polyglactin to isolate the prosthetic mesh from the visceral content. The patient had a good postoperative outcome and was discharged at 48 h. After 8 months of follow-up, she is asymptomatic and has normal colonic transit and fecal continence. Conclusion: the laparoscopic approach for the treatment of rectal prolapse is safe and offers the advantages of minimally invasive surgery. Prosthetic mesh rectopexy is a technically challenging procedure, although has better distant results. (AU)

Comparación entre el uso de malla de prolene y cinta de mersilene en la sacrohisteropexia abdominal para el prolapso apical: ensayo clínico aleatorizado / Abdominal sacro-hysteropexy using proline mesh versus mersilene tape in apical prolapse: A randomized clinical trial

Contexto La preservación uterina se requiere cada vez más en el tratamiento quirúrgico del prolapso de órganos pélvicos. El uso de la malla de prolene puede tener efectos adversos en la reparación quirúrgica del prolapso. Objetivo Comparar el uso de malla de polipropileno y cinta de mersilene en la sacrohisteropexia abdominal para el tratamiento de prolapso apical en estadio ii o superior. Diseño del estudio Este ECA se realizó en el departamento de Obstetricia y Ginecología (hospitales universitarios de Menoufia y Ain Shams, Egipto). La población elegible incluyó a mujeres a las que se había planificado una sacrohisteropexia por prolapso uterino≥estadio 2, asignadas a 2 grupos: grupo de malla (n=38), sometidas a sacrohisteropexia con malla de polipropileno; y grupo de cinta (n=38), tratadas mediante sacrohisteropexia sacra con cinta de mersilene. Resultados Hubo diferencias estadísticamente significativas entre el grupo tratado con cinta y el grupo tratado con malla en cuanto a la duración de la histeropexia: 50,4min en el grupo de cinta vs. 90,6min en el grupo de malla (p<0,001), y en cuanto a la necesidad de analgésicos en el postoperatorio: 14 en el grupo de cinta vs. 27 en el de malla (p<0,005). La estancia hospitalaria media fue de 2,8 días en el grupo de cinta vs. 5,2 días en el grupo de malla (p<0,001). Conclusiones EL uso de cinta de mersilene en la sacrohisteropexia es una alternativa segura a la malla de poliprolileno, con una eficacia comparable y menos complicaciones. El procedimiento con cinta es más fácil, ya que requiere una zona de disección menor para la fijación sacra, por lo que la incidencia de lesiones es más baja (AU)

Background Uterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. Objective Compare between using polyproline mesh and mersilene tape in abdominal sacrohysteropexy repairing apical prolapse stage ?? or more. Study design This RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned sacrohysteropexy for uterine prolapse≥stage 2 assigned to 2 groups: Mesh group (n=38), underwent sacrohysteropexy with polyproline mesh, and tape group (n=38), underwent sacrohysteropexy using mersilene tape. Results High statistically significant difference between tape group and mesh group concerning hysteropexy time was 50.4minute in tape group vs 90.6minute in mesh group (P<.001), need for post operative analgesia was 14 in tape group vs 27 in mesh group (P<.005). The mean hospital stay was 2.8 days in tape group vs 5.2days mesh group (P<.001). Conclusions Using mersilene tape in sacrohysteropexy is a safe alternative to polyproline mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence (AU)

Encuesta nacional a unidades de cirugía colorrectal sobre el cierre de pared abdominal / National survey of colorectal surgery units on abdominal wall closure

Introducción: El objetivo de este estudio es valorar el estado actual y conocimiento de los cirujanos colorrectales españoles en el cierre de pared abdominal. Métodos: Se realizó un cuestionario de 25 preguntas cerradas de respuesta única utilizando un software específico para encuestas online que se distribuyó a cirujanos que se dedican, principalmente, a la cirugía colorrectal en su servicio o pertenecen a una Unidad de Cirugía Colorrectal. Resultados: Respondieron la encuesta 53 cirujanos. La mayoría prefiere el cierre de la laparotomía media con una sutura continua (96,23%) de monofilamento de absorción muy lenta (67,92%) en un solo plano (81,13%). Los puntos en masa, los sistemas de retención y las suturas loop siguen utilizándose. El calibre de sutura habitualmente más utilizado fue del 1 USP (United States Pharmacopeia) (58,49%). La aguja más utilizada es de cuerpo cilíndrico y punta trocar. Solo el 50% realiza habitualmente cierre de la pared tras colocación de un trocar igual o mayor de 10mm. Prácticamente todos conocen la regla del 4:1 y creen que se debe aplicar, pero la técnica de puntos cortos no se realiza. El 50% no colocaría nunca una prótesis profiláctica. El cierre lo suele realizar el mismo cirujano que ha llevado a cabo todo el procedimiento. Uno de cada 5 confiesa desconocer la tasa de hernias incisionales de su unidad. Conclusiones: Se evidencia una falta de consenso y conocimientos básicos en cuanto a los aspectos técnicos de cierre y a la prevención de la aparición de hernias incisionales. Parece aceptado el uso de sutura continua, en un solo plano, con sutura monofilamento de reabsorción lenta. (AU)

Introduction: The purpose of this study is to assess the current status and knowledge of the Spanish colorectal surgeons on the wall closure. Methods: A single answer questionnaire of 25 closed questions was conducted using specific software for online surveys that was distributed to a cohort of colorectal surgeons. Results: 53 surgeons replied to the survey. The vast majority prefer a closure of the midlaparotomy with a very slow absorbing monofilament (67,92%) continuous suture (96,23%) in a single plane (81,13%). Mass stitches, retention systems, and loop sutures continue to be used. The most commonly used suture gauge was USP 1 (United States Pharmacopeia) (58,49%). The most commonly used needle is with a cylindrical body and a trocar tip. Only 50%, routinely perform wall closure after placement of a trocar equal to or greater than 10mm. Almost everyone knows the 4: 1 rule and thinks it should be applied, but the small bites technique is not performed. 50% would never place a prophylactic prosthesis. The closure is usually performed by the same surgeon who has performed the entire procedure. One out of five confesses not knowing the rate of incisional hernias in his unit. Conclusion: There is a lack of consensus and basic knowledge regarding the technical aspects of closure and the prevention of the appearance of incisional hernias. The use of slow absorbing monofilament continuous suture in a single plane seems well accepted. (AU)

Abdominal Sacrohysteropexy using Proline mesh versus Mersilene tape in apical prolapse: A randomized clinical trial.

IMPORTANCE: uterine preservation is increasingly a common demand in surgical management of pelvic organ prolapse. Using Proline mesh in surgical repair of prolapse may have negative drawbacks. OBJECTIVE: compare between using Polyproline mesh and Mersilene tape in abdominal Sacrohysteropexy repairing apical prolapse stage ӀӀ or more. STUDY DESIGN: This RCT study was conducted at the Department of Obstetrics and Gynecology (Menoufia and Ain Shams university hospitals, Egypt). Eligible population included women planned Sacrohysteropexy for uterine prolapse ≥ stage 2 assigned to two groups: Mesh group (n = 38), underwent Sacrohysteropexy with polyproline mesh, and Tape group (n = 38), underwent Sacrohysteropexy using Mersilene tape. RESULTS: High statistically significant difference between TAPE group and MESH group concerning hysteropexy time was 50.4 min in TAPE group vs 90.6 min in MESH group (p < 0.001), need for post operative analgesia was14 in TAPE group vs 27 in MESH group (p < 0.005). The mean hospital stay was 2.8 days in TAPE group vs 5.2days in MESH group (p < 0.001). CONCLUSIONS: Using Mersilene tape in Sacrohysteropexy is a safe alternative to Polyproline Mesh with comparable efficacy with less complications. Tape is easier as it needs less dissection area for sacral fixation so less injury incidence.

Reconstrucción de aparato extensor en sarcoma fibromixoide de bajo grado en rodilla: reporte de caso

Introducción: El sarcoma fibromixoide de bajo grado es una tumoración maligna con alto riesgo de desarrollar recurrencia y metástasis, siendo la resección quirúrgica con márgenes amplios el tratamiento principal, la preservación de la extremidad y su reconstrucción es de alta demanda para los cirujanos. Reporte de caso: Presentamos el caso de una mujer de 67 años con recurrencia de tumoración en rodilla desde hace 12 meses, operado dos años antes. Se realizo resección oncológica de tumoración con reconstrucción de articulación de rodilla con prótesis Endo Model y reconstrucción de aparato extensor con injerto sintético de malla de polipropileno más autoinjerto de semitendinoso y gracilis. La patela se reconstruyó con autoinjerto de cóndilo femoral posterior. A los 16 meses de seguimiento la paciente se encuentra libre de enfermedad, con puntaje de 27 en la escala para miembro inferior de la MSTS (Musculoskeletal Tumour Society). Conclusión: La combinación de injerto sintético con autoinjerto de isquiotibiales puede disminuir la tasa de falla de la reconstrucción del aparato extensor por resecciones oncológicas.

Introduction: Low-grade fibromyxoid sarcoma is a malignant tumor with a high risk of developing recurrence and metastasis, surgical resection with wide margins is the main treatment, limb preservation and reconstruction is in high demand for surgeons. Case of report: We present the case of a 67-year-old woman with a recurrence of a knee tumor that had been operated on two year earlier. Oncological resection of the tumor was performed with reconstruction of the knee joint with an Endo Model prosthesis and extensor mechanism reconstruction with a synthetic polypropylene mesh graft plus a semitendinosus and gracilis autograft. The patella was reconstructed with posterior femoral condyle autograft. At 16 months of patient follow-up, she is free of disease, with a score of 27 on the lower limb scale of the MSTS (Musculoskeletal Tumor Society). Conclusion: The combination of synthetic graft with hamstring autograft can reduce the failure rate of extensor mechanism reconstruction due to oncological resections.

National survey of colorectal surgery units on abdominal wall closure.

INTRODUCTION: The purpose of this study is to assess the current status and knowledge of the Spanish colorectal surgeons on the wall closure. METHODS: A single answer questionnaire of 25 closed questions was conducted using specific software for online surveys that was distributed to a cohort of colorectal surgeons. RESULTS: 53 surgeons replied to the survey. The vast majority prefer a closure of the midlaparotomy with a very slow absorbing monofilament (67.92%) continuous suture (96.23%) in a single plane (81.13%). Mass stitches, retention systems, and loop sutures continue to be used. The most commonly used suture gauge was USP 1 (United States Pharmacopeia) (58.49%). The most commonly used needle is with a cylindrical body and a trocar tip. Only 50%, routinely perform wall closure after placement of a trocar equal to or greater than 10 mm. Almost everyone knows the 4:1 rule and thinks it should be applied, but the small bites technique is not performed. 50% would never place a prophylactic prosthesis. The closure is usually performed by the same surgeon who has performed the entire procedure. One out of five confesses not knowing the rate of incisional hernias in his unit. CONCLUSION: There is a lack of consensus and basic knowledge regarding the technical aspects of closure and the prevention of the appearance of incisional hernias. The use of slow absorbing monofilament continuous suture in a single plane seems well accepted.

Uso de placa malla en el manejo de fracturas conminutas de patela: reporte de caso / Use of mesh plate for the treatment of comminuted patellar fractures: case report

OBJETIVOS Describir la técnica quirúrgica para el uso de placa malla en un caso de fractura conminuta de patela y sus resultados en el seguimiento a mediano plazo. MATERIALES Y MÉTODOS Presentamos un caso de fractura conminuta de patela manejada con el uso de una placa malla y un tornillo canulado asociado, evitando de esta forma la patelectomía parcial y sus posibles complicaciones. RESULTADOS El paciente presentó una evolución satisfactoria, con rango de movimiento de rodilla completo y en condiciones de alta laboral a los cuatro meses desde la cirugía, sin complicaciones ni reintervenciones. DISCUSIÓN El uso de placas malla permite el manejo de fracturas conminutas de patela preservando stock óseo y restaurando la indemnidad del aparato extensor, con una osteosíntesis estable y poco prominente. Casos en que antiguamente la única alternativa era la patelectomía parcial y reinserción del tendón patelar ahora tienen etas placas como opción de manejo. CONCLUSIÓN El uso de placas malla en fracturas conminutas de patela es una alternativa atractiva por la estabilidad que brindan, la capacidad de reservar stock óseo, y la baja tasa de reintervenciones

OBJETIVE To describe the surgical technique for the use of a mesh plate in a case of comminuted patellar fracture and the mid-term follow up outcomes. MATERIALS AND METHODS We present a case of comminuted patella fracture managed with the use of a mesh plate and an associated cannulated screw, thus avoiding partial patellectomy and its possible complications. RESULTS Four months postoperatively, the patient presented full knee range of motion and could be discharged to return to work, with no complications or reinterventions. DISCUSSION The use of mesh plates enables the management of comminuted patellar fractures preserving bone stock and restoring the extensor mechanism with a stable and little prominent osteosynthesis. Cases which previously would only have been treated by partial patellectomy and patellar tendon reinsertion can be treated with these plates. CONCLUSION The use of mesh plates for comminuted patellar fractures is an attractive option due to their stability, their ability to preserve bone stock, and the low rates of reintervention.

Expanding indication of laparoscopic intracorporeal rectus aponeuroplasty (LIRA) to suprapubic area: LIRA & TAPE / Indicación extendida de la aponeuroplastia intracorpórea de rectos laparoscópica (LIRA) al área suprapúbica: LIRA & TAPE

Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) is a minimally invasive technique described to repair M2–M4 primary and incisional hernias. Defects below this area (M5 – Suprapubic area) could be treated using the concept associated to LIRA, expanding the indication of this technique in combination with a transabdominal partially extraperitoneal (TAPE) repair. The aim of this video is to show the surgical steps in the combination of LIRA & TAPE for M2–M5 ventral hernias (AU)

La aponeuroplastia intracorpórea de rectos laparoscópica (LIRA) es una técnica mínimamente invasiva para la reparación de las hernias incisionales de M2 a M4. Los defectos por debajo de esta zona (M5 – área suprapúbica) se pueden reparar mediante una indicación extendida de LIRA combinada con la reparación transabdominal parcialmente extraperitoneal (TAPE). El objetivo de este video es demostrar los pasos quirúrgicos en la combinación de LIRA & TAPE para hernias ventrales de M2 a M5 (AU)

Expanding indication of laparoscopic intracorporeal rectus aponeuroplasty (LIRA) to suprapubic area: LIRA & TAPE.

Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) is a minimally invasive technique described to repair M2-M4 primary and incisional hernias. Defects below this area (M5 - Suprapubic area) could be treated using the concept associated to LIRA, expanding the indication of this technique in combination with a transabdominal partially extraperitoneal (TAPE) repair. The aim of this video is to show the surgical steps in the combination of LIRA & TAPE for M2-M5 ventral hernias.

Well-of-the-well (WOW) versus polyester mesh (PM): a comparison of single-embryo culture systems in bovines

Background: Mexico is innovating in the livestock industry through in vitro generation of bovine embryos with technologies such as well-of-the-well (WOW) and polyester mesh (PM) single-embryo culture systems. These techniques allow to maintain embryos in separate areas of a shared culture medium. Objective: To compare the quantity and quality of bovine embryos produced in WOW and PM culture systems versus the conventional (CG) culture system. Methods: In total, 345 embryos fertilized in vitro were evaluated for blastocyst yield in the three culture systems. To count blastocyst cell numbers, 69 embryos in each system were differentially stained for trophectoderm (TE), inner cell mass (ICM), and apoptotic cells. A qPCR gene expression analysis was performed for embryos in all three systems. Results: The WOW, PM and CG systems developed similar amount of blastocysts (41, 35 and 36%, respectively; p>0.05). Blastocysts in all three systems showed adequate amounts of ICM and apoptotic cells. Blastocysts in the PM system showed a greater number of TE cells [63.7 versus 58.6% in the CG system (p0.05). The ATP5B expression was higher in WOW than in PM (p0.05). The TJP3 expression was higher in PM than in WOW and CG (p<0.05). Expression of ID2 and CLDN4 was higher in WOW than in PM and CG (p<0.05). The biplot graphic from Principal Component Analysis (PCA) revealed that CG was located near degenerated embryos, whereas PM was located near arrested embryos, larger ICM and TE, and TJP3 expression. The WOW was located toward blastocysts, morulae, and expression of CLDN4, ID2 and GNAS. Conclusion: Compared with CG, both the PM and WOW systems are good options for culturing single embryos in the bovine model. Moreover, the PCA results suggest that embryos developed in the WOW system have greater capacity for generating blastocysts with increased ability to form TE and ICM layers, which might improve implantation.

Antecedentes: México está innovando en la industria ganadera a través de la generación in vitro de embriones bovinos con tecnologías de cultivo individual como lo son Pozo dentro de Pozo (WOW) y Malla de Poliéster (PM). Estos mantienen los embriones en áreas separadas mientras comparten un mismo medio de cultivo celular. Objetivo: Comparar la cantidad y calidad de embriones bovinos producidos en los sistemas WOW y PM contra el sistema de cultivo convencional en grupo (CG). Métodos: En total se evaluaron 345 embriones fertilizados in vitro para determinar la producción de blastocistos generados en los tres sistemas. Para contar el número de células por blastocisto, 69 embriones en cada sistema se tiñeron diferencialmente para trofectodermo (TE), masa celular interna (ICM) y células apoptóticas. Se realizó un análisis de expresión génica por qPCR de los embriones obtenidos en los tres sistemas. Resultados: Los sistemas WOW, PM y CG desarrollaron similares cantidades de blastocistos (41, 35 y 36%, respectivamente; p>0,05). Los blastocistos en los tres sistemas mostraron cantidades adecuadas de ICM y células apoptóticas. Los blastocistos en el sistema PM mostraron un mayor número de células TE [63,7% versus 58,6% en el sistema CG (p0,05). La expresión de ATP5B fue mayor en WOW que en PM (p<0,05), pero similar a CG (p<0,05). La expresión de TJP3 fue mayor en PM que en WOW y CG (p<0,05). La expresión de ID2 y CLDN4 fue mayor en WOW que en PM y CG (p<0,05). El gráfico de biplot del análisis de componentes principales reveló que CG se encontró cerca de embriones degenerados, mientras que PM se encontró cerca de embriones en arresto, ICM, TE, y TJP3. El WOW se localizó hacia blastocistos, mórulas y la expresión de CLDN4, ID2 y GNAS. Conclusión: En el modelo bovino los sistemas PM y WOW son buenas opciones para cultivar embriones individuales, ya que se obtienen resultados muy similares a los obtenidos con el sistema CG. Además, los resultados de PCA sugieren que los embriones individuales desarrollados en el sistema WOW generan blastocistos con mayor capacidad de formar TE e ICM, lo que podría mejorar su éxito de implantación.

Antecedentes: O México está inovando na indústria pecuária por meio da geração in vitro de embriões bovinos com tecnologias de cultura de embriões individuais, bem como em poço (WOW) e malha de poliéster (PM). Estes mantêm os embriões em áreas separadas, enquanto compartilham o mesmo meio de cultura de células. Objetivo: Comparar a quantidade e a qualidade de embriões bovinos produzidos nos sistemas de cultura WOW e PM com o sistema convencional de cultura em grupo (CG). Métodos: No total, 345 embriões fertilizados in vitro foram avaliados para determinar a produção de blastocistos gerados nos três sistemas. O número de células por blatocisto foi contado, 69 embriões em cada sistema foram diferencialmente corados para trofectoderme (TE), massa celular interna (ICM) e células apoptóticas. Uma análise de expressão gênica qPCR foi realizada para os embriões obtidos nos três sistemas. Resultados: Os sistemas WOW, PM e CG desenvolveram quantidades semelhantes de blastocistos (41, 35 e 36%, respectivamente; p>0,05). Os blastocistos nos três sistemas mostraram quantidades adequadas de ICM e células apoptóticas. Os blastocistos no sistema PM mostraram um número maior de células TE [63,7 versus 58,6% no sistema CG (p0,05). A expressão de ATP5B foi maior no WOW do que no PM (p<0,05), mas semelhante ao GC (p<0,05). A expressão de TJP3 foi maior no PM do que no WOW e CG (p<0,05). A expressão de ID2 e CLDN4 foi maior no WOW do que no PM e CG (p<0,05). O gráfico biplot da análise de componentes principais revelou que CG foi encontrado próximo a embriões degenerados, enquanto PM foi encontrado próximo a embriões presos, ICM, TE e TJP3. WOW foi encontrado para ter blastocistos, mórulas e a expressão de CLDN4, ID2 e GNAS. Conclusão: Em comparação com o CG, os sistemas PM e WOW são boas opções para a cultura de embriões individuais no modelo bovino. Além disso, os resultados da PCA sugerem que embriões individuais desenvolvidos no sistema WOW têm maior capacidade de desenvolver blastocistos com maior capacidade de formar as camadas TE e ICM, o que poderia melhorar seu sucesso de implantação.

Preliminary identification of pathogenic variants in an Afro-Colombian Raizal family with risk factors for glaucoma / Identificación preliminar de variantes patógenas en una familia raizal afrocolombiana con factores de riesgo para glaucoma

Abstract Objective: To identify pathogenic variants in an Afro-Colombian Raizal family with risk factors for glaucoma. Methods: In the present study, whole exome sequencing was performed on seven members of a Raizal family from the archipelago of San Andrés, Providencia, and Santa Catalina, in the Caribbean region of Colombia. Four of them had been diagnosed with glaucoma. In addition, two healthy volunteers from the island were included. Results: Of the 198 single nucleotide variants associated with glaucoma, previously reported by the DisGeNET database, four were identified in members of the Raizal family: rs11938093, rs7336216, rs3817672, and rs983034. Furthermore, single nucleotide variant rs983034 was identified in the Wnt ligand secretion mediator gene in all members of the family but not in healthy volunteers. Notably, WLS dysfunctions have been linked to pathology in the trabecular meshwork of the eye. Trabecular meshwork is an important regulator of the outflow of aqueous humor that maintains intraocular pressure (intraocular pressure) at normal levels. Damage to trabecular meshwork is associated with ocular hypertension, which leads to glaucoma progression. In relation to the other single nucleotide variants that were identified, their presence was confirmed in some members of the Raizal family. However, it is still unclear the pathophysiological cause that associates these single nucleotide variants with glaucoma. Conclusions: It was possible to identify four non-synonymous single nucleotide variants that predict significant damage to the structure and function of genes associated with glaucoma pathology in an Afro-Colombian.

Resumen Objetivo: Identificar las variantes patogénicas en una familia raizal afrocolombiana con factores de riesgo para el glaucoma. Métodos: En el presente estudio, se realizó una secuenciación de exoma completo en siete miembros de una familia Raizal del archipiélago de San Andrés, Providencia y Santa Catalina del Caribe colombiano. La mitad de ellos habían sido diagnosticados con glaucoma. Además, se incluyeron dos voluntarios sanos de la isla. Resultados: De las 198 variantes de un solo nucleótido (SNV) asociadas con el glaucoma, previamente informadas por la base de datos DisGeNET, se identificaron cuatro en los miembros de la familia Raizal: rs11938093, rs7336216, rs3817672 y rs983034. Ademas, en todos los miembros de la familia, pero no en voluntarios sanos, se identificó SNV rs983034 en el gen mediador de secreción de ligando Wnt (WLS). Notablemente, las disfunciones WLS se han relacionado con patologías en la red trabecular (TM) del ojo. TM es un regulador importante del flujo de salida del humor acuoso que mantiene la presión intraocular (presión intraocular) en niveles normales. El daño a la TM se asocia con hipertensión ocular que conduce a la progresión del glaucoma. En relación con los demás SNV identificados, se constató su presencia en algunos miembros de la familia Raizal. Sin embargo, aún no está clara la causa fisiopatológica que asocia estas SNV con el glaucoma. Conclusiones: Fue posible identificar cuatro SNVs no sinónimos con predicción de daño significativo en la estructura y función de genes asociados a patología de glaucoma en un afrocolombiano.

Reacción anafilactoide a látex tras colocación de malla transvaginal para corrección de cistocele / Anaphylactoid latex reaction after transvaginal mesh placement for cystocele correction

La incidencia de alergia al látex en la población general es del 1-2%, siendo las reacciones más frecuentemente descritas de hipersensibilidad inmediata o tipo i y tardía o tipo iv, aunque también han sido descritas reacciones de hipersensibilidad no mediadas por IgE.Presentamos el caso de una mujer de 71 años con factores de riesgo cardiovascular (HTA y DLP) e intervenida previamente de colecistectomía y cistocele que ingresa de forma programada para intervención de recidiva de cistocele grado iv tras 4 años de la primera intervención.En el postoperatorio inmediato presenta fracaso renal agudo, por lo que se retira la malla a las 24h, persistiendo deterioro progresivo del estado general con dificultad respiratoria, disminución del nivel de conciencia y empeoramiento de la función renal. Tras una exploración exhaustiva se visualiza eritema en región vulvar e inguinal, por lo que se sospecha reacción anafiláctica a sonda de látex, que se recambia por una sonda de silicona, iniciándose tratamiento con metilprednisolona intravenosa y se consulta con el servicio de Alergología, que establece finalmente el diagnóstico.La paciente requirió ingreso en la unidad de cuidados intensivos durante 10 días por insuficiencia renal aguda e insuficiencia respiratoria aguda asociadas a íleo paralítico y coagulopatía.La anafilaxia es una reacción sistémica aguda que resulta en la liberación brusca de mediadores de los mastocitos y basófilos, mediada o no por IgE. Se admite que es una reacción de hipersensibilidad sistémica grave, de inicio repentino y potencialmente mortal. Clínicamente se asocia a la aparición de manifestaciones cutáneas relacionadas con alteraciones cardiovasculares, respiratorias o gastrointestinales.

Allergy to latex in the general population is 1-2%, the most frequent reactions described being immediate or type i and late or type iv hypersensitivity, although non-IgE-mediated hypersensitivity reactions have also been described.We present the case of a 71-year-old woman with cardiovascular risk factors (HTN and PLD) and previously operated on for cholecystectomy and cystocele who was admitted on a scheduled basis for intervention for grade iv cystocele recurrence, 4 years after the first intervention.In the immediate postoperative period, she presented acute renal failure, for which the mesh was removed after 24h, her general condition progressively deteriorated with respiratory distress, decreased level of consciousness, and worsening of renal function. After an exhaustive examination, erythema was visualized in the vulvar and inguinal region, hence the suspicion of an anaphylactic reaction to a latex catheter, which was replaced by a silicone catheter. Treatment was started with intravenous methylprednisolone, and the Allergology service was consulted who finally established the diagnosis.The patient required admission to the intensive care unit for 10 days due to acute renal failure and acute respiratory failure, associated with paralytic ileus and coagulopathy.Anaphylaxis is an acute systemic reaction that results in the abrupt release of mediators from mast cells and basophils, mediated or not by IgE. It is recognized to be a severe, sudden onset, and life-threatening systemic hypersensitivity reaction. Clinically, it is associated with the appearance of skin manifestations related to cardiovascular, respiratory, or gastrointestinal disorders.

Resultados de la utilización de malla única en la reparación laparoscópica transabdominal (TAPP) de hernias inguinales bilaterales directas / Outcomes of laparoscopic transabdominal (TAPP) inguinal hernia repair with single mesh in bilateral direct inguinal hernias

RESUMEN Antecedentes: La cirugía laparoscópica presenta ventajas que son claramente observadas en la reparación de hernias bilaterales y recidivadas. El uso de una malla única como alternativa en la reparación de las inguinales bilaterales laparoscópicas con técnica transabdominal (TAPP) puede reducir el índice de recidivas y las chances de dolor crónico. Objetivo: describir y analizar los beneficios del uso de una malla única en el tratamiento de las hernias inguinales bilaterales con técnica TAPP. Material y métodos: análisis retrospectivo de hernioplastias inguinales laparoscópicas directas o mixtas operadas por vía transabdominal con malla única, efectuadas en pacientes con hernias inguinales bilaterales. Resultados: entre enero de 2016 y enero de 2017 se operaron 177 pacientes con hernia inguinal. Noventa y tres (93) pacientes presentaron hernias bilaterales, de las cuales 39 fueron operadas mediante el uso de la técnica con malla única, incluidas en este estudio. Conclusión: la utilización de una malla única es una alternativa segura en el tratamiento de las hernias inguinales bilaterales directas o mixtas operadas por vía laparoscópica con técnica TAPP.

ABSTRACT Background: The laparoscopic approach has clear advantages for repairing bilateral hernias and recurrent hernias. The use of a single mesh as an option in the laparoscopic treatment of direct bilateral inguinal hernias with the transabdominal preperitoneal (TAPP) technique, may reduce the recurrence rate and chronic pain. Objective: The aim of this study is to analyze the benefits of single mesh for the treatment of bilateral inguinal hernias with the TAPP technique. Material and methods: We conducted a retrospective analysis of patients with bilateral direct inguinal hernias undergoing laparoscopic hernia repair with the TAPP technique using a single mesh. Results: Between January 2016 and January 207 177 patients underwent inguinal hernia repair. Of the 93 patients with bilateral hernias, a single mesh was used in 39, which were included in this study. Conclusion: The use of a single mesh is a safe option for the laparoscopic treatment of direct bilateral inguinal hernias with the TAPP technique.

Uso de prótesis esofágicas cubiertas de doble malla en fístulas esofágicas postquirúrgicas y perforaciones esofágicas: experiencia en nuestro centro / Use of double-layered covered esophageal stents in post-surgical esophageal leaks and esophageal perforation: Our experience

Introducción: El uso de prótesis esofágicas para el manejo endoscópico de fístulas y perforaciones se ha convertido en un procedimiento habitual. Una de sus limitaciones es su alta tasa de migración. Para resolver esta situación, se ha propuesto el uso de prótesis cubiertas de doble malla.Objetivos: Analizar nuestra experiencia práctica en el empleo de prótesis esofágicas cubiertas de doble malla (PECDM) (modelo Niti S™ DOUBLE™ Esophageal Metal Stent) en pacientes con fístula o perforación esofágica.Material y métodos: Estudio retrospectivo, descriptivo y unicéntrico, donde se incluyen pacientes con diagnóstico de fístula o perforación esofágica, desde noviembre 2010 hasta octubre 2018. Como objetivo primario, se evaluará su eficacia en términos de éxito técnico. Como objetivo secundario, se analizará su perfil de seguridad.Resultados: Se incluyeron inicialmente un total de 31 pacientes, siendo 8 de ellos excluidos por fallecimiento por causas ajenas a la técnica. Se detectó un éxito técnico del 100%, con un éxito primario del 75% tras la recolocación de la prótesis. Entre sus complicaciones, la migración ocurrió en un 21,7% de los pacientes (n=5), resolviéndose vía endoscópica en el 100% de los casos.Conclusiones: Según nuestros hallazgos, las PECDM suponen una alternativa en el tratamiento de fístulas y perforaciones esofágicas, con una alta tasa de éxito en la resolución de fístulas y baja de complicaciones, en contraste con lo expuesto en las series publicadas. En todos los casos, la migración de la prótesis se resolvió mediante recolocación endoscópica, sin requerir nueva prótesis ni cirugía.(AU)

Introduction: The use of esophageal stents for the endoscopic management of esophageal leaks and perforations has become a usual procedure. One of its limitations is its high migration rate. To solve this incovenience, the double-layered covered esophageal stents have become an option.Objectives: To analyse our daily practice according to the usage of double-layered covered esophageal metal stents (DLCEMS) (Niti S™ DOUBLE™ Esophageal Metal Stent Model) among patients diagnosed of esophageal leak or perforation.Methods: Retrospective, descriptive and unicentric study, with inclusion of patients diagnosed of esophageal leak or perforation, from November 2010 until October 2018. The main aim is to evaluate the efficacy of DLCEMS, in terms of primary success and technical success. The secondary aim is to evaluate their (the DLCEMS) safety profile.Results: Thirty-one patients were firstly included. Among those, 8 were excluded due to mortality not related to the procedure. Following stent placement, technical success was reached in 100% of the cases, and primary success, in 75% (n=17). Among the complications, stent migration was present in 21.7% of the patients (n=5), in whom the incident was solved by endoscopic means.Conclusions: According to our findings, DLCEMS represent an alternative for esophageal leak and perforation management, with a high success rate in leak and perforation resolutions and low complication rate, in contrast to the published data. The whole number of migrations were corrected by endoscopic replacement, without the need of a new stent or surgery.(AU)

Herbo-metallic ethnomedicine 'Malla Sindoor' ameliorates lung inflammation in murine model of allergic asthma by modulating cytokines status and oxidative stress.

ETHNOPHARMACOLOGICAL RELEVANCE: Asthma is the leading inflammatory disease of the airways with inadequate therapeutic options. 'Malla Sindoor' (MS) is a metal-based ethnomedicinal formulation that has been prescribed in the ancient traditional medicinal system for treating chronic inflammations. AIM OF THE STUDY: Here, we validated the anti-inflammatory and anti-asthmatic properties of traditional metallic medicine MS in asthmatic mice model and in LPS stimulated human monocytic THP-1 cells, by examining the relevant cellular, biochemical and molecular intermediates. MATERIALS AND METHODS: Scanning Electron Microscope (SEM), Electron Dispersive X-ray (EDX), and X-Ray Diffraction (XRD) were performed to characterize MS particles. Allergic asthma was induced in Balb/c mice through intraperitoneal ovalbumin (OVA) injection. Experimental groups include, normal control, disease control, Dexamethasone (2 mg/kg) and three MS treated groups: 4.3 mg/kg, 13 mg/kg, and 39 mg/kg. Quantitative PCR, inflammatory cytokines and anti-oxidant enzymes, and histological analysis were performed, in the treated mice and LPS stimulated human monocytic THP-1 cells for determining the MS efficacy. RESULTS: SEM image analysis showed the MS to be heterogenous in shape with a particle size distribution between 100 nm-1 µm. Elemental composition showed the presence of mercury (Hg), arsenic (As), and sulphur (S) along with other elements in the forms of mercury sulfide, arsenic trioxide, and their alloy crystals. OVA-challenge of the Balb/c mice resulted in the development of overt pathological features for allergic asthma including smooth muscle thickening and collagen deposition. Mice receiving MS-exhibited alleviation of allergic asthma features. BAL fluid analysis showed a decrease in the total cell count and decreases in neutrophils, monocytes, lymphocytes, and eosinophils. Further, the stimulated levels of interleukin (IL)-1ß, -6, and TNF-α cytokines and antioxidant levels were also reduced upon MS-treatment. At the molecular level, MS-treatment reduced stimulated mRNA expression levels for IL-4, -5, -10, -13, -33, and IFN-γ cytokines. Histological analysis following MS-treatment of OVA-stimulated mice lungs showed a reduction in mucus accumulation in airways, decreases in peribronchial collagen deposition, bronchial smooth muscle thickening, and attenuation of inflammatory cell infiltration. In addition, under in-vitro conditions, MS-treatment attenuated the LPS induced secretion of IL-1ß, -6, and TNF-α from THP-1 cells. CONCLUSION: Collectively, the results suggest that MS acts as an effective anti-asthmatic and anti-inflammatory agent, by regulating various cellular, biochemical and molecular intermediates.