Flat patch mesh versus three-dimensional mesh (plug) for open umbilical or epigastric hernia repair. A retrospective study.

INTRODUCTION: Hernia repair using prosthetic mesh materials has become the preferred method of repair, as the recurrence rates are much lower than with conventional repair techniques. The aim of this retrospective study was to compare open small- and medium-sized abdominal wall hernia repair with flat patch mesh versus three-dimensional mesh (plug) in terms of recurrence and complication rates. METHODS: The medical records of 300 patients who underwent abdominal wall hernia repair using flat patch mesh versus three-dimensional mesh between January 2010 to December 2015 were reviewed. All patients were followed up after 1 month, 3 month and 1 year. The rate of recurrence, and short-term postoperative complications such as incidence of Surgical Site Infections (SSIs), hematoma and seroma were evaluated. RESULTS: Short-term follow-up data were available for all patients. The first group was composed of 150 patients that were treated with a flat polypropylene mesh (68% presened umbilical hernia and 32% presented epigastric hernia). The second group was composed of 150 patients that were treated with a three-dimensional polypropylene mesh (60% presented umbilical hernia and 40% presented epigastric hernia). The majority of postoperative (1-month) complications were wound related, representing superficial SSI or seroma. Our results showed a statistically significant reduction of SSIs [3 (2%) vs 13 (8.6%); p = 0.038] and seroma [2 (1.3%) vs 12 (8%); p = 0.030] in the group of patients treated with plugs compared to flat-mesh group. There was no statistically significant difference in hernia recurrences. DISCUSSION: Usage three-dimensional mesh for open small- and medium-sized umbilical or epigastric hernia repair represents a feasible and safe technique that significantly lowers the incidence of complications such as SSIs and seroma. Furthermore, compared to flat patch mesh, plugs displayed non-inferiority in terms recurrence. Further, well-designed clinical trials could be realized to investigate possible applications of plugs in treatment of small- and medium-sized umbilical and epigastric hernias. KEY WORDS: Mesh, Umbilical Hernia.

Postcholecystectomy syndrome: biliary-related complications.

In Italy, about 100,000 cholecystectomies are carried out annually, the majority of them laparoscopically. Complications following cholecystectomy are common and increase morbidity and cost burden. Biliary damage (0.08-0.5%), bile leak (0.42-1.1%), retained common bile duct stones (0.8-5.7%), postcholecystectomy syndrome (10-15%), and postcholecystectomy diarrhea (5-12%) are a few of the most often occurring laparoscopic cholecystectomy consequences. In many instances, endoscopy can offer conclusive management and is crucial for the identification and treatment of biliary problems. Regarding the ideal treatment strategy for biliary problems, there is no universal agreement. A skilled interdisciplinary team should therefore approach biliary problems. The surgeon must be knowledgeable on how to handle these issues.

Methodological consideration for a physical activity intervention in breast cancer population: An umbrella review.

Objective: Breast cancer patients and survivors are increasing in the last years such as their mean age. A feasible and useful complementary intervention to improve physical and psychological health, and decrease some disease symptoms seems to be physical activity. Consequently, this umbrella review wanted to analyze the protocols of different physical activity interventions and to eventually propose a standard operating procedure for possible exercise training in breast cancer patients.Design, Data sources, Eligibility criteria. The electronic databases PubMed, Scopus, and Web of Science were searched till 25 March 2022 to detect all systematic review and meta-analysis of randomized controlled trials on this topic. The studies were analyzed narratively and evaluated with a scale to assess their quality. Results: The studies presented heterogeneity in their population included in terms of disease stage and treatments, intervention protocols and outcomes evaluated. This made difficult to synthesize the findings. Conclusion: It was not possible to propose a standard operating procedure but some indications were proposed to provide feedback for future studies. Ideally, an intervention should be composed of combined training (aerobic and resistance training) with a component of a mindfulness intervention, with an intensity from moderate to high, and 3 times a week. The intervention should be supervised in the first period and then it could be home-based. Exercise training should be personalized to the patients treated.

Laparoscopic prosthetic repair of laparocele. A comparison of techniques and a review of the literature.

Incisional hernia, or post-laparotomy hernia, is a defect in the abdominal wall, which can produce mechanical and systemic changes in both respiratory and splanchnic circulation. This pathology has an important impact on Health and Society, with an incidence ranging from 2% to 20%, stimulating the improvement or development of surgical techniques, to reduce discomfort and complications, e.g. imprisonment, strangulation and recurrences. The growing availability of prostheses, with greater resistance and lower risk of visceral adhesions, has improved the result and reduced relapses. Over the past 15 years, further improvements have been achieved, thanks to the greater use of laparoscopy, decreasing relapses and complications and improving patient comfort. In this regard, the Ventralight Echo PS prosthesis, introduced for the first time in 2013 and routinely used by our team, have shown encouraging results. In this work, a retrospective study aims to compare in different aspects two groups of patients, suffering from defects on the abdominal wall and undergoing reconstructive surgery with laparoscopic technique. It has been used simple prostheses for the first, whereas the Echo PS~ Positioning System with Ventralight - ST Mesh or Composix - L/P Mesh for the second group. In our experience, we conclude that the use of prostheses, such as the Ventralight Echo PS, in the treatment of incisional hernias, regardless of the location of the defect, is a valid and safe alternative to the use of non-self-expandable prostheses. KEY WORDS: Incisional Hernia, Hernia Repair, Laparoscopic Technique.

Thermography and rasterstereography as a combined infrared method to assess the posture of healthy individuals.

The demand for noninvasive methods to assess postural defections is increasing because back alterations are more common among the healthy population. We propose a combined infrared method of rasterstereography and thermography to assess the back without harmful effects. This study aims to provide reference data on rasterstereography and thermography to evaluate the back of a healthy population and to further study the correlation between these two methods. This cross-sectional research involved 175 healthy individuals (85 males and 90 females) aged 22 to 35 years. There is a large Cohen's d effect size in the cervical depth (males = 43.77 ± 10.96 mm vs. females = 34.29 ± 7.04 mm, d = 1.03), and in the lumbar lordosis angle (males = 37.69 ± 8.89° vs. females = 46.49 ± 8.25°, d = - 1.03). The back temperature was different for gender in the cervical area (males = 33.83 ± 0.63 °C vs. females = 34.26 ± 0.84 °C, d = - 0.58) and dorsal area (males = 33.13 ± 0.71 °C vs. females = 33.59 ± 0.97 °C, d = - 0.55). Furthermore, in the female group there was a moderate correlation of lumbar temperature with lumbar lordosis angle (r = - 0.50) and dorsal temperature with shoulders torsion (r = 0.43). Males showed a moderate correlation for vertebral surface rotation RMS with cervical (r = - 0.46), dorsal (r = - 0.60), and lumbar (r = - 0.50) areas and cervical temperature with shoulders obliquity (r = 0.58). These results highlight a possible correlation between rasterstereography and thermography, which may elucidate the underlying mechanics of spinal alterations and thermal muscle response. Our findings may represent reference data for other studies using noninvasive methods to assess postural alterations.

Postural Evaluation in Young Healthy Adults through a Digital and Reproducible Method.

Different tools for the assessment of posture exist, from the simplest and cheap plumb line to complex, expensive, 3D-marker-based systems. The aim of this study is to present digital postural normative data of young adults collected through a mobile app to expand the possibilities of digital postural evaluation. A sample of 100 healthy volunteers, 50 males and 50 females, was analyzed with the mobile app Apecs-AI Posture Evaluation and Correction System® (Apecs). The Student's t-test evaluated differences between gender to highlight if the digital posture evaluation may differ between groups. A significant difference was present in the anterior coronal plane for axillary alignment (p = 0.04), trunk inclination (p = 0.03), and knee alignment (p = 0.01). Head inclination (p = 0.04), tibia shift (p = 0.01), and foot angle (p < 0.001) presented significant differences in the sagittal plane, while there were no significant differences in the posterior coronal plane. The intraclass correlation coefficient (ICC) was considered to evaluate reproducibility. Thirteen parameters out of twenty-two provided an ICC > 0.90, three provided an ICC > 0.60, and six variables did not meet the cut-off criteria. The results highlight that digital posture analysis of healthy individuals may present slight differences related to gender. Additionally, the mobile app showed good reproducibility according to ICC. Digital postural assessment with Apecs could represent a quick method for preventing screening in the general population. Therefore, clinicians should consider this app's worth as an auxiliary posture evaluation tool.

How Physical Activity Affects Knee Cartilage and a Standard Intervention Procedure for an Exercise Program: A Systematic Review.

(1) Background: Cartilage degeneration with the natural aging process and the role of physical activity on cartilage wellness is still not clear. The objective of the present review was to understand how different physical activity interventions affect the cartilage and to propose a Standard Operating Procedure for an exercise program to maintain knee joint health; (2) Methods: Articles were collected on three different electronic databases and screened against the eligibility criteria. Results were collected in tables and the main outcomes were discussed narratively; (3) Results: A total of 24 studies have been included after the screening process and aerobic, strength, flexibility, postural balance, and mobility interventions were detected. Different protocols and types of interventions were adopted by the authors; (4) Conclusions: Physical activity interventions have mainly positive outcomes on cartilage structure, but the protocols adopted are different and various. A Standard Operating Procedure has been proposed for a physical intervention focalized on cartilage wellness that could be adopted as an intervention in the clinical setting. Furthermore, the creation of a standardized protocol wants to help scientific research to move in the same direction.

Neuropathic inguinal pain: neurectomy associated with open prosthetic hernioplasty for the prevention of post-operative pain.

INTRODUCTION: Inguinal hernia is one of the most common surgical diseases in the world. Today, this disease is treated by surgical technique only. Among the late complications after surgery, the most frequent is the appearance of chronic post-operative pain after surgical treatment. The incidence of this complication is about 28% of patients undergoing hernioplasty suffering a varying degree of chronic pain, severe enough to interfere with normal daily activities. OBJECTIVES: In this study we evaluated the onset of the neuropathic pain as a complication of inguinal prosthetic hernioplasty surgery. METHODS: This is a prospective observational study run between September 2019 and August 2020. All patients, during the first visit conducted in an outpatient clinic, were recruited in a specific database. Subsequently, surgery was planned in election on one day surgery, patients were administered a specific questionnaire aiming at the identification of any pain and its exact location. The Inguinal Pain Questionnarie (IPQ) was used. During the surgical procedure the selective neurectomy of the 3 nerves has been documented, the entire population of patients has undergone a standardized surgical treatment. At the end of surgery, a follow-up was carried out administering two questionnaires (IPQ Short Form Modified and the IPQ Short Form Paresthesia Modified) concerning the possible chronic post-operative pain and the eventual paresthesia. The questionnaires were administered at first, third and sixth month from the date of surgery. RESULTS: A total of 266 patients were screened from September 2019 to October 2020. Fiftyseven male patients were included in the study with a confirmed diagnosis of primary inguinal hernia. Clinical data, baseline characteristics and outcomes are described. Preoperatively, at the time of IPQ administration, 1.8% of patients had a pain score of 6, 10% of 5, 21% of 4, 31% of 3, 28% with a score of 2 and 7% of patients with a score of 1. In all cases the ileoinguinals and ileohypogastric nerves found were subjected to neurectomy, in 19% of cases also the genitofemoral nerve was subjected to surgical resection. At the end of the follow-up, the first questionnaire (IPQ Short Form Modified) results did show that, among the total of patients who had an open prosthetic hernioplasty with extensive nerves resection in the inguinal canal, 84% of them indicated a pain score equal to 0 (no pain) after 6 months of treatment and only 1.7% indicated a score equal to 4. Analyzing the second questionnaire on paresthesia (IPQ Short Form Paresthesia Modified), 79% of patients indicated a score equal to 0 by describing no paresthesia and no changes in sensitivity; 15.7% score 1; 3.5% score 2; 1.7% score 3. CONCLUSIONS: Based on our experience and according to the modern literature, we would advise prophylactic total neurectomy of the inguinal canal nerves during prosthetic inguinal hernioplasty. KEY WORDS: Abdominal Surgery, Chronic pain, Inguinal hernioplasty, Neurectomy, Paresthesia.

The Practice of Physical Activity on Psychological, Mental, Physical, and Social Wellbeing for Breast-Cancer Survivors: An Umbrella Review.

(1) Background: The number of breast-cancer patients and survivors is increasing in the last years. Physical activity seems to be a feasible and useful complementary intervention to improve the physical, psychological, and social spheres and decrease some symptoms, especially for survivors. Consequently, the objective of the present umbrella review was to analyze the efficacy of different physical-activity interventions in the physical, mental, and social spheres of breast-cancer survivors. (2) Methods: Systematic reviews and meta-analyses of randomized controlled trials on breast-cancer survivors and physical-activity effects were searched on the electronic databases PubMed, Web of Science, and Scopus till 9 August 2022. The quality of the studies included was evaluated, and the results were narratively analyzed. (3) Results: Physical-activity intervention generally improves the physical, mental, and social spheres of breast-cancer survivors, but the studies included present heterogeneity in the protocols adopted. (4) Conclusions: A well-structured and planned physical-activity intervention is useful for improvements in the physical, mental, and social spheres of breast-cancer survivors, but the studies presented high heterogeneity. Yoga seems to be the most effective physical intervention to complement medical therapy.

Running Footwear and Impact Peak Differences in Recreational Runners.

Running is a physical activity and the investigation of its biomechanical aspects is crucial both to avoid injuries and enhance performance. Recreational runners may be liable to increased stress over the body, particularly to lower limb joints. This study investigates the different running patterns of recreational runners by analyzing characteristics of the footwear impact peak, spatiotemporal, and kinematic parameters among those that present with a peak impact and those that do not, with a 3D markerless system. Thirty recreational runners were divided into two groups: impact peak group (IP) (n = 16) and no impact peak group (n = 14) (n-IP). Kinematic and spatiotemporal parameters showed a large Cohen's d effect size between the groups. The mean hip flexion was IP 40.40° versus n-IP 32.30° (d = -0.82). Hip extension was IP 30.20° versus n-IP 27.70° (d = -0.58), and ankle dorsiflexion was IP 20.80°, versus n-IP 13.37° (d = -1.17). Stride length was IP 117.90 cm versus n-IP 105.50 cm (d = -0.84). Steps per minute was IP group 170 spm, versus n-IP 163 spm (d = -0.51). The heel-to-toe drop was mainly 10-12 mm for the IP group and 4-6 mm for the n-IP group. Recreational runners whose hip extension is around 40°, ankle dorsiflexion around 20°, and initial foot contact around 14°, may be predisposed to the presence of an impact peak.

Grynfeltt-Lesshaft hernia Personal experience of nine cases and a review of the literature.

Grynfeltt's lumbar hernia, from the author who first described it in 1866, is the rarest among all hernias of the abdominal wall and it represents, according to the most recent literature, only 2% of all hernias. Of these, about 20% are congenital, secondary mainly to defects of embryonic development, while 80% are acquired defects. Surgeries, penetrating wounds, and infections are risk factors for the development of secondary and therefore iatrogenic lumbar hernias. In the literature, there is a predominance of the left Grynfeltt hernia while a bilateral presentation is exceptional. Our recent observation of a massive Grynfeltt hernia brought us to perform a revision of the literature and of our case studies. Based on our personal experience, with the most recent literature, we believe that in the case of Grynfeltt's lumbar hernias, the laparotomy approach with the use of prosthetic materials is the most appropriate, thus making the procedure fast, easy, and safe, compared to the treatment of all other wall defects that often require a laparoscopic approach. To confirm this, it is perceived that the open technique is currently more widespread; in fact, a small lumbotomy is easy to perform, fast, and can also be performed under loco-regional or epidural anaesthesia. KEY WORDS: Lumbar hernioplasty, Grynfeltt hernia, Hernia repair.