Totally endoscopic surgery on diastasis recti associated with midline hernias. The advantages of a minimally invasive approach. Prospective cohort study.

PURPOSE: To evaluate prospectively the feasibility and the duration of the plication of both aponeurosis through a totally endoscopic approach to the diastasis recti associated with midline hernias, correcting both pathologies simultaneously and objectively looking at their advantages and complications. METHODS: The prospective cohort study included patients suffering from midline hernias equal to or bigger than 2 cm size and associated diastasis recti, from April 2011 to October 2012. Full endoscopic subcutaneous approach is used to perform the surgery. An ultrasound scan was carried out to identify inter-rectus distances and recurrences in xiphoid, 3 cm supraumbilical and 2 cm subumbilical locations. RESULTS: A total of 21 patients were included in the study, with a mean follow-up of 20 months. The main complication was seroma. A significant reduction in the average distance between the rectus muscles was shown before surgery and at 1 month postoperative measures in all three locations (p < 0.001). No significant differences between the measured distances to the first and second year. A significant improvement at first postoperative year in cosmetic outcome compared with preoperative cosmetic condition (p < 0.001) was confirmed. Back pain improves significantly when diastasis recti is surgically corrected. CONCLUSIONS: Totally endoscopic approach to diastasis recti associated with midline hernias is a feasible and reproducible method. It brings considerable esthetic advantages. Diastasis or hernia recurrences in medium term follow-up have not been observed. Diastasis greater than 6-7 cm or associated with severe musculoaponeurotic laxity of the abdominal wall could benefit from the use of reinforced prosthesis.

Hemorragia digestiva alta de etiología inusual / Upper GI bleeding of unusual cause

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[A giant adrenal mass: the anatomicopathological surprise finding]. / Masa suprarrenal gigante: sorpresa anatomopatológica.

OBJECTIVE: The present study reviews the differential diagnosis of adrenal masses, including the uncommon forms, as the one described herein. METHOD/RESULTS: A patient with a giant adrenal mass that required differential diagnosis from other types of adrenal masses is presented. The diagnosis could only be made following anatomopathological analyses. CONCLUSIONS: The present case demonstrates that the uncommon forms of adrenal masses must be taken into account in the differential diagnosis, which, however, can only be confirmed by the pathological analysis since the findings on diagnostic imaging mimic other forms.

[Pyo-urachal cyst]. / Quiste piouracal.

A case of infected and suppurating pyourachal cyst is described. The rarity of urachal pathology in the adult prompted us to report the present case. The clinical features, diagnosis and treatment of this urachal complication are discussed.

Hemangiopericytoma of the spleen.

Hemangiopericytomas are rare vascular tumors, most frequently found in the muscles of the lower extremities. A parenchymatous origin is extremely uncommon. We present here what we believe is the first case ever reported of an hemangiopericytoma of the spleen.