Hallazgo incidental de hernia de Amyand en un lactante de 10 meses de edad con antecedente de prematuridad extrema: Presentación de caso y propuesta de manejo / Incidental finding of Amyand's hernia in a 10-month-old infant with a history of extreme prematurity: Case report and proposed management

Introducción. La hernia de Amyand es una condición en la que el apéndice cecal está contenido dentro del saco herniario inguinal. Su diagnóstico y su manejo continúan siendo un reto al tratarse de una patología poco frecuente. Caso clínico. Lactante varón de 10 meses con antecedente de prematuridad extrema, quien presentó hernia de Amyand derecha con apéndice normal. Se retornó el apéndice a la cavidad y se procedió a la reparación de la hernia. Resultado. Después de un año de seguimiento, el paciente no presentó complicaciones. Conclusiones. Se ha reportado que el riesgo de incarceración en niños nacidos a término es del 12 % y en prematuros del 39 %, por tanto, la reparación quirúrgica de una hernia inguinal siempre es necesaria. No existe un tratamiento estándar para la hernia de Amyand en niños, por tanto, la clasificación CiX podría considerarse para el manejo. Se presenta una propuesta de tratamiento en la población pediátrica, donde se incluyeron 3 tipos, considerando el estadio evolutivo del apéndice cecal y que casi la totalidad de hernias inguinales en niños son debidas a persistencia del proceso vaginal, por tanto, el tratamiento quirúrgico solo incluye herniotomía. Al no utilizar material protésico, se facilita el manejo y se reduce el riesgo de infección.

Introduction. Amyand's hernia is a condition in which the cecal appendix is contained within the inguinal hernia sac, its diagnosis and management continue to be a challenge as it is a rare pathology. Case report. A 10-month-old male infant with a history of extreme prematurity presented a right Amyand's hernia and a normal appendix. The appendix was returned to the cavity and the hernia was repaired. Result. After one year of follow-up, the patient had no complications. Conclusions. Has been reported that the risk of incarceration in full-term children is 12% and in premature babies it is 39%, therefore, surgical repair of an inguinal hernia is always necessary. There is no standard treatment for Amyand hernia in children, therefore the CiX classification could be considered for management. A treatment proposal is presented in the pediatric population, where three types were included, considering the evolutionary stage of the cecal appendix and that almost all inguinal hernias in children are due to persistence of the vaginal process; therefore, surgical treatment only includes herniotomy. By not using prosthetic material, handling is facilitated and the risk of infection is reduced.

Manejo expectante de amniocele en paciente con espectro de placenta accreta: reporte de caso / Expectant management of amniocele in a patient with placenta accreta: a case report

Introducción: El amniocele es una hernia del saco amniótico a través de un defecto en la pared del útero, el cual puede deberse a ruptura uterina, secundario a daños preexistentes, anomalías uterinas o en un útero sin cicatrices. Caso clínico: Presentamos el caso de una paciente de 37 años, con antecedente de dos partos por cesárea, a quien en la semana 25,5 de embarazo se le diagnostica por ecografía amniocele en la pared anterior de útero contenido por la vejiga, además de signos ecográficos de acretismo placentario. La posterior realización de resonancia magnética confirma el diagnóstico. Se realiza manejo expectante con estancia continua intrahospitalaria estricta. Resolución obstétrica a las 34 semanas por cesárea, con extracción fetal por fondo uterino sin complicaciones, con posterior realización de histerectomía con placenta in situ. Conclusiones: Este reporte de caso ilustra la importancia de la identificación temprana de esta condición por ser una complicación infrecuente, pero de grave pronóstico fetomaterno en ausencia de atención inmediata.

Introduction: Amniocele is a hernia of the amniotic sac through a defect in the uterine wall, which can be caused by uterine rupture secondary to preexisting damage, uterine anomalies, or a scarless uterus. Case report: We present a case of a 37-year-old patient with a history of two previous cesarean deliveries. At 25.5 weeks of gestation, the diagnosis of amniocele in the anterior uterine wall, contained by the bladder, along with ultrasound signs of placenta accreta, was confirmed through ultrasound. Subsequent magnetic resonance imaging further confirmed the diagnosis. Expectant management with strict continuous intrahospital stay was implemented. Obstetric resolution was achieved at 34 weeks through cesarean delivery, with uncomplicated fetal extraction through the uterine fundus. Subsequently, a hysterectomy was performed with the placenta left in situ. Conclusions: This case report illustrates the importance of early identification of this condition due to its infrequent but serious feto-maternal prognosis in the absence of immediate attention.

Ileostomy: early and late complications

Introduction: Ileostomy formation is performed for multiple purposes related to intestinal pathology, such as obstructive malignant or benign tumors, inflammatory bowel diseases, intestinal ischemia, and, for the most part, as a protective stoma in high-risk anastomosis. The creation of this surgical opening, despite being considered a simple procedure, is undoubtedly followed by complications in certain cases. Materials and Methods: We conducted an electronic literature search in the MEDLINE database using the PubMed search engine. A total of 43 articles were included in the present review. Results/Discussion: Over the course of the present work, we were able to explore different types of complications that can arise in patients with an ileostomy. High-output stomas were found to be associated with dehydration and electrolyte imbalance. Skin-related morbidity was shown to be present in a great percentage of patients. More severe complications, such as peristomal pyoderma gangrenosum and necrosis, are less frequent and require urgent management. Several risk factors were identified in cases of retraction, obstruction, prolapse, and parastomal herniation. Conclusion: Even though ileostomies may present numerous benefits in certain patients, they are also associated with many complications, which should be avoided and quickly managed, because they can severely affect the quality of life of the patients. Surveillance and follow-up by a multidisciplinary team is strongly advisable, bearing in mind that a good performance on the part of the responsible surgeon is also a key factor. (AU)

Opportunities and challenges for the high-quality development of hernia and abdominal wall surgery in China / 中华外科杂志

Hernia and abdominal wall surgery is a relatively new subspecialty in surgery. Although it started late in China, after 25 years of rapid development, it has made remarkable achievements and has become an important part of surgery, laying a solid foundation for the further development of the discipline. At the same time, one should also be soberly aware of the present deficiencies in this field. The development of the field should be more detailed and in-depth from the following aspects: correct understanding of new concepts of hernia and abdominal wall surgery, establishment of hernia patient registration and quality control system, technological innovation and development of technical equipment, especially the expansion of robot surgical systems, materials science progression to hernia and abdominal wall surgery. Faced with this challenge, China is expected to achieve high-quality development in the field of hernia and abdominal surgery.

How do young surgeons understand and grasp the new concepts, new techniques, and recent progress of hernia and abdominal wall surgery? / 中华外科杂志

With the development of modern surgery, the field of hernia and abdominal wall surgery is undergoing a transformative change, and new techniques, new concepts, and recent progress are being updated, which have motivated the high-quality development of the discipline. In the past two decades, the development of hernia and abdominal wall surgery in China has been recognized by international peers. Many young surgeons have gradually become the main force in the treatment of hernia and leaders in surgical technique. The innovation and development of discipline will never terminate; young surgeons as the main force should seriously think about how to improve their professional qualities. Young surgeons are interested in the innovation of surgical techniques and need to push for a traditional operation on the one hand and an innovative operation on the other. Updates to concepts and acquisition of new materials are more important, which can provide a solid foundation for technological innovation. Young surgeons should start with the basics and classics. Understanding the history and development of new techniques, new concepts and recent progress, and grasping indications of clinical application, is the important part of growing up for young surgeons, which can make surgical treatment more standardized, benefit patients, and promote the progress of Chinese specialized medical education.

Summary of experience with patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision in rectal cancer / 中华外科杂志

Objective: To examine the patterning cropped and shaped mesh repair for perineal hernia after abdominoperineal excision (APE) in rectal cancer. Methods: The clinical data of 8 patients with perineal hernia after APE who accepted surgical treatment in the Department of Hepatopancreatobiliary and Hernia Surgery, the First Affiliated Hospital of Fujian Medical University from March 2017 to December 2022 were retrospectively reviewed. There were 3 males and 5 females, aged (67.6±7.2) years (range: 56 to 76 years). Eight patients developed a perineal mass at (11.3±2.9) months (range: 5 to 13 months) after APE. After surgical separation of adhesion and exposing the pelvic floor defect, a 15 cm×20 cm anti-adhesion mesh was fashioned as a three-dimensional pocket shape to fit the pelvic defect, then fixed to the promontory or sacrum and sutured to the pelvic sidewalls and the anterior peritoneum, while two side slender slings were tailored in front of the mesh and fixed on the pectineal ligament. Results: The repair of their perineal hernias went well, with an operating time of (240.6±48.8) minutes (range: 155 to 300 minutes). Five patients underwent laparotomy, 3 patients tried laparoscopic surgery first and then transferred to laparotomy combined with the perineal approach. Intraoperative bowel injury was observed in 3 patients. All patients did not have an intestinal fistula, bleeding occurred. No reoperation was performed and their preoperative symptoms improved significantly. The postoperative hospital stay was (13.5±2.9) days (range: 7 to 17 days) and two patients had postoperative ileus, which improved after conservative treatment. Two patients had a postoperative perineal hernia sac effusion, one of them underwent placement of a tube to puncture the hernia sac effusion due to infection, and continued irrigation and drainage. The postoperative follow-up was (34.8±14.0) months (range: 13 to 48 months), and 1 patient developed recurrence in the seventh postoperative month, no further surgery was performed. Conclusions: Surgical repair of the perineal hernia after APE can be preferred transabdominal approach, routine application of laparoscopy is not recommended, combined abdominoperineal approach can be considered if necessary. The perineal hernia after APE can be repaired safely and effectively using the described technique of patterning cropped and shaped mesh repair.

Comparative study of laparoscopic Keyhole and Sugarbaker technique in the treatment of terminal paracolostomy hernia / 中华外科杂志

Objective: To compare laparoscopic Keyhole repair with Sugarbaker repair in consecutive patients with parastomal hernia. Methods: From January 2015 to December 2021, 117 patients with parastomal hernia were treated with Keyhole or Sugarbaker laparoscopy repairs in the Department of Hernia and Bariatrci Surgery, the First Affiliated Hospital of University of Science and Technology of China, and the clinical data were retrospectively analyzed. There were 45 males and 72 females, aged (68.6±8.6) years (range: 44 to 84 years). Laparoscopic Sugarbaker repair was performed in 89 cases, and Keyhole repair was performed in 28 cases. The t-test, Mann-Whitney U test, χ2 test and Fisher exact test were used to compare the observation indicators between the two groups, such as operation time, incidence of operation-related complications, and postoperative recurrence rate. Results: The follow-up period was (M(IQR)) 33 (36) months (range: 12 to 84 months). Compared to the Sugarbaker group, the hernia ring area of the Keyhole group was bigger (35 (26) cm2 vs. 25 (16) cm2, Z=1.974, P=0.048), length of stay was longer ((22.0±8.0) d vs. (14.1±6.2) d, t=5.485, P<0.01), and the postoperative rate of recurrence was higher (28.6% (8/28) vs. 6.7% (6/89), χ2=7.675, P=0.006). There was no difference in operation time and postoperative complications between the two groups. Conclusions: Laparoscopic Sugarbaker repair is superior to Keyhole repair in the recurrence rate of parastomal hernia treated with compsite mesh (not funnel-shaped mesh). There are no differences in operation time and postoperative complications between the two groups.

Herniation of intervertebral disc into thoracolumbar fracture vertebral body leads to malunion of fracture and decrease of intervertebral space height / 中国骨伤

OBJECTIVE@#To analyze the clinical characteristics of intervertebral disc tissue injury and herniation into the vertebral body in thoracolumbar fracture on fracture healing, vertebral bone defect volume and intervertebral space height.@*METHODS@#From April 2016 to April 2020, a total of 140 patients with thoracolumbar single vertebral fracture combined with upper intervertebral disc injury treated with pedicle screw rod system reduction and internal fixation in our hospital. There were 83 males and 57 females, aged from 19 to 58 years old, with an average age of (39.33±10.26) years old. All patients were followed up regularly 6 months, 12 months and 18 months after surgery. The patients with injured intervertebral disc tissue not herniated into the fractured vertebral body were the control group, and the patients with injured intervertebral disc and herniated into the fractured vertebral body were the observation group. By detecting the thoracolumbar AP and lateral X-ray films, CT and MRI of the thoracolumbar segment at different follow-up time, calculate the changes of the wedge angle of the fractured vertebral body, the sagittal kyphosis angle and the height of the superior adjacent intervertebral space, the changes of the fracture healing and bone defect volume after the reduction of the vertebral body, and the changes of the intervertebral disc degeneration grade. The prognosis was evaluated by visual analogue scale(VAS) and Oswestry disability index(ODI). Finally, the differences of the above results among different groups were comprehensively analyzed.@*RESULTS@#All the patients had normal wound healing without complications. A total of 87 patients received complete follow-up data, at least 18 months after internal fixation. Thoracolumbar AP and lateral X-ray films showed that 18 months after the reduction and internal fixation operation, the vertebral wedge angle, sagittal kyphosis angle and the height of the upper adjacent intervertebral space in the observation group were greater than those in the control group(P<0.05). CT scanning showed that the deformity of the fracture healed 12 months after the vertebral body reduction in the observation group and formed a "cavity" of bone defect connected with the intervertebral space, and its volume was significantly increased compared with that before (P<0.05). MRI scanning showed that the degeneration rate of injured intervertebral discs in the observation group was more serious than that in the control group 12 months after operation(P<0.05). However, there was no significant difference in VAS and ODI score at each time.@*CONCLUSION@#Herniation of injured intervertebral disc tissue hernias into the fractured vertebral body leads to increased bone resorption defect volume around the fracture and forms a malunion "cavity" connected with the intervertebral space. This may be the main reason for the change of vertebral wedge angle, the increase of sagittal kyphosis angle and the decrease of intervertebral space height after removal of internal fixation devices.

Hernies pariétales au CHU Souro Sanou de Bobo Dioulasso: profil sociodémographique, diagnostique et thérapeutique / Parietal hernias at the CHU Souro Sanou in Bobo Dioulasso: sociodemographic, diagnostic and therapeutic profile

But : étudier le profil sociodémographique, diagnostique et thérapeutique des hernies pariétales au Centre Hospitalier Universitaire Sourô Sanou. Patients et méthodes Il s'est agi d'une étude transversale descriptive allant du 1ier janvier au 31 décembre 2022. Les patients opérés pour une hernie pariétale ont été inclus. Résultats Il s'agissait de 101 patients d'un âge moyen de 45,6 ans avec un sex-ratio de 2,1. Parmi les patients avec une activité physique intense, les cultivateurs étaient au nombre de 34 (32,7%), les ouvriers au nombre de 10 (9,9%) et les militaires au nombre de 10 (9,9%). Il y'avait 104 cas de hernie selon le siège. Trois patients étaient porteurs d'une hernie inguinale bilatérale. La hernie était congénitale dans 23 (22%) cas. Il s'agissait d'une récidive après cure chirurgicale sans prothèse dans 16 (15,4%) cas. Le siège de la hernie était inguinal dans 65 (62,5%) cas, la ligne blanche 24 (23,1%) cas, ombilical dans 12 (11,5%) cas, crural dans 3 (2,9%) cas. La hernie était étranglée dans 39 (37,5%) cas. L'anesthésie était générale chez 73 (72,3%) patients et on avait une rachianesthésie chez 28 (27,7%) patients. Quatre résections intestinales ont été réalisées. La cure herniaire était une plastie prothétique dans 15 (14,4%) cas. Sept (6,9%) patients ont présenté une complication dont cinq (4,9%) infections du site opératoire et deux (2%) hématomes scrotaux. Aucun décès n'a été enregistré. Conclusion Les hernies pariétales étaient fréquentes et de siège inguinal, compliquées d'étranglement, avec la présence de cas de récidive. Les prothèses herniaires étaient peu utilisées.

Introduction Objective: to study the sociodemographic, diagnostic and therapeutic profile of parietal hernias at the Sourô Sanou University Teaching Hospital. Patients and methods This was a descriptive cross-sectional study lasting one year from January 1 to December 31, 2022. Patients operated on for a parietal hernia were included. Results There were 101 patients with an average age of 45.6 years and a sex-ratio of 2.1. Among the patients with intense physical activity, the farmers were 34 (32.7%), the workers 10 (9.9%) and the military 10 (9.9%). There were 104 cases of hernia depending on the site. Three patients had a bilateral inguinal hernia. The hernia was congenital in 23 (22%) cases. It was a recurrence after surgical treatment without prosthesis in 16 (15.4%) cases. The site of the hernia was inguinal in 65 (62.5%) cases, the linea alba in 24 (23.1%) cases, umbilical in 12 (11.5%) cases, crural in 3 (2.9%) . The hernia was strangulated in 39 (37.5%) cases. The anesthesia was general in 73 (72.3%) patients and there was spinal anesthesia in 28 (27.7%) patients. Four bowel resections were performed. The hernia cure was a prosthetic plasty in 15 (14.4%) cases. Seven (6.9%) patients presented a complication including five (4.9%) surgical site infection and two (2%) scrotal hematomas. No deaths have been recorded. Conclusion Parietal hernias were frequent and inguinal in location, complicated by strangulation, with the presence of cases of recurrence. Hernial prostheses were rarely used.

Experimental evaluation of the use of starch and carboxymethylcellulose in the prevention of intraperitoneal adhesions in hernia surgery with coated meshes

Purpose: Laparoscopic hernia repair involves a risk of adhesion between coated mesh and viscera. Plant polysaccharides such as starch and carboxymethylcellulose (SC) make up a product that acts as a barrier and prevents intraperitoneal adhesions. This study aimed to evaluate whether topical SC can also reduce adhesions between mesh and intra-abdominal organs. Methods: Forty rats each received placement of two intraperitoneal mesh fragments, one on each side of the abdominal wall. Randomly, 20 animals received SC on the right and other 20 on the left, leaving the contralateral side as a control. Fourteen days after the surgery, the animals underwent an additional laparotomy in which macroscopic analysis was performed. Results: As for the percentage of the mesh area affected by adhesion, one (2.6%) animal had > 75% adhesion on the experimental side, and 11 animals (28.9%) on the control side. The adhesion intensity score showed firm adhesions in three (7.9%) animals on the experimental side and nine (23.7%) on the control side. Conclusions: The use of SC decreased the intensity of adhesions and the surface area of the mesh affected by adhesions. There was no negative interference of the product in the incorporation of the mesh into the abdominal wall.

Hérnia muscular: relato de caso diagnosticado pela ultrassonográfico / Muscular herniation: case report diagnosed by ultrasonography / Herniación muscular: reporte de caso diagnosticado por ultrasonografía

A hérnia muscular em extremidades é uma condição incomum e subdiagnosticada. A maioria das massas é indolor e assintomática. No entanto, em alguns casos, podem se tornar dolorosas após exercícios físicos prolongados. Neste relato de caso temos um paciente de 18 anos, queixando-se de abaulamento na perna esquerda após atividade física, com suspeita inicial de lipoma de extremidade A ultrassonografia identificou uma hernia muscular, destacando a importância de uma detecção precoce para que haja um tratamento adequado sem complicações, gastos desnecessários e diagnósticos equivocados.

Muscular hernia in extremities is an uncommon and underdiagnosed condition. Most masses are painless and asymptomatic. However, in some cases, muscle hernia can become painful after prolonged physical exercise. In this case report, we present an 18-year-old patient complaining of bulging in the left leg after physical activity, with initial suspicion of lipoma of the extremity. Ultrasonography identified a muscle hernia, highlighting the importance of early detection and leading adequate treatment without complications, unnecessary expenses, and misdiagnoses.

La hernia muscular en extremidades es una patología poco frecuente e infradiagnosticada. La mayoría de las masas son indoloras y asintomáticas. Sin embargo, en algunos casos, la hernia muscular puede volverse dolorosa después de un ejercicio físico prolongado. En este reporte de caso, presentamos a un paciente de 18 años que consulta por abultamiento en la pierna izquierda después de la actividad física, con sospecha inicial de lipoma de la extremidad. La ecografía identificó una hernia muscular, destacando la importancia de la detección temprana y conducir un tratamiento adecuado sin complicaciones, gastos innecesarios y diagnósticos erróneos.

Manejo laparoscópico de las hernias ventrales mediante abordaje totalmente extraperitoneal (eTEP): experiencia inicial y resultados a corto plazo / Laparoscopic Management of Ventral Hernias by Totally Extraperitoneal (eTEP) Approach: Initial Experience and Short-Term Results / Manejo laparoscópico de hérnias ventrais usando uma abordagem totalmente extraperitoneal (eTEP): experiência inicial e resultados em curto prazo

Introducción. El manejo de la hernia ventral sigue siendo un desafío para los cirujanos. Su reparación mediante técnicas mínimamente invasivas, como la totalmente extraperitoneal (eTEP) laparoscópica, permite una amplia disección del espacio a reparar, una recuperación postoperatoria más rápida, menor dolor postoperatorio y estancia hospitalaria. El abordaje eTEP es un enfoque novedoso que utiliza el espacio retromuscular para colocar material protésico y fortalecer la pared abdominal. El objetivo es describir los resultados a corto plazo de nuestra experiencia inicial con la técnica eTEP en el manejo de las hernias ventrales. Metodología. Estudio observacional, descriptivo, retrospectivo, donde se incluyen pacientes con el diagnóstico de hernia ventral, sometidos a cirugía laparoscópicaeTEP, entre julio-2021 y junio-2022. Resultados. De un total de 21 pacientes, el 61.9% fueron hombres. El 47.6% tenían sobrepeso y el 52.4% obesidad. Estancia hospitalaria media: 1.6 días. El 66.7% fueron hernias incisionales. Las técnicas quirúrgicas realizadas fueron: Rives-Stoppa (71.4%) asociándose liberación del músculo transverso en el 28.6%. El 19% de los pacientes presentaron complicaciones globales y solo uno fue grave, requiriendo reintervención quirúrgica. Se observó la presencia de seroma clínico en el 9.5% y ecográfico en 57.1%. No se evidenciaron hematomas, infección de herida quirúrgica ni casos de recidiva herniaria. Discusión y conclusiones. El abordaje laparoscópico eTEP Rives-Stoppa, asociado o no a separación posterior de componentes, en el manejo de las hernias ventrales ofrece buenos resultados asociando una baja incidencia de complicaciones postoperatorias, corta estancia hospitalaria, baja incidencia de recidivas herniarias, por lo que podría considerarse una técnica segura y efectiva en el tratamiento de las hernias ventrales.

Introduction. Managing ventral hernia remains a challenge for surgeons. Repairing it using minimally invasive techniques, such as laparoscopic totally extraperitoneal (eTEP), which allows for a wide dissection of the space to be repaired, faster postoperative recovery, less postoperative pain and shorter hospital stay. The eTEP approach is a novel technique that focus on the uses of the retromuscular space to place prosthetic material and strengthen the abdominal wall. The objective is to describe the short-term results of our initial experience with the eTEP technique in the management of ventral hernias. Methodology. Observational, descriptive, retrospective, study, which included patients with a diagnosis of ventral hernia, undergoing laparoscopic eTEP surgery, between July-2021 and June-2022. Results. Of a total of 21 patients, 61.9% were men. 47.6% were overweight and 52.4% were obese. Average hospital stay: 1.6 days. 66.7% were incisional hernias. The surgical techniques performed were: Rives-Stoppa (71.4%) with associated transversus abdominis muscle release in 28.6%. 19% of the patients presented global complications and only one was severe, requiring surgical reintervention. The presence of clinical seroma was observed in 9.5% and ultrasound in 57.1%. There was no evidence of hematomas, surgical wound infection or cases of hernia recurrence. Discussion and conclusions. The laparoscopic-eTEP Rives-Stoppa approach, associated or not with posterior separation of components, in the management of ventral hernias offers good results with a low incidence of postoperative complications, short hospital stay, low incidence of hernia recurrences, so it could be considered a safe and effective technique in the treatment of ventral hernias.

Introdução. O manejo da hérnia ventral continua sendo um desafio para os cirurgiões. Seu reparo por meio de técnicas minimamente invasivas, como a totalmente extraperitoneal (eTEP) laparoscópica, permite ampla dissecção do espaço a ser reparado, recuperação pós-operatória mais rápida, menor dor pós-operatória e menor tempo de internação. A abordagem eTEP é uma nova abordagem que usa o espaço retromuscular para colocar material protético e fortalecer a parede abdominal. O objetivo é descrever os resultados de curto prazo de nossa experiência inicial com a técnica eTEP no manejo de hérnias ventrais. Metodologia. Estudo observacional, descritivo, retrospectivo, longitudinal, que inclui pacientes com diagnóstico de hérnia ventral, submetidos a cirurgia laparoscópica-eTEP, entre julho-2021 e junho-2022. Resultados. De um total de 21 pacientes, 61.9% eram homens; 47.6% estavam com sobrepeso e 52.4% obesos. Tempo médio de internação: 1.6 dias; 66.7% eran hérnias incisionais. As técnicas cirúrgicas realizadas foram: Rives-Stoppa (71.4%) associada à liberação do músculo transverso em 28.6%. 19% dos pacientes apresentaram complicações globais e apenas um foi grave, necesitando de reintervenção cirúrgica. A presença de seroma clínico foi observada em 9.5% e ultrassonográfica em 57.1%. Não houve evidência de hematoma, infecção de ferida cirúrgica ou casos de recidiva de hérnia. Discussão e conclusões. A abordagem laparoscópica eTEP Rives-Stoppa, associada ou não à separação posterior dos componentes, no manejo das hérnias ventrais oferece bons resultados associando baixa incidência de complicações pós-operatórias, curto tempo de internação, baixa incidência de recidivas de hérnias, pelo que pode ser considerada uma técnica segura e eficaz no tratamento das hérnias ventrais.

Hernias traumáticas de la pared abdominal en pediatría: serie de tres casos / Traumatic hernias of the abdominal wall in pediatrics: Series of three cases

Introducción. Las hernias traumáticas de la pared abdominal son una entidad de muy rara ocurrencia en niños, con pocos casos descritos. Son lesiones causadas por trauma cerrado cuando las fuerzas resultantes del trauma no tienen la suficiente energía para romper la piel, pero son suficientes para producir una disrupción de las fibras musculares y la fascia. Métodos. Se presentan tres casos clínicos de niños con hernias traumáticas, el primero tipo I y los otros dos, tipo II, cuyo diagnóstico y tratamiento quirúrgico se llevaron a cabo por el servicio de cirugía pediátrica en un hospital de alto nivel de atención en Colombia. Resultados. Los tres pacientes fueron llevados a manejo quirúrgico sin prótesis, el primero por abordaje abierto y los otros dos por cirugía videoasistida, con buena evolución y sin recidivas en el seguimiento. Discusión. Las hernias traumáticas de la pared abdominal son más frecuentes en varones, como en nuestros casos, y del lado derecho. El diagnóstico de este tipo de hernias es clínico y se apoya en imágenes, teniendo en cuenta que no hay antecedente de hernia en la región afectada. El tratamiento es quirúrgico, pero es controversial el momento del mismo y el uso de materiales protésicos, puesto que existe la posibilidad de recidiva en los primeros meses en los casos de reparo primario. Conclusión. A pesar de la rareza de esta entidad, presentamos tres pacientes pediátricos a quienes se les realizó diagnóstico y manejo quirúrgico tempranos, con buena evolución y seguimiento a más de tres años.

Introduction. Traumatic hernias of the abdominal wall in children are a very rare entity, with few cases described. They are injuries caused by blunt trauma when the forces resulting from low-energy trauma to break the skin, but enough to produce a disruption of the muscle fibers and fascia. Methods. Three clinical cases of traumatic hernias in children are presented, one type I and the other two type II, whose diagnosis and surgical treatment were carried out by the pediatric surgery service in a high-level hospital in Colombia. Results. The three patients underwent surgical management without prosthesis, one by open approach and the other two by video-assisted surgery, with good evolution and no recurrence during follow-up. Discussion. Traumatic hernias of the abdominal wall are more common in male patients as in our cases, and on the right side of the abdomen. The diagnosis of this type of hernia is clinical and based on images, taking into account that there is no history of hernia in the affected region. The treatment is surgical, but its timing and the use of prosthetic materials are controversial, since there is the possibility of recurrence in the first few months in cases of primary repair. Conclusion. Despite the rarity of this entity, we present three pediatric patients who underwent early diagnosis and surgical management, with good evolution and follow-up for more than three years.

Bourse aiguë de l'enfant en chirurgie pédiatrique du chu Gabriel touré / Acute bursa of the child in pediatric surgery at the teaching hospital Gabriel Touré

La bourse aiguë est une urgence médico-chirurgicale de part ses nombreuses étiologies menaçant le pronostic fonctionnel des testicules et leurs annexes. Objectifs : Identifier les causes des bourses aiguës de l'enfant et décrire leurs aspects cliniques et thérapeutiques. Matériels et méthode : Il s'agissait d'une étude descriptive retroprospective allant du 1er janvier 2010 au 31 Décembre 2015 portant sur tous les enfants âgés de 0 à 15 ans reçus et traités pour bourse aiguë dans le service de Chirurgie Pédiatrique du CHU Gabriel Touré. Résultats: En 6 ans, nous avons enregistré 42 patients soit une fréquence de 1,4% des urgences chirurgicales. L'âge moyen était de 2,98 ans (24jours-14 ans). La prématurité a représenté 11,9 % des cas. La tuméfaction scrotale douloureuse était le principal motif de consultation (76,2%), Les principales étiologies étaient la HISE (90,5%), le traumatisme scrotal (4,7%), l'orchiépididymite (2,4%) et la torsion testiculaire (2,4%). Le traitement était chirurgical dans 97,6% des cas. L'évolution après 3 mois était simple dans 97,6% des cas. Conclusion: La bourse aigue de l'enfant est une pathologie peu fréquente touchant surtout les nourrissons. La hernie inguino-scrotale étranglée était la principale étiologie. Le diagnostic doit être précoce et le traitement adéquat afin de reduire la morbi-mortalité

Acute bursa is a medico-surgical emergency because of its many etiologies threatening the functional prognosis of the testes and their appendages. Objectives: Identify the causes of acute bursaries in the child and describe their clinical and therapeutic aspects. Materials and method: This were a retrospective descriptive study from January 1, 2010, to December 31, 2015, on all children aged 0 to 15 years received and treated for acute scholarship in the Pediatric Surgery department at the teaching hospital Gabriel Touré. Results: In 6 years, we registered 42 patients, ie a frequency of 1.4% of surgical emergencies. The mean age was 2.98 years (24 days-14 years). Prematurity represented 11.9% of cases. Painful scrotal tumefaction was the main reason for consultation (76.2%), The main a etiologies were HISE (90.5%), scrotal trauma (4.7%), orchi epididymitis (2.4%) and testicular torsion (2.4%). The treatment was surgical in 97.6% of cases. The course after 3 months was simple in 97.6% of cases. Conclusion: Acute bursa in children is an uncommon condition, especially affecting infants. Strangulated inguino-scrotal hernia was the main aetiology. The diagnosis must be early and the treatment adequate in order to reduce morbidity and mortality

Prevalence and characteristics of upper lumbar disc herniations in our practice: a retrospective analysis / Prevalência e características das hérnias lombares superiores em nosso meio: análise retrospectiva / Prevalencia y características de las hernias lumbares altas en nuestro medio: analisis retrospectivo

ABSTRACT Introduction: Upper lumbar disc herniations (ULDH) are considered infrequent injuries (1-11%). They present, most often in older adults, with special clinical features that make diagnosis and therapeutic decision-making difficult. The prevalence, location, and management of these herniations and the medical history of our patients were analyzed. Methods: Sex, age, injury level, previous surgery, and patient treatment data from July 2018 to May 2021 were collected retrospectively. During this period, 179 patients underwent surgery, 33 of whom patients presented ULDH. Results: Thirty-three patients were included in the study (18 male and 15 female). Ages ranged from 39 to 85 years, with a predominance of elderly patients. The levels operated were L1-L2 in seven patients, L2-L3 in ten patients, L3-L4 in fourteen patients, and surgery in two levels (L2-L3, L3-L4) in two patients. In our practice, microdiscectomy is the preferred approach and was performed in all cases, with the addition of fusion in four of the 33 patients. Finally, a history of low lumbar disc herniation (LLDH) surgery was found in 16 patients. Conclusions: In our population, ULDHs are a rare entity with lower prevalence at the higher lumbar levels. They occur more frequently in elderly patients and clinical presentation can vary, which is a challenge for surgeons. In older adults, the development of lumbar kyphosis due to vertebral wedging is considered a risk factor for the development of ULDH. Surgical management by microdiscectomy is considered a technique with good results for this pathology. Level of Evidence III; Retrospective, longitudinal, descriptive, observational study.

RESUMO Introdução: As hérnias de disco lombares altas (ULDH) são consideradas lesões infrequentes (1% a 11%). Ocorrem principalmente em idosos com características clínicas especiais que dificultam o diagnóstico e a decisão terapêutica. A prevalência, localização, o tratamento e a história de nossos pacientes foram analisados. Métodos: Dados sobre sexo, idade, nível das lesões, história cirúrgica e tratamento de nossos pacientes foram coletados retrospectivamente de julho de 2018 a maio de 2021. Nesse período, 179 pacientes foram operados, dos quais 33 apresentavam ULDH. Resultados: Trinta e três pacientes foram incluídos neste estudo, sendo 18 homens e 15 mulheres. A faixa etária variou de 39 a 85 anos, predominando os pacientes idosos. Os níveis operados foram L1-L2 em sete pacientes, L2-L3 em dez pacientes, L3-L4 em catorze pacientes e cirurgia em 2 níveis (L2-L3, L3-L4) em dois pacientes. Em nosso meio, a microdiscectomia é o tratamento de escolha, que foi realizado em todos os casos, adicionando fusão em 4 dos 33 pacientes. Finalmente, encontrou-se o antecedente de cirurgia de hérnia de disco lombar baixa (LLDH) em 16 pacientes. Conclusões: Em nosso meio, a ULDH é uma entidade rara e com menor prevalência em níveis lombares mais altos. Ocorrem com maior frequência em idosos e seu quadro clínico pode ser variado, o que representa um desafio para o cirurgião. Em idosos, o desenvolvimento de cifose lombar devido ao acunhamento vertebral é considerado um fator de risco para o desenvolvimento de ULDH. A cirurgia de microdiscectomia é considerada uma técnica com bons resultados nessa patologia. Nível de Evidência III; Estudo retrospectivo, transversal, descritivo, observacional.

RESUMEN Introducción: Las hernias discales lumbares altas (ULDH) son consideradas lesiones infrecuentes (1-11%). Se presentan principalmente en adultos mayores con características clínicas especiales que dificultan su diagnóstico y decisión terapéutica. La prevalencia, localización, manejo y antecedentes de nuestros pacientes fueron analizados. Métodos: Los datos con respecto a sexo, edad, nivel de lesión, antecedentes quirúrgicos y manejo de nuestros pacientes fueron recolectados retrospectivamente desde julio del 2018 hasta mayo del 2021. Durante este periodo 179 pacientes fueron operados, de los cuales 33 presentaron ULDH. Resultados: Treinta y tres pacientes fueron incluidos en éste estudio, de los cuales 18 eran hombres y 15 mujeres. Los rangos de edad variaron entre 39 y 85 años, predominando pacientes de la tercera edad. Los niveles intervenidos fueron L1-L2 en siete pacientes, L2-L3 en diez pacientes, L3-L4 en catorce pacientes y cirugía en 2 niveles (L2-L3, L3-L4) en dos pacientes. En nuestro medio, la microdiscectomía es el manejo preferido, el cual se realizó en todos los casos, agregando fusión en 4 de los 33 pacientes. Finalmente se encontró antecedente de cirugía por hernias discales lumbares bajas (LLDH) en 16 pacientes. Conclusiones: En nuestro medio, las ULDH son una entidad rara con menor prevalencia en niveles lumbares más altos. Se presentan con mayor frecuencia en personas de edad avanzada y su cuadro clínico puede ser variado, lo cual representa un reto para cirujano. En adultos mayores el desarrollo de cifosis lumbar por acuñamientos vertebrales se considera un factor de riesgo para el desarrollo de ULDH. El manejo quirúrgico mediante microdiscectomía se considera una técnica con buenos resultados en ésta patología. Nivel de Evidencia III; Estudio retrospectivo, transversal, descriptivo, observacional.

Manejo quirúrgico de la hernia perineal primaria / Surgical management of primary perineal hernia

Las hernias perineales presentan una incidencia variable entre el 0,3-6 %. El abordaje quirúrgico se puede realizar por vía perineal o por vía laparoscópica. Se presentan las imágenes de una paciente con una hernia perineal adquirida primaria, tratada exitosamente mediante un abordaje mixto.

Perineal hernias present a variable incidence between 0.3-6%. The surgical approach can be performed perineally or laparoscopically. Images of a patient with a primary acquired perineal hernia, successfully treated using a mixed approach, are presented.

Técnica TAPP en manos jóvenes. Es posible reproducir los resultados de la técnica Lichtenstein para la hernia inguinal sintomática primaria unilateral / Tapp technique performed by young hands. Reproducing the results of the lichtenstein procedure for symptomatic primary unilateral inguinal hernia

RESUMEN Antecedentes: La hernioplastia inguinal es el procedimiento quirúrgico más frecuentemente realizado dentro de la Cirugía General. Se realizan anualmente 20 millones de hernioplastias; la técnica de Lichtenstein y la transabdominal preperitoneal (TAPP) mediante cirugía laparoscópica son las más utilzadas. Objetivo: El objetivo del presente estudio es valorar la factibilidad de la realización del TAPP, en un centro universitario, por parte de residentes y cirujanos jóvenes en formación. Se comparó dicho procedimiento con la técnica de Lichtenstein valorando los resultados en los primeros 30 días del posoperatorio. Las principales variables para estudiar fueron: complicaciones, dolor posoperatorio, estadía hospitalaria y costo del procedimiento. Como variables para estudiar, a largo plazo, se compararon la recidiva herniaria y el dolor crónico. Material y métodos: Se realizó un estudio observacional comparando dos técnicas quirúrgicas utilizando la base de datos del Servicio con información adquirida de forma prospectiva. Se analizaron 80 pacientes, divididos en dos grupos: hernioplastia de Lichtenstein (grupo1) y hernioplastia por TAPP (grupo 2), durante el período comprendido desde mayo de 2015 hasta mayo de 2019, en dos Centros Universitarios de Montevideo Uruguay (Hospital de Clínicas y Hospital Español). Resultados: No hubo diferencia significativa en la estadía hospitalaria y complicaciones posoperatorias. El grupo del Lichtenstein presentó una recidiva herniaria. La hernioplastia laparoscópica presentó un tiempo operatorio promedio de 20 minutos más y el costo de materiales fue mayor. Si bien el dolor posoperatorio en las primeras 24 horas fue mayor en TAPP, el dolor a las 48 horas, 7días, un mes, tres meses y seis meses fue similar en ambos grupos. Conclusión: La técnica de TAPP, para la hernia inguinal primaria unilateral, es factible de ser realizada por cirujanos jóvenes o en formación, con un porcentaje de complicaciones, dolor posoperatorio y recidivas similares al Lichtenstein, aunque con un costo de materiales y tiempo operatorio levemente mayor.

ABSTRACT Background: Inguinal hernia repair is one of the most common procedures in general surgery. Each year, 20 million surgeries for inguinal hernia repaired are performed; the most common techniques used are the Lichtenstein procedure and the transabdominal preperitoneal (TAPP) laparoscopic approach. Objective: The aim of the present study is to evaluate the outcomes of the TAPP approach performed by residents and young surgeons in training in a university center. TAPP was compared with the Lichtenstein and the outcomes at 30 days were compared. The variables considered were complications, postoperative pain, length of hospital stay and procedure-related costs. The long-term variables analyzed were recurrence and chronic pain. Material and methods: We conducted an observational study comparing two surgical techniques, using prospectively acquired information from the database of our department. The cohort was made up of 80 patients undergoing inguinal hernia repair in two university-based hospitals in Montevideo, Uruguay (Hospital de Clínicas and Hospital Español), between May 2015 and May 2019. The patients were divided into two groups: Lichtenstein procedure (group 1) and TAPP procedure (group 2). Results: There were no significant differences in length of hospital stay and postoperative complications. One patient in the Lichtenstein group presented hernia recurrence. Mean operative time was 20 minutes longer with laparoscopic hernia repair, and the cost of the materials was higher. Postoperative pain at 24 hours was greater in the TAPP group, but was similar at 48 hours, 7 days, one month, three months and six months in both groups. Conclusion: The use of TAPP technique for unilateral primary inguinal hernia is feasible to perform by young surgeons or surgeons in training, and the percentage of complications, postoperative pain and recurrences is similar to that of the Lichtenstein technique, although the cost of materials and operative time are slightly higher.

Hernia de Garengeot y revisión de las variantes de hernias encarceladas / Garengeot's hernia and review of variants of incarcerated hernias

Introducción. La hernia de Garengeot se caracteriza por contener el apéndice cecal dentro del saco femoral, y forma parte de una variedad de hernias que reciben el epónimo de acuerdo con su localización anatómica. Entre ellas se encuentra la hernia de Richter, la hernia de Amyand, la hernia de Littré y la hernia de Spiegel. Se presenta una revisión de los abordajes laparoscópicos para estas diversas variantes. Caso clínico. Paciente femenina de 82 años de edad quien consultó al servicio de urgencias por dolor inguinal derecho de ocho días de evolución, asociado a clínica de obstrucción intestinal. Se hizo diagnóstico de hernia inguinal encarcelada y se llevó a cirugía encontrando una hernia de Garengeot. Discusión. Además de los tipos de hernia tradicionalmente conocidos, existen variantes inusuales de hernias de la pared abdominal, que deben ser sospechadas y tenidas en cuenta como diagnóstico diferencial, lo que permitirá realizar su tratamiento de forma oportuna disminuyendo el riesgo de que ocurra una perforación intestinal. Conclusiones. Las variantes de hernia inguinal o de localización inusual, son susceptibles de tratamiento quirúrgico mediante abordajes laparoscópicos con adecuados resultados.

Introduction. Garengeot's hernia is characterized by containing the cecal appendix within the femoral sac, and is part of a variety of hernias that receive their eponymous according to their anatomical location. These include Richter's hernia, Amyand's hernia, Littré's hernia, and Spiegel's hernia. We present a review of the laparoscopic approaches for these variants. Clinical case. An 82-year-old female patient consulted to the emergency department for right groin pain of eight days of evolution, associated with symptoms of intestinal obstruction. With a diagnosis of incarcerated inguinal hernia, she underwent surgery finding a Garengeot ́s hernia. Discussion. In addition to the traditionally known types of hernia, there are unusual variants of hernias of the abdominal wall, which must be suspected and taken into account as a differential diagnosis, which will allow treatment to be carried out in a timely manner, reducing the risk of intestinal perforation. Conclusions. Variants of inguinal hernia or unusual location are susceptible to surgical treatment by laparoscopic approaches with adequate results.

Síndrome lumbocostovertebral. Reporte de un caso / Lumbocostovertebral syndrome. A case report

Introducción. El síndrome lumbocostovertebral es una anomalía poco frecuente, que afecta a los cuerpos vertebrales, las costillas y músculos de la pared abdominal, y puede estar asociada a múltiples anomalías congénitas. Requiere un manejo multidisciplinario y tratamiento quirúrgico temprano para evitar complicaciones. Caso clínico. Se reporta el caso de un neonato masculino de 10 días de edad, que presentó desde el nacimiento 2 tumoraciones lumbares derechas, una que aumentaba de tamaño con el llanto, correspondió a una hernia lumbar, y la otra, a mielomeningocele. En estudios complementarios se evidenció fusión de costillas, fusión de cuerpos vertebrales lumbares, sacros (hemivértebras) y defecto de pared abdominal con protrusión de contenido intestinal. Se realizó cierre de la hernia lumbar con refuerzo protésico de pericardio bovino, sin complicaciones. Conclusión. En defectos extensos, como el que se reporta en este paciente, puede ser recomendable emplear material protésico. El pericardio bovino aparece como una opción segura, bien tolerada y eficaz para estos pacientes en particular. Este síndrome es una entidad rara, que amerita un equipo multidisciplinario para la resolución quirúrgica temprana y con ello evitar complicaciones.

Introduction. Lumbocostovertebral syndrome is a rare anomaly that affects the vertebral bodies, ribs and muscles of the abdominal wall, and can be associated with multiple congenital abnormalities. It requires multidisciplinary management and early surgical treatment to avoid complications. Clinical case. The case of a 10-day-old male neonate is reported, who presented from birth 2 right lumbar tumors, one that increased in size with crying, corresponded to a lumbar hernia, and the other, to myelomeningocele. In complementary studies, rib fusion, fusion of lumbar and sacral vertebral bodies (hemivertebrae), and abdominal wall defect with protrusion of intestinal contents were evidenced. The lumbar hernia was closed with prosthetic reinforcement with a bovine pericardium, without complications. Conclusion. In extensive defects, such as the one reported in this patient, it may be advisable to use prosthetic material. The bovine pericardium appears as a safe, well tolerated and effective option for these patients in particular. This syndrome is a rare entity, which requires a multidisciplinary team for early surgical resolution and thus avoid complications.