Urinary Bladder Matrix Scaffolds Promote Pericardium Repair in a Porcine Model.

Pericardium closure after cardiac surgery is recommended to prevent postoperative adhesions to the sternum. Synthetic materials have been used as substitutes, with limited results because of impaired remodeling and fibrotic tissue formation. Urinary bladder matrix (UBM) scaffolds promote constructive remodeling that more closely resemble the native tissue. The aim of the study is to evaluate the host response to UBM scaffolds in a porcine model of partial pericardial resection. Twelve Landrace pigs were subjected to a median sternotomy. A 5 × 7 cm pericardial defect was created and then closed with a 5 × 7 cm multilayer UBM patch (UBM group) or left as an open defect (control group). Animals were survived for 8 wk. End points included gross morphology, biomechanical testing, histology with semiquantitative score, and cardiac function. The UBM group showed mild adhesions, whereas the control group showed fibrosis at the repair site, with robust adhesions and injury to the coronary bed. Load at failure (gr) and stiffness (gr/mm) were lower in the UBM group compared with the native pericardium (199.9 ± 59.2 versus 405.3 ± 99.89 g, P = 0.0536 and 44.23 ± 15.01 versus 146.5 ± 24.38 g/mm, P = 0.0025, respectively). In the UBM group, the histology resembled native pericardial tissue, with neovascularization, neofibroblasts, and little inflammatory signs. In contrast, control group showed fibrotic tissue with mononuclear infiltrates and a lack of organized collagen fibers validated with a histologic score. Both groups had normal ultrasonography results without cardiac motility disorders. In this setting, UBM scaffolds showed appropriate features for pericardial repair, restoring tissue properties that could help reduce postsurgical adhesions and prevent its associated complications.

Biomechanical Features of Reinforced Esophageal Hiatus Repair in a Porcine Model.

Recurrence rates in the laparoscopic repair of the hiatal hernia range from 12% to 59%. Limitation of reinforcement has been principally the risk of adverse events caused by synthetic materials. Biologic and resorbable synthetic materials are valid alternatives. This study compares the host response to all these materials after hiatal hernia repair. A total of 20 Landrace pigs, underwent laparoscopic primary hiatal hernia repair and reinforced with a polypropylene mesh (PROLENE: polypropylene [PP]), an absorbable synthetic scaffold (GOREBIO-A: polyglycolic acid [PGA]), a urinary bladder matrix scaffold, (Gentrix: urinary bladder matrix [UBM]), or without reinforcement, control group (C). Animals were survived for 3 months. Endpoints included gross morphology, biomechanical testing, and histology. Pigs in PP and PGA groups showed fibrosis at the repair site, with robust adhesions. In UBM and C groups, only mild adhesions were found. Load at failure (gr) and stiffness (gr/mm) of PP were higher than C group (PP:2103 ± 548.3 versus C:951.1 ± 372.7, P = 0.02; PP:643.3 ± 301 versus C:152.6 ± 142.7, P = 0.01). PGA and UBM values for both parameters were in between PP and C samples. However, stiffness in UBM was tended to be lower than PP group, and approached a significant difference (643.3 ± 301 versus 243 ± 122.1, P = 0.0536). In UBM group, the histology resembled native tissue. By contrast, PP and PGA groups showed mononuclear infiltrates, fibroencapsulation, necrosis, remnants of mesh, and disorganized tissue that was validated with a histologic score. In this setting, UBM scaffolds showed the most appropriate features for hiatal hernia repair, recovering the tissue properties that can help reduce the possibility of early failure and prevent complications associated with the implanted material.

Esophageal Erosion of Adjustable Gastric Band, Endoscopic Solution of an Unreported Complication.

Although laparoscopic adjustable gastric band (LAGB) placement appears as a safe and reproducible procedure, serious complications can occur. We present a patient with fever, dysphagia, epigastric pain, and port site inflammation. Esophagogastroduodenoscopy and computed tomography (CT) scan diagnosed esophageal erosion of the gastric band. An endoscopic retrieval was proposed to avoid accessing the abdominal cavity and mediastinum, reduce recovery time, and minimize complications. The patient successfully underwent the procedure with immediate improvement of symptoms and discharge on the seventh postoperative day. This article aims to report the first clinical case of an esophageal erosion of LAGB completely treated with an endoscopic approach.

Tratamiento no operatorio en traumatismo cerrado de abdomen en el Hospital Municipal Dr. Leónidas Lucero: nuestra experiencia / Nonoperative treatment of blunt abdominal trauma at the Municipal Hospital Dr. Leonidas Lucero

Antecedentes: existe una tendencia creciente hacia el tratamiento no operatorio (TNO) en el trauma-tismo cerrado de abdomen (TCA), en pacientes estables hemodinámicamente, sin abdomen agudo peritoneal. No hay consenso sobre: momento de inicio de la dieta, deambulación, proflaxis anttrom-bótica, seguimiento y control, y reinicio de la actividad fisica. Objetivo: describir los resultados del manejo de pacientes con TCA, admitidos en nuestro Servicio de Cirugía. Material y métodos: incluimos pacientes mayores de 15 años internados desde enero de 2011 hasta septembre de 2014, con TCA sometidos a TNO. Se recabaron las variables analizadas de una base de datos electrónica de fichaje prospectivo. Resultados: del total de pacientes 31 TCA, 15 se intervinieron quirúrgicamente al ingreso y 16 pacientes se someteron a TNO. El 73,3% presentó lesiones asociadas extraabdominales. A todos se les realizó ecografa abdominal, donde se encontró líquido libre en el 80% y se identificó lesión de órgano sólido en el 60%. En 11 pacientes se realizó TC confrmando lesión objetivada en la ecografa e iden-tificando 3 no evidenciadas previamente. Se diagnosticaron 5 traumatismos hepáticos, 2 asociados a traumatismo renal; 6 traumatismos esplénicos, 4 renales y un paciente con hemoperitoneo. En 7 pacientes se utlizó tromboproflaxis. El TNO fue exitoso en todos los casos. Tres pacientes presentaron complicaciones. No se registró mortalidad. Conclusiones: los pacientes sometidos a TNO en nuestro hospital fueron tratados exitosamente en todos los casos. No se registró mortalidad en la serie analizada.

Background: there is a growing trend towards non-operative management (NOM) in the blunt abdominal trauma (BAT) in hemodynamically stable patentis without peritoneal acute abdomen. However, there is stll no consensus on: tme of onset of diet, ambulaton, antthrombotic prophylaxis, follow-up, and resumpton of physical activity. Objective: to describe the management of patentis with BAT, admited to the Department of Surgery of our insttuton. Material and methods: we included patentis age 15 and older admited from January 2011 to Sept-ember 2014, with BAT who underwent NOM. The variables analyzed were collected from an electronic database of prospective signing. Resultis: 31 TCA were identifed, 15 were operated on at admission and 16 patentis underwent NOM. 75% were men; mean age of 29 (range 18-58). In 100% abdominal ultrasound was performed, finding free fuid in 80% and identifying organ damage in 60% of the total. In 11 patentis CT scan was perfor-med confrming identifed organ injury on ultrasound and diagnosing three not evidenced previously. We included 5 patentis with liver trauma, 2 associated renal trauma; 6 splenic trauma; 4 kidney trauma and 1 patent with hemoperitoneum. Thromboprophylaxis was used in 7 patentis. NOM was successful in all cases. Three patentis presented complicatons, not associated with trauma. No mortality was recorded. Conclusions: patentis undergoing NOT in our hospital were successfully treated in all cases. There were no complicatons associated with management of the NOT. No mortality was recorded.