An easier Lichtenstein hernioplasty.

BACKGROUND: The Lichtenstein technique is used worldwide because of its rapid learning curve, good results and low recurrence rates. In this approach, a lateral tie-shaped incision is made on the mesh, involving the spermatic funiculus and thus correcting the deep inguinal ring defect by narrowing it. The lateral tie, however, does not prevent the wrinkling of the upper portion of the mesh that is caused by the arched shape of the inguinal ligament, where the lower edge of the prosthesis is sutured. OBJECTIVE: To describe a variation of the Lichtenstein technique that is easy to perform, maintains the advantages and prevents wrinkling of the mesh and allows for better mesh accommodation in the inguinal region. METHODS: The main feature of this approach is to cut the mesh vertically and to make the tie over the spermatic cord by overlapping the two resulting portions without wrinkling them. The final appearance is clearly more anatomical, allowing the mesh to be perfectly adapted for each patient. RESULTS: We operated on consecutive patients using this approach for more than 5 years. There have been no recurrences or specific mesh complications during follow-up, and the surgical aspect of this technique was clearly more anatomical. CONCLUSIONS: This method appears to be easier to perform and the surgical aspects of the technique are more anatomical for the patient.

N-Acetylcysteine Use in Hepatic Ischemia/Reperfusion in Rats Minimizing Bowel Injury.

BACKGROUND: The ischemia/reperfusion (I/R) phenomenon can cause the dysfunction of some transplanted organs and other distant organs. Liver surgery success, including transplantations, may depend on the adverse effects of intestinal mucosa injury arising from temporary porta triad occlusion. The study objective was to examine I/R liver effects on the small intestine in rats after N-acetylcysteine (NAC) treatment. METHODS: Twenty-four male Wistar rats were randomly divided into 2 groups. After anesthesia, they underwent 30 minutes of hepatic ischemia by clamping the porta triad, followed by reperfusion for 30 minutes or 6 hours. Each group was divided into 2 subgroups (n = 6), with 1 group receiving 0.9% saline solution (control) and the other receiving 150 mg/kg of NAC, 15 minutes before hepatic ischemia. At the end of reperfusion, blood was collected for enzyme dosage (alanine aminotransferase [ALT], aspartate aminotransferase [AST], lactate dehydrogenase [LDH], alkaline phosphatase [ALP]), and the terminal ileum was resected to study mucosal morphology by optical microscopy, computerized histomorphometry, and immunohistochemical assessment of apoptosis with caspase 3. RESULTS: After 30 minutes of reperfusion, animals receiving NAC had lower injury in the intestinal mucosa compared to the control subgroup (P < .05). After 6 hours, AST was higher in the control subgroup than in the NAC subgroup (P < .05), and AST, ALT and LDH values showed a significant increase in both subgroups (P < .05). CONCLUSION: These findings show the deleterious effects of late (6-hour) reperfusion and the protective effect of NAC at 30 minutes, when evaluating the small intestine impact of I/R liver damage.

Comparative study of shrinkage, inflammatory response and fibroplasia in heavyweight and lightweight meshes.

PURPOSE: In this manuscript, the authors describe an animal study comparing shrinkage, inflammatory response and fibroplasia in heavyweight (HW-PP) and lightweight polypropylene (LW-PP) meshes. METHODS: Both meshes were fixed on abdominal fascia of 25 Wistar rats (epifascial onlay placement). They were killed at 7, 28 and 90 days to measure the prostheses. Histological analysis was performed with hematoxylin-eosin for cellular counting and immunohistochemistry to measure collagen types I and III. RESULTS: The authors found that the LW-PP mesh presented greater median shrinkage than HW-PP mesh at 7 (P = .036), 28 (P = .674) and 90 days (P = .038) postoperatively. There were more neutrophils on LW-PP mesh (P = .008) at 7 days, gradually diminishing in both prostheses. Lymphocytes were similar between the implants at 7 days, diminishing about 50 % on LW-PP mesh (P < .001) at 90 days. Macrophages and giant cells diminished on LW-PP and increased on HW-PP meshes (P < .001). Collagen I/III ratio presented a progressive, almost fivefold rise at 90 days, on both mesh types (P < .001). The collagen I/III ratio was similar between LW-PP and HW-PP meshes at the three times studied. CONCLUSIONS: It is concluded that LW-PP showed more shrinkage than HW-PP mesh at 7 and 90 days, despite the fact that HW-PP presented more lately foreign body reaction. The collagen I/III ratio was similar between the prostheses and increased during the postimplant period.

Retraction and fibroplasia in a polypropylene prosthesis: experimental study in rats.

BACKGROUND: The treatment of hernia, independent of anatomical site and technique utilized, generally involves using prostheses, which may cause complications, despite their unarguable advantage in allowing safe reinforcement. An example of this is possible retraction, which causes discomfort and hernia recurrence. Polypropylene is still the most often used biomaterial of the great number available. The purpose of this study is to evaluate the amount of retraction of the polypropylene mesh, as well as the histological reactions that accompany this phenomenon. METHODS: Polypropylene meshes (Marlex) were inserted in an anterior position to the whole abdominal aponeurosis of 25 Wistar rats (Rattus norvegicus albinus). The animals were divided into groups and another intervention was performed 7, 28, and 90 days later to measure the dimensions of the prostheses and to calculate the final area. Histological analysis was performed with hematoxylin-eosin to evaluate neutrophils, macrophages, giant cells, and lymphocytes surrounding the mesh threads in ten random fields of each slide. RESULTS: Seven days after the mesh was inserted, the mean rate of retraction was 1.75% (P = 0.64); at 28 days, it was 3.75% (P = 0.02); and at 90 days, it was 2.5% (P = 0.01). As to the histological analysis, there was a total decline of neutrophils and a progressive increase of macrophages, giant cells, and lymphocytes proportional to the post-implant time of the mesh (P < 0.05). CONCLUSION: There was a statistically significant retraction of 3.75% at 28 days and 2.5% at 90 days after the prosthesis was inserted. There is a well-established sequence of cellular events which aim at synthesizing new connective tissue to reinforce the mesh.