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JSLS : Journal of the Society of... 2024We operated on a series of mostly obese patients with diastasis recti abdominis using the "Slim-Mesh" technique to repair/reinforce the diastasis and linea alba/recti...
BACKGROUND AND OBJECTIVE
We operated on a series of mostly obese patients with diastasis recti abdominis using the "Slim-Mesh" technique to repair/reinforce the diastasis and linea alba/recti muscles without plicating and traumatizing them. Additional objectives were to decrease operation time and intra- and postoperative complications.
METHODS
We considered T1 cases diastasis after pregnancy and T2 cases obesity (BMI ≥ 30 mg/kg); D1, D2, and D3 when the diastasis measured 2-3, 3-5, and ≥ 5 cm, respectively; H0 and H1 without and concomitant umbilical and/or epigastric hernia, respectively. At our Department, between May 2010 and November 2022, 47 patients with diastasis recti were operated on with the "Slim-Mesh" technique to reinforce/repair the traumatized linea alba/recti muscles, without plicating them. This was a prospective (83%)-retrospective study.
RESULTS
We studied 23 males and 24 females. Mean age and BMI was 58 years and 29 kg/m, respectively. Groups D1, D2, and D3 comprised 6, 23 and 18 patients, respectively; groups T1, T2, H0 and H1 comprised 22, 25, 13 and 34 patients, respectively. Mean operation time for all cases was 100 minutes. Mean length of hospital stay was 2.3 days and follow-up time was 5 years. We had 6 late postoperative complications: 3 hernia recurrences and 3 trocar site hernias.
CONCLUSION
Considering the lack of agreement on the best surgery for diastasis recti abdominis repair, in our experience the "Slim-Mesh" technique is a valid, safe and easy-to-reproduce way to save, repair and reinforce linea alba/recti muscles in diastasis recti patients, including the obese population (53%).
Topics: Male; Pregnancy; Female; Humans; Rectus Abdominis; Retrospective Studies; Surgical Mesh; Prospective Studies; Hernia, Abdominal; Obesity; Herniorrhaphy
PubMed: 38562947
DOI: 10.4293/JSLS.2024.00003 -
International Journal of Surgical... Apr 2024Routine histopathological examination of hernia sac in adults remains a controversial topic. We undertook a retrospective study to assess possible clinical benefits of... (Review)
Review
Routine histopathological examination of hernia sac in adults remains a controversial topic. We undertook a retrospective study to assess possible clinical benefits of pathological examination of hernia sac specimens. Our pathology database between 1992 and 2020 was searched for adult specimens submitted as hernia sac. The clinical and pathological data of patients with abnormal histopathological findings were reviewed. There were 5424 hernia sac specimens (3722 inguinal, 1625 umbilical, and 77 femoral), 32/5424 (0.59%) with malignancies (28 epithelial and 4 lymphoid) and 25/32 were located in the umbilical region. Twelve out of twenty-five malignancies (48%) presented as primary clinical manifestations of the diseases (5 GI tract carcinomas, 5 gynecological tract carcinomas, and 2 lymphoid neoplasms); and 13/25 (52%) specimens were involved by previously known tumors (8 gynecological carcinomas, 3 colon carcinomas, 1 breast carcinoma, and 1 lymphoma). Among the 7 inguinal hernia sacs with malignancies, 3 (42.9%) were primary presentations of the tumors (2 prostatic carcinomas, 1 pancreatic carcinoma), and 4 (57.1%) were previously known tumors (2 ovarian carcinomas, 1 colon carcinoma, 1 lymphoid). Benign lesions were 12/5424 (0.22%), including 7 adrenal rests, 4 endometriosis, and 1 inguinal sarcoidosis. The incidence of hernia sacs with malignancies was 32/5424 (0.59%), most commonly from nearby organs in gynecological tract. However distant metastases from breast were also present. Near half of the hernia sac with malignancies (15/32, 47%) presented as the first clinical manifestation. Routine histopathological examination of hernia sac in adults is recommended, since it may provide important clinical information.
Topics: Adult; Female; Humans; Breast Neoplasms; Carcinoma; Colonic Neoplasms; Hernia; Retrospective Studies
PubMed: 37291883
DOI: 10.1177/10668969231177706 -
Contact Lens & Anterior Eye : the... Oct 2023To evaluate the correlation between keratoconus and systemic manifestations of tissue hyperlaxity in the general population.
PURPOSE
To evaluate the correlation between keratoconus and systemic manifestations of tissue hyperlaxity in the general population.
METHODS
In this population based cross-sectional study 940,763 medical records of Israeli adolescents and young adults in military service were reviewed. Demographic and medical data were extracted. The prevalence of ligament injuries, habitual orthopedic deformities and umbilical/inguinal hernia was evaluated in cases with and without keratoconus. The association was tested using uni- and multivariant analyses.
RESULTS
Overall 938,411 adolescents and adults were included. Mean age was 17.55 ± 1.50 years, and 40.70% were female. Keratoconus was documented in 1,529 cases, with a prevalence of 0.16%. Compared to the general population, patients with keratoconus were significantly more likely to be diagnosed with genu varum/valgus (OR = 2.75, CI 1.48-5.13, p = 0.0015), pes planus (OR = 1.97, 95% CI: 1.62-2.38, p < 0.0001), scoliosis (OR = 1.88, 95% CI: 1.45-2.43, p < 0.0001) and umbilical/inguinal hernias (OR = 2.18, 95% CI: 1.47-3.24, p = 0.0001). On multivariate analysis the results remained significant (p < 0.05 for all). Joint injuries (ankle sprains, shoulder dislocation and injury to knee ligaments and menisci) were not significantly related to keratoconus (p > 0.05 for all).
CONCLUSIONS
In this large cohort of adolescents and young adults, an association was found between keratoconus and connective tissue hyperlaxity manifestations involving the knees, feet, spine and abdomen. These findings suggest that keratoconus might be a manifestation of a generalized connective tissue disorder, rather than just a local ocular phenomenon.
Topics: Adolescent; Young Adult; Humans; Female; Adult; Male; Keratoconus; Cross-Sectional Studies; Connective Tissue
PubMed: 37479535
DOI: 10.1016/j.clae.2023.101892 -
Medicina Clinica Oct 2023
PubMed: 37438190
DOI: 10.1016/j.medcli.2023.03.033 -
Children (Basel, Switzerland) Aug 2023The main goal of surgical treatment for gastroschisis and omphalocele is the reduction of viscera in the abdominal cavity and closure of the abdomen, but the challenge...
The main goal of surgical treatment for gastroschisis and omphalocele is the reduction of viscera in the abdominal cavity and closure of the abdomen, but the challenge is to succeed without the detrimental effects of increased intraabdominal pressure. In this regard, we performed a retrospective study for all patients admitted for gastroschisis and omphalocele to the Neonatal Intensive Care Unit of 'Marie Sklodowska Curie' Emergency Clinical Hospital for Children, from January 2011 until June 2021. Our aim was to highlight the presence of postoperative abdominal compartment syndrome. We observed that six out of forty-seven patients developed clinical signs of abdominal compartment syndrome, five associated with primary closure and one with staged closure with a polyvinyl chloride patch. Following the results, we decided to implement the trans-bladder measurement of intraabdominal pressure to avoid closing the abdomen at pressures higher than 10 mmHg in order to prevent the development of abdominal compartment syndrome. We consider that there is still place for the improvement of congenital abdominal wall defects management and that the measurement of intraabdominal pressure might help us reach our goal.
PubMed: 37628383
DOI: 10.3390/children10081384 -
International Journal of Surgery Case... Nov 2023The sternum, pericardium, diaphragm, abdominal wall, and heart are all affected by the unusual congenital condition known as Cantrell pentalogy. It is a rare congenital...
INTRODUCTION
The sternum, pericardium, diaphragm, abdominal wall, and heart are all affected by the unusual congenital condition known as Cantrell pentalogy. It is a rare congenital disorder that requires multidisciplinary care. Early diagnosis and appropriate management are crucial for improving outcomes in affected individuals. To illustrate the difficulties and complexity of Cantrell pentalogy, we provide two cases.
PRESENTATION OF CASE
In case 1, a routine antenatal scan at 12 weeks' gestation revealed thoracoabdominal ectopia cordis in a 29-year-old woman. The pregnancy was terminated medically due to the severity of the anomalies and the poor prognosis. A 32-year-old patient in case 2 had a diaphragmatic hernia, thoracoabdominal ectopia cordis and midline abdominal wall abnormalities. After counselling, a medical termination was chosen. The ultra-sonographic features were confirmed by autopsy results in 2 cases.
DISCUSSION
Early diagnosis is feasible in the first trimester if ectopia cordis and omphalocele exist. Additionally, development in ultrasound technology provides us with better visualization and early diagnosis. With patients who have fully developed Cantrell syndrome and those who also have accompanying anomalies, the prognosis is often poor, with short survival and quality of life.
CONCLUSIONS
Cantrell pentalogy is a rather uncommon congenital condition. Early detection is possible in the first trimester. The severity of the illness varies greatly, and treatment is determined by the precise abnormalities present. Early diagnosis necessitates adequate initial training as well as ongoing in-service training for sonographers. Early detection and treatment are critical for improving outcomes in affected persons.
PubMed: 37879290
DOI: 10.1016/j.ijscr.2023.108941 -
Northern Clinics of Istanbul 2023Umbilical hernia repair can be easily performed simultaneously with laparoscopic cholecystectomy. The use of mesh is recommended for hernias larger than 1 cm. In this...
OBJECTIVE
Umbilical hernia repair can be easily performed simultaneously with laparoscopic cholecystectomy. The use of mesh is recommended for hernias larger than 1 cm. In this study, patients with primary repair of umbilical hernia simultaneously with laparoscopic cholecystectomy were evaluated. It aimed to present the effectiveness of this method and the effect of body mass index (BMI) on treatment results.
METHODS
The records of patients who underwent primary repair of umbilical hernia simultaneously with laparoscopic cholecystectomy between 2014 and 2021 were reviewed retrospectively. Patients' age, gender, BMI, length of hospital stay, recurrence and reoperation information, and follow-up times were analyzed. The patients were examined in three groups according to their BMI, and the effect of BMI on treatment was investigated.
RESULTS
patients were included in the study. Median values of the patients for age, BMI, hospitalization, and follow-up were 63 (28-94), 31 (20-51) kg/m, 1 (1-25) days, and 23 (0.6-76) months, respectively. Recurrence was detected in 8 patients. BMI was <25 in one patient with recurrence and >30 in 5 patients. There was no significant correlation between length of stay, number of relapse and reoperation, and BMI (p>0.05).
CONCLUSION
In our study, the recurrence rate was found to be higher than the studies reported with the use of mesh, and most of the patients with recurrence are obese, although it is not statistically significant. If the recurrence rate is acceptable, we believe that repair with primary suture is feasible in umbilical hernia.
PubMed: 37829743
DOI: 10.14744/nci.2022.02700 -
Surgical Endoscopy Dec 2023Preoperative optimization cut-offs are frequently utilized to determine eligibility for elective ventral hernia repair. Our objective was to assess the relationship...
BACKGROUND
Preoperative optimization cut-offs are frequently utilized to determine eligibility for elective ventral hernia repair. Our objective was to assess the relationship between gender, race, and socioeconomic status and preoperative optimization goals.
METHODS
We queried our institutional database for adults with ventral hernia diagnoses between 2016 and 2021. Demographics, comorbidities, laboratory, and operative data were collected and analyzed. The following cut-offs were used to determine eligibility for elective repair: body mass index (BMI) < 40 kg/m, no active smoking, and glycated hemoglobin (HbA1c) < 8%. Socioeconomic status was assessed using the Distressed Communities Index.
RESULTS
A total of 5638 patients were included [Whites = 4321 (77%), Blacks = 794 (14%), Hispanics = 318 (6%), and other/unknown 205 (4%)]. Median age was 61 years and 50% were male. Most common hernia types were umbilical (36%) and incisional (20%). 10% had BMI > 40 kg/m, 9% were active smokers and 4% had HbA1c > 8%. 21% of all patients did not meet the preoperative optimization cut-offs at time of diagnosis and those were less likely to undergo hernia repair during the study timeframe compared to those who did (OR 0.50; 95% CI [0.42-0.60]). There was a higher proportion of females (21%) and Blacks (22%) with BMI > 40 kg/m compared to males (11%) and other races (11-15%), p = 0.002. As the level of socioeconomic distress increased, there was a corresponding increase in the proportion of patients who did not meet preoperative optimization cut-offs from 16% in prosperous communities to 25% in distressed communities (p < 0.0001).
CONCLUSION
Nearly 1 of 5 patients with ventral hernias is affected by commonly used arbitrary preoperative optimization cut-offs. These cut-offs disproportionately impact females, Black patients and those with higher socioeconomic distress. These disparities need to be considered when planning preoperative optimization protocols and resource allocation to ensure equitable access to elective ventral hernia repair.
Topics: Adult; Female; Humans; Male; Middle Aged; Herniorrhaphy; Socioeconomic Disparities in Health; Glycated Hemoglobin; Goals; Hernia, Ventral; Retrospective Studies
PubMed: 37658198
DOI: 10.1007/s00464-023-10365-7 -
American Journal of Medical Genetics.... Apr 2024Bladder exstrophy epispadias complex (BEEC) encompasses a spectrum of conditions ranging from mild epispadias to the most severe form: omphalocele-bladder...
Bladder exstrophy epispadias complex (BEEC) encompasses a spectrum of conditions ranging from mild epispadias to the most severe form: omphalocele-bladder exstrophy-imperforate anus-spinal defects (OEIS). BEEC involves abnormalities related to anatomical structures that are proposed to have a similar underlying etiology and pathogenesis. In general, BEEC, is considered to arise from a sequence of events in embryonic development and is believed to be a multi-etiological disease with contributions from genetic and environmental factors. Several genes have been implicated and mouse models have been generated, including a knockout model of p63, which is involved in the synthesis of stratified epithelium. Mice lacking p63 have undifferentiated ventral urothelium. MNX1 has also been implicated. In addition, cigarette smoking, diazepam and clomid have been implied as environmental factors due to their relative association. By in large, the etiology and pathogenesis of human BEEC is unknown. We performed de novo analysis of whole exome sequencing (WES) of germline samples from 31 unrelated trios where the probands have a diagnosis of BEEC syndrome. We also evaluated the DECIPHER database to identify copy number variants (CNVs) in genes in individuals with the search terms "bladder exstrophy" in an attempt to identify additional candidate genes within these regions. Several de novo variants were identified; however, a candidate gene is still unclear. This data further supports the multi-etiological nature of BEEC.
Topics: Pregnancy; Female; Humans; Animals; Mice; Bladder Exstrophy; Epispadias; Exome Sequencing; Urinary Bladder; Transcription Factors; Homeodomain Proteins; Anus, Imperforate; Hernia, Umbilical; Scoliosis; Urogenital Abnormalities
PubMed: 38082334
DOI: 10.1002/ajmg.a.63501 -
Clinical Case Reports Jun 2024In babies presenting with an omphalocele, other components of the prune belly syndrome should be scrutinized for early diagnosis and timely intervention.
KEY CLINICAL MESSAGE
In babies presenting with an omphalocele, other components of the prune belly syndrome should be scrutinized for early diagnosis and timely intervention.
ABSTRACT
A male baby on his 13th day of life presented with an omphalocele. On evaluation, he had congenital absence of left kidney and bilateral cryptorchidism. Therefore, he was diagnosed with prune belly syndrome. He responded well to abdminoplasty, and wait and watch policy was applied for his cryptorchidism.
PubMed: 38895052
DOI: 10.1002/ccr3.8922