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The Acidaminococcus genus is a part of the normal flora in gastrointestinal tract. It is a strictly anaerob Gram-negative coccus that is rarely pathogenic. We report the case of a 58-year-old man, who presented to surgery department A of the Charles Nicolle hospital, complaining of a wide inflammatory lesion in the anterior abdominal wall evolving for two weeks. Patient's anamnestic data included smoking, hypertension, and diabetes mellitus with poor compliance. The patient underwent flattening with excision of necrotic tissues and surgical drainage using a DELBET blade. Empirical antibiotic therapy with imipenem 1gx3/d, teicoplanin 400 mg 1 inj x2/d and gentamicin 400 mg 1 inj/d was administered pending bacteriological results. The bacteriological examination of a sample of necrotic tissue, after 72 h of incubation at 37 °C in anaerobic atmosphere, was able to detect a Gram-negative coccus, that the VITEK2 ANC system identified as Actinomyces canis with an accuracy of 80%. Whole genome sequencing was subsequently performed, that identified Acidaminococcus sp. AM33-14BH and demonstrated the following resistance genes: cfxa, tet(X) and tet(Q). An antibiogram for anaerobes was performed showing that the strain was resistant to amoxicillin but sensitive to amoxicillin-clavulanic acid, piperacillin-tazobactam, ertapenem, imipenem, meropenem and rifampin. Patient's condition improved after treatment with imipenem for 2 weeks, followed by oral amoxicillin-clavulanic acid for 16 days. This work highlights the role of molecular biology in the diagnosis of infections caused by anaerobes. Although the Vitek 2 ANC card provides rapid and acceptable identification of the most common anaerobic bacteria, improvements are needed for the identification of bacteria in the genera Acidaminococcus and Actinomyces. [ABSTRACT FROM AUTHOR]

There is an increase in the worldwide prevalence of congenital abdominal wall defects (CAWD), with gastroschisis (GS) and omphalocele (OC) being the most common. It is widely accepted that folic acid supplementation (FAS) in the maternal diet decreases the incidence of anomalies such as neural tube defects, but there is controversy regarding the possible beneficial role for other congenital malformations. Several epidemiological studies raise controversy regarding a possible relationship between vitamin supplementation with the occurrence of abdominal wall malformations. The aim of the present study is to obtain an updated review of the global frequency of CAWD in neonates and the relationship with FAS in the mothers. For this we have carried out a systematic search of epidemiological studies in different article databases between 2011 and 2022. The analysis of 25 studies conducted in different countries where cases of OC and/or GS are registered directly or together with other congenital defects shows that 60% inquire into the relationship of FAS with the incidence of CAWD. Half of them proposes a beneficial effect of FAS and the other half find no association, concluding that there is no unanimous evidence that FAS in the maternal diet decreases the incidence of CAWD. However, it seems that an influential factor to take into account is the nutritional habits of the mothers. [ABSTRACT FROM AUTHOR]

Internal herniation through the foramen of Winslow (FoW) is a rare, life-threatening diagnosis. We present a case of intestinal obstruction due to herniation of the ileum, cecum, appendix, and ascending colon through the FoW. We reduced the herniation using a small colotomy and preserved the entirety of the bowel. We closed the FoW and colotomy and secured the bowel to the lateral abdominal wall by suture cecopexy. Due to the rarity of this pathology, the literature remains unclear about the benefits of prophylactic measures, hence, we recommend continued reporting of cases and research on prophylactic measures. Further, our own treatment strategy outlined in this report may provide further insight into the misdiagnosis and management of FoW hernias. [ABSTRACT FROM AUTHOR]

The article "Abdominal muscle mass" in Skeletal Radiology discusses a case of a 32-year-old woman with a firm, rapidly growing mass on her abdominal wall following childbirth. The document includes ultrasound and MRI images of the lesion in the right rectus abdominis, as well as histological slides showing muscle tissue and myofibroblasts. The authors of the article are Thomas Saliba, Sanjiva Pather, and Karim Abdelkafi. [Extracted from the article]

Although ventriculoperitoneal shunt tip migration into an inguinal hernia is considered common in children, while in adults it is quite rare. In fact, only a handful of cases have been reported in the literature. We report a rare case whereby two catheter tips (one from a lateral ventricle shunt and a second from a 4th ventricular shunt) migrated into an inguinal hernia. This migration caused distal shunt malfunction, and only distal catheter shortening and suturing to the abdominal wall caused the two shunts to function again. [ABSTRACT FROM AUTHOR]

Bladder Exstrophic diseases, referred to collectively as Bladder Exstrophy-Epispadiasis complex, are a spectrum of embryological anomalies with a rare prevalence of approximately 3.3 per 1,00,000 live births with a male gender predominance. An 18-year-old man presented to Urology Outpatient Department (OPD) with subumbilical abdominal wall defect, absent anterior bladder wall with epispadiasis and was diagnosed as a case of adult classic bladder exstrophy with Epispadiasis complex. There was no history of any fever, haematuria, dysuria or abdominal pain. His ultrasound abdomen and intravenous pyelography reported normal kidney function. He had a low Body Mass Index (BMI) (17.5 kg/m²) with serum creatinine of 0.6 mg/dL. The patient underwent a complete primary repair, including bladder template closure and bladder neck reconstruction using Young-Dees-Leadbetter technique. Epispadias was repaired with the Modified Cantwell-Ransley approach. Abdominal wall defect closure was done with the help of rectus abdominis muscle flap which was later grafted using Split Thickness Skin Graft (STSG). Postoperatively, a small vesicocutaneous fistula developed which healed spontaneously over two weeks period. On follow-up patient was on clean intermittent catheterisation with some incontinence episodes during night-time. Bladder exstrophy in adult patients is rare, as the condition is usually identified in the neonatal period and can be surgically corrected early on. Due to the complexity of the surgery, these cases require thorough multidisciplinary evaluation and careful planning for successful correction. [ABSTRACT FROM AUTHOR]

Abstract Background Surgeries for sarcomas in the abdominal wall require wide resections, often radical en bloc resections, which generate major defects involving a very complex repair. The combined use of porcine dermal xenografts, together with composite meshes, may assist in the repair of these defects with minimal complications. Method We present a series of 19 patients (10 males and 9 females), with a mean age of 53.2 years (range: 11–86 years) treated in the Sarcoma Unit of the Virgen de la Arrixaca University Hospital from January 2015 to December 2021. Histopathologically, there were four chondrosarcomas (21%), three Ewing sarcomas (15.7%), two desmoid tumours (10.5%), two undifferentiated pleomorphic sarcomas (10.5%), two well-differentiated liposarcomas (10.5%), two leiomyosarcomas (10.5%), one synovial sarcoma, one dermatofibrosarcoma protuberans, one fibromyxoid sarcoma (or Evans tumour), and one metastasis from an adenocarcinoma of unknown origin. All the patients were resected following surgical oncology principles and reconstructed by means of the combined use of a composite mesh acting as a neoperitoneum and a porcine dermal xenograft acting as an abdominal neofascia. Results The mean size of the defects generated after surgery for tumour excision was 262.8 cm2 (range: 150–600 cm2). After a mean follow-up of 38 months, six patients (31.5%) developed complications—two cases of wound dehiscence, one case of surgical wound infection, one case of graft partial necrosis, one case of anastomotic leak and one death due to multiorgan failure secondary to massive bronchoaspiration. Conclusion Surgeries for sarcomas of the abdominal wall require wide oncological resections, which generate major abdominal wall defects. The repair of these defects by means of the combined use of synthetic and biological meshes is a technique associated with minimal complications and excellent medium-term results.

Acute appendicitis represents one of the most common causes of acute abdomen that may warrant emergency surgery. Necrotizing fasciitis complicated by acute appendicitis is considered a rare complication with life-threatening implications. A 65-year-old man presented with abdominal pain, where a scan, revealed a perforated appendicitis complicated by an anterior abdominal wall collection. He underwent percutaneous drainage, but subsequently developed extensive necrotizing fasciitis requiring extensive debridement and reconstruction. The rapid progression of necrotizing fasciitis calls for early recognition and prompt intervention. The key management principles employed were broad spectrum antibiotics and aggressive surgical debridement. This case demonstrated the use of vacuum-assisted closure dressing and multidisciplinary care in wound healing and coverage. To ensure early diagnosis and intervention for acute appendicitis complicated by necrotizing fasciitis, a high degree of clinical suspicion and awareness of this complication is required.

Background: An extremely rare kind of hernia is the traumatic abdominal hernia. It is frequently misdiagnosed, and diagnosing it calls for a high degree of suspicion. Case history: Following a collision with a scooter and a blow to his abdomen from one of the handles, a 40-year-old man was brought to the emergency room complaining of abdominal pain. A left lower abdominal wall hernia was suggested by USG-eFAST. Hernioplasty with meshplasty was performed on the patient. Results: There were no complications following surgery. Conclusions: When a patient is diagnosed with a traumatic abdominal wall hernia, they should have a thorough examination to rule out early signs of organ damage and then have their abdomens radiologically examined to check for intra-abdominal injuries. The diagnosis and treatment of these cases still depend heavily on clinical examination and judgment. Given the possibility of the bowel loop becoming incarcerated, the definitive course of treatment, in this case, is surgical exploration combined with the primary repair of the defect.

La obesidad es una afección crónica y no transmisible relacionada con enfermedades cardiovasculares, diabetes, hipertensión arterial, cáncer, entre otras, por lo que es un grave problema de salud pública y una de las mayores epidemias del siglo XXI. Esta revisión narrativa tiene como objetivo presentar un análisis comparativo de diferentes métodos doblemente indirectos de medición de la composición corporal en humanos: aspectos prácticos, ventajas y desventajas. La búsqueda bibliográfica se realizó en las bases de datos PubMed, SciELO, BVS, Dialnet y ScienceDirect. Se incluyeron 77 artículos la mayoría publicados entre 2013 y 2023. Los métodos directos de medición de la composición corporal como la disección de cadáveres y los métodos indirectos como las imágenes diagnósticas son confiables y precisos. Sin embargo, los parámetros antropométricos (métodos doblemente indirectos) son más usados en la práctica clínica, en especial en el IMC y el PA, dado que aportan información relevante y confiable sobre la obesidad y el riesgo cardiometabólico. Los métodos directos e indirectos de medición de la composición corporal son poco asequibles y costosos, pero poseen una alta confiabilidad. Por su parte, los índices antropométricos son más prácticos y fáciles de medir a pesar de su discreta confiabilidad; además, son mucho más económicos, de fácil interpretación y de gran utilidad en estudios epidemiológicos.

Background: The authors sought better outcomes for uncomplicated gastroschisis through development of clinical practice guidelines. Methods: The authors and the American Pediatric Surgical Association Outcomes and Evidenced-based Practice Committee used an iterative process and chose two questions to develop clinical practice guidelines regarding (1) standardized nutrition protocols and (2) postnatal management strategies. An English language search of PubMed, MEDLINE, OVID, SCOPUS, and the Cochrane Library Database identified literature published between January 1, 1970, and December 31, 2019, with snowballing to 2022. The Appraisal of Guideline, Research and Evaluation reporting checklist was followed. Results: Thirty-three studies were included with a Level of Evidence that ranged from 2 to 5 and recommendation Grades B–D. Nine evaluated standardized nutrition protocols and 24 examined postnatal management strategies. The adherence to gastroschisis-specific nutrition protocols promotes intestinal feeding and reduces TPN administration. The implementation of a standardized postnatal clinical management protocol is often significantly associated with shorter hospital stays, less mechanical ventilation use, and fewer infections. Conclusions: There is a lack of comparative studies to guide practice changes that improve uncomplicated gastroschisis outcomes. The implementation of gastroschisis-specific feeding and clinical care protocols is recommended. Feeding protocols often significantly reduce TPN administration, although the length of hospital stay may not consistently decrease. [ABSTRACT FROM AUTHOR]

Background: Surgeries for sarcomas in the abdominal wall require wide resections, often radical en bloc resections, which generate major defects involving a very complex repair. The combined use of porcine dermal xenografts, together with composite meshes, may assist in the repair of these defects with minimal complications. Method: We present a series of 19 patients (10 males and 9 females), with a mean age of 53.2 years (range: 11–86 years) treated in the Sarcoma Unit of the Virgen de la Arrixaca University Hospital from January 2015 to December 2021. Histopathologically, there were four chondrosarcomas (21%), three Ewing sarcomas (15.7%), two desmoid tumours (10.5%), two undifferentiated pleomorphic sarcomas (10.5%), two well-differentiated liposarcomas (10.5%), two leiomyosarcomas (10.5%), one synovial sarcoma, one dermatofibrosarcoma protuberans, one fibromyxoid sarcoma (or Evans tumour), and one metastasis from an adenocarcinoma of unknown origin. All the patients were resected following surgical oncology principles and reconstructed by means of the combined use of a composite mesh acting as a neoperitoneum and a porcine dermal xenograft acting as an abdominal neofascia. Results: The mean size of the defects generated after surgery for tumour excision was 262.8 cm2 (range: 150–600 cm2). After a mean follow-up of 38 months, six patients (31.5%) developed complications—two cases of wound dehiscence, one case of surgical wound infection, one case of graft partial necrosis, one case of anastomotic leak and one death due to multiorgan failure secondary to massive bronchoaspiration. Conclusion: Surgeries for sarcomas of the abdominal wall require wide oncological resections, which generate major abdominal wall defects. The repair of these defects by means of the combined use of synthetic and biological meshes is a technique associated with minimal complications and excellent medium-term results. [ABSTRACT FROM AUTHOR]

Purpose: In this study, we attempted to create skeletal muscle sheets made of directly converted myoblasts (dMBs) with a nanogel scaffold on a biosheet using a mouse gastroschisis model. Methods: dMBs were prepared by the co-transfection of MYOD1 and MYCL into human fibroblasts. Silicon tubes were implanted under the skin of NOG/SCID mice, and biosheets were formed. The nanogel was a nanoscale hydrogel based on cholesterol-modified pullulan, and a NanoClip-FD gel was prepared by freeze-drying the nanogel. 7 mm in length was created in the abdominal wall of NOG/SCID mice as a mouse gastroschisis model. Matrigel or NanoCliP-FD gel seeded with dMBs was placed on the biosheet and implanted on the model mice. Results: Fourteen days after surgery, dMBs with Matrigel showed a small amount of coarse aggregations of muscle-like cells. In contrast, dMBs with NanoCliP-FD gel showed multinucleated muscle-like cells, which were expressed as desmin and myogenin by fluorescent immunostaining. Conclusion: Nanogels have a porous structure and are useful as scaffolds for tissue regeneration by supplying oxygen and nutrients supply to the cells. Combining dMBs and nanogels on the biosheets resulted in the differentiation and engraftment of skeletal muscle, suggesting the possibility of developing skeletal muscle sheets derived from autologous cells and tissues. [ABSTRACT FROM AUTHOR]

Background/purpose: Living donor liver transplantation (LDLT) is vital for pediatric end-stage liver disease due to organ shortages. The graft-to-recipient weight ratio (GRWR) preoperatively measured predicts the outcomes of LDLT. We typically target between 0.8 and 3.0–4.0%, but the ideal GRWR remains controversial. We compared the outcomes of LDLT according to the GRWR to examine whether the criteria could be expanded while ensuring safety. Methods: We retrospectively reviewed 99 patients who underwent LDLT in our department by dividing them into three groups according to their GRWR: Group S, with GRWR values lower than the normal range (GRWR < 0.8%); Group M, with GRWR values in the normal range (GRWR ≥ 0.8 to < 3.5%); and Group L, with GRWR values above the normal range (GRWR ≥ 3.5%). Results: In Groups S and L, 46.2 and 44.4% of patients underwent splenectomy and delayed abdominal wall closure, respectively. After these intraoperative adjustments, there were no significant differences between the groups in 5-year patient survival, 5-year graft survival, or the occurrence of post-transplantation thrombosis. Conclusion: When the GRWR is beyond the normal threshold, the risk of complications associated with graft size might be reduced by adjustments to provide appropriate portal blood flow and by delayed abdominal wall closure. [ABSTRACT FROM AUTHOR]

Previous research confirmed gut dysbiosis and translocation of selected intestinal bacteria into the vessel wall in abdominal aortic aneurysm patients. We studied the stool, blood, thrombus and aneurysm microbiomes of 21 abdominal aortic aneurysm patients using 16S rRNA sequencing. Our goals were to determine: 1. whether the microbiome characteristic of an aneurysm differs from that of a healthy vessel, 2. whether bacteria detectable in the aneurysm are translocated from the gut through the bloodstream, 3. whether the enzymatic activity of the aneurysm microbiome can contribute to the destruction of the vessel wall. The abundance of Acinetobacter, Burkholderia, Escherichia, and Sphingobium in the aneurysm samples was significantly higher than that in the microbiome of healthy vessels, but only a part of these bacteria can come from the intestine via the blood. Environmental bacteria due to the oral cavity or skin penetration route, such as Acinetobacter, Sphingobium, Enhydrobacter, and Aquabacterium, were present in the thrombus and aneurysm with a significantly higher abundance compared to the blood. Among the enzymes of the microbiome associated with the healthy vessel wall, Iron-chelate-transporting ATPase and Polar-amino-acid-transporting ATPase have protective effects. In addition, bacterial Peptidylprolyl isomerase activity found in the aneurysm has an aggravating effect on the formation of aneurysm. [ABSTRACT FROM AUTHOR]

Purpose: Clarify the composition of the Posterior wall of the Inguinal Canal(PWIC), the location and composition of the Transverse Fascia(TF), and the tissue origin of the Cremaster(C) by observing the anatomy of the inguinal region of the cadaver. Methods: 30 cadavers were dissected to observe the alignment of the muscles and fascia of the inguinal canal and the anterior peritoneal space. the anatomical levels of the posterior wall of the inguinal canal and the alignment of the Spermatic Cord(SC) were observed. Results: (1) The posterior wall of the inguinal canal was white, bright, and tough tendon membrane-like tissue; (2) the transverse fascia was a thin fascial tissue with only one layer of membranous structure located in the abdominal wall under the abdominal wall on the side of the blood vessels of the peritoneal cavity; (3) the internal oblique muscle and its tendon membrane, and the transversus abdominis muscle and its tendon membrane extended on the surface of the spermatic cord, and fused and continued to the cremaster on the surface of the spermatic cord. Conclusions: 1. PWIC is mainly composed of Internal oblique muscle of abdomen (IOMA), Aponeurosis of internal oblique muscle of abdomen (AIOMA), Transverse abdominal muscle (TAM), and Transverse abdominal aponeurosis(TAA) as the following four types: (1) TAM and AIOMA fused to form a tendinous layer; (2) IOMA and TAM form the posterior wall of the muscle in the PWIC; (3) IOMA and AIOMA continue in the PWIC; 4) TAM and TAA continue in the PWIC. 2.TF is a thin fascial tissue with only one layer of membrane structure, TF is not involved in the composition of PWIC, so this fascia has nothing to do with resisting the occurrence of inguinal hernia. 3. The spermatic cord that travels in the inguinal canal is fixed to the lower wall of the inguinal canal by the tendon membrane of the cremaster, which is organized from the internal oblique and transversus abdominis muscles and their tendon membranes, The inguinal canal is a musculotendinous canal. [ABSTRACT FROM AUTHOR]

Mesh-augmented hernia repair is the gold standard in abdominal wall and hiatal/diaphragmatic hernia management and ranks among the most common procedures performed by general surgeons. However, it is associated with a series of drawbacks, including recurrence, mesh infection, and adhesion formation. To address these weaknesses, numerous biomaterials have been investigated for mesh coating. Platelet-rich plasma (PRP) is an autologous agent that promotes tissue healing through numerous cytokines and growth factors. In addition, many reports highlight its contribution to better integration of different types of coated meshes, compared to conventional uncoated meshes. The use of PRP-coated meshes for hernia repair has been reported in the literature, but a review of technical aspects and outcomes is missing. The aim of this comprehensive review is to report the experimental studies investigating the synergistic use of PRP and mesh implants in hernia animal models. A comprehensive literature search was conducted across PubMed/Medline, Web of Science, and Scopus without chronological constraints. In total, fourteen experimental and three clinical studies have been included. Among experimental trials, synthetic, biologic, and composite meshes were used in four, nine, and one study, respectively. In synthetic meshes, PRP-coating leads to increased antioxidant levels and collaged deposition, reduced oxidative stress, and improved inflammatory response, while studies on biological meshes revealed increased neovascularization and tissue integration, reduced inflammation, adhesion severity, and mechanical failure rates. Finally, PRP-coating of composite meshes results in reduced adhesions and improved mechanical strength. Despite the abundance of preclinical data, there is a scarcity of clinical studies, mainly due to the absence of an established protocol regarding PRP preparation and application. To this point in time, PRP has been used as a coating agent for the repair of abdominal and diaphragmatic hernias, as well as for mesh fixation. Clinical application of conclusions drawn from experimental studies may lead to improved results in hernia repair. [ABSTRACT FROM AUTHOR]

Aim: Incisional herniation (IH) is a frequent complication following midline abdominal closure with significant associated morbidity. Randomized controlled trials have demonstrated that the small bites technique (SBT) and prophylactic mesh augmentation (PMA) may reduce IH compared to mass closure techniques, but data are lacking on their implementation in contemporary surgical practice. This survey aimed to evaluate the use of the SBT and PMA and to identify factors associated with their adoption. Method: Between 22 January 2023 and 16 March 2023, consultant surgeons across the UK were asked to complete a 25‐question survey on closure of an elective primary midline incision. Results: Responses were received from 267 of 675 eligible surgeons (39.6%) in 38 NHS Trusts. Respondents were evenly split between tertiary centres (47.6%) and district general hospitals (49.4%). SBT and PMA were used by 19.9% and 3.0% of respondents, respectively. Compared to other techniques, surgeons using the SBT were more likely to close the anterior aponeurotic layer only, use single suture filaments, 2–0 gauge sutures and sharp needle points and routinely dissect abdominal layers to aid closure (all p < 0.001). Attendance at lectures/conferences on SBT (p = 0.043) and basing practice on available evidence (p < 0.001) were independently associated with use of the SBT. The commonest barriers to adopting SBT were a perceived lack of evidence (23.8%) and belief that personal IH rates were low (16.8%). Conclusion: A minority of UK consultant surgeons have adopted the SBT or PMA. Practice change should be driven by more widespread dissemination of current evidence and procedural information. [ABSTRACT FROM AUTHOR]

Background: In observational medication pregnancy safety studies, children are often followed from birth to 1 year of age. However, some major congenital malformations (MCM) may take longer to diagnose. Objectives: We aimed to investigate the proportion of children with detected MCMs at different lengths of follow‐up and compare them to the proportion detected at 1 year after birth. Methods: This population‐based register study included all singleton children liveborn in Sweden from 2006 to 2016. MCM were identified by ICD‐10 codes in the Medical Birth Register and National Patient Register, aligned to the EUROCAT classification system. Cumulative proportion of children with detected MCM at birth, 90 days, 1, 2, and 3 years was calculated and compared between children born preterm and at term. Results: In 1,138,113 liveborn children, the cumulative proportion of children with a detected MCM increased from 1.9% at birth to 3.1%, 3.9%, 4.4% and 4.7% at 90 days, 1, 2, and 3 years after birth, respectively, and varied by MCM subgroup. MCMs of the eye, ear‐face‐neck, nervous system and genitals were detected with the longest delay, with 31%–59% more detected at 3‐ versus 1‐year follow‐up. Compared to children born at term, the proportion of children with any MCM was 2.5 times higher amongst preterm children, with a higher proportion detected over the first 90 days for most MCM subgroups. Conclusions: The proportion of children with a detected MCM varied by MCM subgroup and follow‐up time. In pharmacoepidemiology studies of medication safety in pregnancy using Swedish national data, the length of child follow‐up should be chosen in accordance with the expected age at detection if a specific subgroup of MCM is under investigation, for example, eye and genital MCM require longer follow‐up for detection than abdominal wall and digestive system MCM. However, in most circumstances, 1 year of follow‐up is sufficient. [ABSTRACT FROM AUTHOR]

Background/Objectives: The success of peritoneal dialysis is highly dependent on the integrity of the abdominal wall. Therefore, routine examination and treatment of abdominal hernias can prevent peritoneal dialysis (PD) failure, discontinuation, and conversion to hemodialysis. In this present study, we present our examination protocol for patients proposed for PD and our attitude in treating parietal defects in patients on peritoneal dialysis. Objectives: highlight whether PD is a risk factor for the occurrence of ventral hernias, the relationship between associated pathologies and the occurrence of hernias and the need for an HD switch in the postoperative period. Methods: Between January 2016 and December 2022, a group of 133 patients proposed for insertion of a PD catheter were evaluated according to the protocol established by our hospital. Routine examination for the diagnosis of abdominal hernias and repair before starting the DP is part of the procedure. We included patients with a 3 year minimum follow-up after insertion and evaluated the incidence of parietal defects that appeared during PD treatment. Results: Nine patients were diagnosed and operated on for abdominal hernia before starting peritoneal dialysis and none of them had a recurrence of hernia during PD. Twelve patients were diagnosed with abdominal hernias during dialysis treatment (9% incidence) and the median length of time at which parietal defects occur during PD is 12.5 months [range 2–48]. Median BMI is 27.12 [range 22.3–31.24], with a female–male ratio of 2:1 Five patients were transferred to HD, three permanently and two patients temporarily. No patient abandoned PD treatment due to the presence of an abdominal parietal defect. Conclusions: Diagnosis of ventral hernias prior to the time of catheterization for PD leads to a decrease in the incidence of parietal defects during PD and is mandatory in patients who are candidates for PD. Open alloplastic surgical procedures are safe procedures with a low recurrence rate in PD patients. The postoperative continuation of PD is feasible but the decision is to be made by the multidisciplinary team and individualized for each patient. [ABSTRACT FROM AUTHOR]

Background: Diastasis recti (DR) is a common condition, especially in women after pregnancy, often associated with concomitant hernia defects and defined as a rupture of the midline and a separation of the rectus muscle more than 2 cm. Symptoms related to this are low back pain, urinary incontinence and pelvic prolapse, as well as abdominal bulging and core instability. We analyzed clinical and functional outcomes after treatment of DR alone or associated with midline hernias in 219 patients who underwent a midline reconstruction using miSAR® technique (minimally invasive stapled abdominal wall reconstruction). Methods: Between April 2019 and April 2022, 219 patients were treated with miSAR®. All patients were requested to quantify preoperative and postoperative functional symptoms (urinary incontinence, low back pain, abdominal swelling, and respiratory distress). Results: Twenty-seven men and 192 women underwent the miSAR® technique. The mean body mass index was 23.9 kg/m2. We performed the miSAR® technique in patients affected by incisional midline hernia and umbilical hernia alone or associated with DR. Composite mesh was used in 91.8% of cases. The average operating time was 90 minutes. Seven percent of the patients had postoperative complications, including two retromuscular hematomas, two retromuscular seromas, and one postoperative bleeding event. Two patients were readmitted for bowel obstruction. After surgery, there was symptomatic improvement in urinary incontinence, low back pain, respiratory symptoms, and abdominal swelling; this improvement was confirmed at 6 months and at 1- and 2-year follow-up. At the 1-year follow-up, the overall recurrence rate was 2.83%. Conclusion: miSAR® is a feasible and effective technique and shows promising results in the treatment of DR and ventral hernia. Possible enhancements include use of preoperative Botox to treat defects larger than 6 cm. Multicentric analysis is needed to validate the technique, and longer follow-up is required to assess the recurrence rate. [ABSTRACT FROM AUTHOR]

Cord lipomas are frequent findings in laparoscopic inguinal hernia surgeries in male patients. The symptoms of lipoma and the potential benefits of removing them are often overlooked because the focus is on the primary pathology of the hernia itself. Current recommendations are to reduce this fatty content, when present. When inguinal cord lipomas are left untreated in inguinal hernia surgery they can potentially cause symptoms and be detected in follow-up imaging exams. The objective of this study was to study incidence of cord lipomas in a cohort operated on by a single group specializing in abdominal wall surgery, as well as to analyze the possible relationship of this finding with the patient's symptoms, the characteristics of the operated hernia and postoperative outcome. This is a prospective study of male patients operated on for inguinal hernia laparoscopically or robotically in a single reference center. Of the total of 141 hernias, the distribution according to European Hernia Society classification showed that 45.4% were lateral, 19.1% medial and 35.5% mixed, highlighting a variety in the presentation of hernias. Analysis of the size of the hernias revealed that the majority (35.5%) were ≤ 1.5 cm. Inguinal cord lipoma was present in 64.5% of the samples, with no statistically significant association between the presence of the lipoma and an indirect hernia sac or obesity. The incidence of surgical site occurrences (SSO) was 9,2%, with seroma and hematoma. No recurrences were observed during follow-up, indicating a successful approach. There were no statistically significant relationships between SSO, the presence of lipoma and indirect hernial sac. [ABSTRACT FROM AUTHOR]

Purpose: Patients with abdominal rectus diastasis (ARD) may have muscular functional impairments, but clinics lack appropriate objective assessment tools. The aim was to establish the relative and absolute reliability, and convergent validity, of muscular activity using Surface Electromyography (SEMG) during isometric abdominal muscle strength testing in patients with ARD and controls without ARD. Methods: Twenty-six patients with ARD were matched for age, sex and BMI with controls without ARD. Participants were tested twice during isometric muscular contractions using SEMG located on six abdominal sites. Mean amplitude, fatigue, and recruitment order were analyzed. Relative reliability was evaluated with Intraclass Correlation Coefficients (ICC), while absolute reliability was estimated by calculating the Standard Error of Measurement and Minimal Detectable Change. Convergent validity was addressed in relation to participant characteristics, functional ability, and symptoms. Results: Mean SEMG amplitude for all abdominal wall muscle contractions showed moderate to excellent relative test–retest reliability, with ICC values ranging from 0.46 to 0.97. In contrast, fatigue and recruitment order displayed poor to moderate relative reliability in both groups. Absolute reliability measures were generally high. A moderate to high convergent validity (ARD: rho-value 0.41–0.70; Controls: rho-value 0.41–0.75) was observed for mean amplitude in relation to a functional sit-to-stand test, abdominal circumference, BMI, back pain, and quality-of-life. Conclusions: The results of applying SEMG during isometric abdominal muscle support practicing the method in clinics, although additional development is needed with further standardization and more functional testing. Furthermore, the method demonstrates construct validity in patients with ARD and in age- and sex-matched controls. [ABSTRACT FROM AUTHOR]

Purpose: Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. Methods: A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. Results: Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24–25) vs 14 (range 5–22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10–11) vs 8 (range 3–10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. Conclusion: Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication. [ABSTRACT FROM AUTHOR]

Background: Recurrent ventral hernia repair can be challenging due to scarred tissue planes and the increasing complexity of disease related to multiple recurrences. Given the challenges of acquiring complete and accurate prior operative reports, surgeons often rely on computed tomography (CT) scans to obtain information and plan for re-operation. Still, the contribution of CT scans and the ability of surgeons to interpret them is controversial. Previously, we examined the ability of surgeons to determine prior operative techniques based on CT scans. Here, we assessed the accuracy of expert abdominal wall reconstruction (AWR) surgeons in identifying the type of prior mesh using CT imaging. Methods: A total of 22 highly experienced AWR surgeons were asked to evaluate 21 CT scans of patients who had undergone open ventral hernia repair with bilateral transversus abdominis release utilizing mesh. The surgeons were required to identify the mesh type from a multiple-choice selection. Additionally, negative controls (patients without a history of prior laparotomy) and positive controls (patients with laparotomy but no ventral hernia repair) were incorporated. The accuracy of the surgeons and interrater reliability was calculated. Results: The accuracy rate of the surgeons in correctly identifying the mesh type was 46%, with heavy-weight synthetic mesh (HWSM) being identified only 35.4% of the time, Strattice mesh and medium-weight synthetic mesh (MWSM) were identified at 46.3%, and 51.8%, respectively. The interrater reliability analysis found a moderate level of agreement 0.428 (95% CI 0.356–0.503), and the repeatability measure was poor—0.053 (95% CI 0–0.119); this indicates that surgeons cannot reliably replicate the identification process. Conclusions: Surgeons' ability to accurately identify the type of previous mesh using CT scans is poor. This study underscores the importance of documenting the type of mesh used in the operative report and the need for standardized operative notes to improve the accuracy and consistency of documentation. [ABSTRACT FROM AUTHOR]

Purpose: Intraoperative fascial traction (IFT) for the treatment of large ventral hernias and loss of domain (LOD) hernias is a promising tool in abdominal wall surgery. However, little is known about the extent of gain in myofascial advancement especially for the anterior rectus sheath. We, therefore, used a cadaveric model to determine the medialization during IFT. Methods: 4 fresh frozen specimens were used. Retromuscular preparation was carried out followed by IFT with diagonal vertical traction for 30 min. Medial advancement of the anterior rectus sheath was measured after 15 and 30 min as well as traction forces. Results: Total medialization for anterior rectus sheath after 30 min of IFT was 10.5 cm (mean). The mean traction force was 16.28 kg. Total medialization was significantly higher during the first 15 min of vertical fascial traction (p < 0.05). Conclusions: IFT provides significant medialization for the anterior rectus sheath in the cadaveric model. The findings align with results from a retrospective case study. Therefore, we see IFT as a beneficial tool in abdominal wall surgery. [ABSTRACT FROM AUTHOR]

Background: The aim of this multicentre study was to analyse the outcomes of biosynthetic absorbable poly-4-hydroxybutyrate (P4HB) prosthesis implantation in patients undergoing ventral hernia repair (VHR) in the context of different degrees of contamination. Methods: From May 2016 to December 2021, a multicentre retrospective analysis of patients who underwent elective or urgent hernia repair with P4HB prosthesis was performed in seven hospitals in Spain and Portugal. Patients with a postoperative follow-up of less than 20 months and those within the theoretical period of prosthesis resorption were excluded from the study. Regarding the degree of contamination, patients were assessed according to the modified Ventral Hernia Working Group (VHWG) classification. Epidemiological data, hernia characteristics, surgical and postoperative variables (Clavien–Dindo classification) of these patients were analyzed. Risk factors related to long-term recurrence were studied by a multivariate analysis. Results: In 236 cases of P4HB prosthesis implantation, repair in cases of Grade 3 was the most frequent (49.1%), followed by Grade 2 in 42.3% of cases and Grade 1 in 8.4%. The most frequent complications were Grade 1, with the majority occurring during the first year. The overall rate of surgical site occurrences (SSO) was 30%. The hernia recurrence rate was 14.4% (n = 34), with a mean postoperative follow-up time of 41 months (22–61). The multivariate analysis showed that the onlay location of the mesh (OR 1.07; CI 1.42–2.70, p = 0.004) was a significant independent risk factor for recurrence. Conclusions: The use of a P4HB bioresorbable mesh for the VHR with different degrees of contamination leads to favourable results overall, with an acceptable rate of hernia recurrence. The onlay location of the P4HB prosthesis is the main factor in recurrence in both elective and emergency settings. [ABSTRACT FROM AUTHOR]

Introduction: Desmoid tumor (DT) is a rare proliferative disease occurring in connective tissues, characterized by high infiltration and recurrence rates. While surgery remains the primary treatment, its recurrence risk is high, and some extra-abdominal desmoid tumors are inoperable due to their locations. Despite attempts with radiotherapy and systemic therapy, the efficacy remains limited. Methods: We used low-power cumulative high-intensity focused ultrasound (HIFU) therapy as an initial treatment for desmoid tumor patients either ineligible or unwilling for surgery. Low-power cumulative HIFU employs slower heat accumulation and diffusion, minimizing damage to surrounding tissues while enhancing efficacy. Results: Fifty-seven non-FAP desmoid tumor patients, previously untreated surgically, underwent low-power cumulative HIFU therapy. Among them, 35 had abdominal wall DT, 20 had extra-abdominal DT, and 2 had intra-abdominal DT, with an 85% median ablation ratio. Abdominal wall DT patients showed significantly better response rates (91.4% vs. 86%) and disease control rates (100% vs. 32%) than that of non-abdominal wall DT patients. Median event-free survival time was not reached after a median follow-up duration of 34 months. Discussion: With its high response rate, durable efficacy, and mild adverse effects, our findings suggest that low-power cumulative HIFU presents a promising novel treatment for desmoid tumors, particularly abdominal wall DT patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Three cats with recurrent rectal prolapses were successfully treated using total laparoscopic colopexy (TLC). Minimally invasive procedures are increasingly popular in veterinary medicine because of their low postoperative morbidity and quicker recovery. The TLC technique, inspired by laparoscopic-assisted colopexy, involves strategically placed portals to minimize wound complications and ensure effective adhesion of the colon to the abdominal wall. In these cases, non-incisional colopexy using thermal injury was employed to enhance fibrous adhesion, reducing bleeding and avoiding luminal penetration risks. Barbed sutures, used in a continuous single row, facilitated the procedure by eliminating the need for intracorporeal knots, thus reducing surgical time to 30 min. No complications or recurrences were noted during follow-ups. In one case, a viable colopexy was confirmed during a subsequent laparoscopic procedure, demonstrating the technique's success. Overall, TLC was found to be a feasible, safe, and effective method for treating recurrent rectal prolapses in cats, although further studies with larger sample sizes are necessary to validate these findings. The use of minimally invasive methods has grown in popularity due to decreased postoperative morbidity and a quicker recovery. Colopexy is a surgical method that includes the permanent adhesion of the colonic seromuscular layer to the abdominal wall to avoid rectal prolapses in cats and dogs with viable prolapsed tissues. In this case series, we describe the treatment of three cats with total laparoscopic colopexy (TLC) for recurrent rectal prolapses. A non-incisional colopexy was created by suturing the colon to the abdominal wall with a barbed suture. There were no intraoperative complications and a 6-month follow-up revealed no prolapse recurrence. Our study demonstrates that TLC approaches are feasible, safe, and free of problems when used to treat recurrent rectal prolapses in cats, although a larger caseload is required to validate the results obtained from our reported cases. [ABSTRACT FROM AUTHOR]

We encountered a rare case of appendiceal carcinoma associated with Amyand's hernia, which was difficult to diagnose preoperatively. A 74-year-old man presented to our hospital with right lower abdominal pain. A hard mass was palpable in the right lower abdomen, and blood tests showed a slightly elevated inflammatory response. Computed tomography revealed a 7 × 5 cm mass with indistinct borders and heterogeneous internal density extending from the cecum to the right lower abdominal wall. We diagnosed appendiceal abscess, however, percutaneous biopsy which was performed for differential diagnosis with appendiceal carcinoma showed no malignancy. Thereafter, the patient was followed up. Two months later, a blood test showed insignificant changes in the inflammatory response and a high serum carcinoembryonic antigen level (48.6 ng/mL). An ultrasound showed a mass contiguous to the appendix, extending to the abdominal wall, with abundant blood flow signals. Fluorodeoxyglucose-positron emission tomography showed a high accumulation of fluorodeoxyglucose in the mass. Four months after the initial visit, the patient had an open ileocecal resection combined with an abdominal wall resection based on the preoperative diagnosis of appendiceal carcinoma invading the abdominal wall. During laparotomy, an enlarged appendix tip extended from the internal inguinal ring outside the inferior epigastric artery to the abdominal wall. Histopathological examination of the appendiceal tumor revealed well-differentiated adenocarcinoma, T4b (abdominal wall), N0, Ly0, and V0. When a right lower abdominal mass extends from the cecum to the abdominal wall, appendiceal tumors associated with Amyand's hernia should be considered. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study is to compare the thickness of the transverse abdominis, internal oblique, external oblique, rectus abdominis, and rectus abdominis distance, the quality of life (SF-36), the presence of chronic pelvic pain (CPPQ-Mohedo), and sexual dysfunction (IIEF) in men who practice CrossFit® versus men who do not. Design, setting, participants, and main outcome measures: Sixty-four healthy men with an average age of 37.19 were recruited at a private sports club and divided into two groups for this cross-sectional observational study. Additionally, participants completed the CPPQ-M, IIEF, and SF-36 questionnaires. Results: Significant differences were found in the thickness of the internal oblique at rest (p = 0.018, d = 0.61), which was greater in the CrossFit® group. In the SF-36 quality of life questionnaire (p = 0.05, d = 0.50), the CrossFit® group also obtained a higher score. Conclusion: CrossFit® improves the quality of life and self-esteem of the participants, in addition to increasing the thickness of the internal oblique. Neither more chronic pelvic pain nor more erectile dysfunction was observed in the CrossFit® group. [ABSTRACT FROM AUTHOR]

Omphalocele and gastroschisis are the most common types of abdominal wall defects. Comprehensive local experience helps parents to make decisions on the pregnancy and foresee the disease journey. A retrospective review of abdominal wall defect patients in all three pediatric surgical centers in Hong Kong between January 2003 and February 2023 was conducted. All patients consecutively diagnosed with omphalocele and gastroschisis were included, excluding other forms. Data of demographics and short- and long-term outcome parameters were collected. A total of 99 cases were reviewed and 85 patients met the inclusion criteria. Diagnoses include omphalocele major (n = 49, 57.6%), omphalocele minor (n = 22, 25.9%) and gastroschisis (n = 14, 16.5%), with mean gestational age 37 weeks (SD 2.2) and birth weight 2.7 kg (SD 0.6). Omphalocele is most commonly associated with cardiovascular (n = 28, 39.4%) and chromosomal defects (n = 11, 15.5%). Surgical procedures including primary repair (n = 38, 53.5%), staged closure (n = 30, 42.3%) with average 8.6 days (SD 4.7) of silo reduction, and conservative management (n = 3, 4.2%) were performed. The mortality rate was 14.1% (n = 10) and the complication rate was 36.6% (n = 26). The majority of patients had normal intellectual development (92.5%) and growth (79.2%) on the latest follow-up. For gastroschisis, one patient (7.1%) had intestinal atresia. Surgical procedures included primary repair (n = 9, 64.3%) and staged closure (n = 5, 35.7%) with average 8 days (SD 3.5) of silo reduction. Complication rate was 21.4% (n = 3), with one mortality (7.1%). All patients had normal intellectual development and growth. The mean follow-up time of this series is 76.9 months (SD 62.9). Most abdominal wall defects in our series were managed surgically with a good overall survival rate and long-term outcome. This information is essential during antenatal and postnatal counseling for parents. [ABSTRACT FROM AUTHOR]

Background: Pregnancy and labor can impact women's body contours. After a cesarean section, some women may experience aesthetic issues such as the formation of a panniculus and a bulging mons pubis. This study aimed to investigate the impact of cesarean sections on the dimensions of the mons pubis and their ratios. Methods: The study included 194 multiparous Caucasian women. Participants' ages ranged from 18 to 40 years, and their BMI ranged from 18 to 30. They were divided into two BMI groups. Each group was further subdivided based on the mode of delivery into vaginal delivery (VD) and cesarean section (CS) groups. Manual measurements of the three dimensions of the mons pubis (monal height, monal width, and monal length) were conducted. Measurements were recorded in centimeters in the lithotomy position using iGaging 8-inch digital outside calipers. Monal height is the distance between the anterior surface of the symphysis pubis and the maximum height of the mons pubis (calculated by measuring the distance between the anterior wall of the vagina and the maximum height of the mons pubis minus the distance between the anterior wall of the vagina and the anterior surface of the symphysis pubis). Monal width is the maximum transverse distance between the merging borders of the mons pubis and the fat of the lower abdominal wall. Monal length is the maximum longitudinal distance between the merging upper border of the mons pubis and the fat of the lower abdominal wall and the upper end of the pudendal cleft. Results: No significant statistical difference was observed between the three dimensions of the mons pubis in vaginal delivery and cesarean section populations in the two groups. The changes in the ratios between the two groups' different monal dimensions in the cesarean section population are minimal and do not follow a consistent pattern. There were no significant differences between the dimensions of single and repeated CS populations, with non-trendy changes in the different ratios in the repeated CS group. Conclusion: Even when repeated, cesarean section minimally affects the dimensions and ratios of the mons pubis. However, more studies with standardized fascial and subcutaneous fat closure are needed. [ABSTRACT FROM AUTHOR]

Tumors originating from soft tissues are uncommon, among these tumors, liposarcomas are the most frequent. These tumors remain asymptomatic for a long time, and only revealing themselves when they reach an important size. In such cases, treatment is difficult, requiring extensive surgery procedures that can excise several adjacent structures, potentially completed by adjuvant radiotherapy. Despite successful treatment, the recurrence rate remains very high. We report the case of a giant liposarcoma requiring a monobloc extensive resection involving the removal of the tumor, left kidney, left adrenal gland, and a portion of the posterior abdominal wall. [ABSTRACT FROM AUTHOR]

Peripheral magnetic stimulation has recently been introduced as a non-invasive but effective physical agent to improve muscle strength and everyday function. The aim of this study was to evaluate the feasibility and safety of an exercise program focusing on the abdominal muscles in combination with the peripheral magnetic stimulation of the abdominal muscles. Male and female overweight and obese adults (n = 19) participated in an eight-week exercise program with the additional peripheral magnetic stimulation of the abdominal muscles. Outcome measures included changes in abdominal subcutaneous fat thickness, trunk muscle strength, body composition, and self-reported body satisfaction. Subcutaneous fat thickness was significantly reduced after the intervention (p < 0.01–p < 0.001). Trunk flexion and left side flexion strength increased significantly after the intervention, although no significant changes were observed for trunk extension (p = 0.07) and right side flexion strength (p = 0.13). The body satisfaction self-assessment score significantly increased (p < 0.01), while body mass, body mass index, and fat mass significantly decreased after the intervention (p < 0.05). Our findings suggest that an exercise program with the additional peripheral magnetic stimulation is feasible and safe for overweight and obese participants. These results support the use of peripheral magnetic stimulation as a safe adjunct to the voluntary abdominal muscle contraction. Future studies are needed to evaluate the efficacy of the additional peripheral magnetic stimulation of the abdominal muscles compared to the voluntary contraction of the abdominal muscles alone. [ABSTRACT FROM AUTHOR]

Introduction. Preoperative application of botulinum toxin type A has demonstrated to be safe and effective in the closure of complex ventral hernias in adults. However, its use in pediatrics has been little documented. Clinical case. We present the case of a 22-month-old girl with a complex abdominal wall ventral hernia secondary to multiple neonatal laparotomies. In a first procedure, botulinum toxin was administered using an intramuscular approach at six sites of the muscle layers surrounding the defect, under general anesthesia and ultrasound control. 4 weeks later, an open hernia repair was conducted, without complications. Discussion. Botulinum toxin at low doses could facilitate the surgical treatment of complex ventral incisional hernias in children. Even though it is important to adjust dosage and anatomical reference points according to hernia type and patient age and weight, further studies are required to optimize these variables. [ABSTRACT FROM AUTHOR]

Combined thoracic and abdominal trauma is considered one of the most severe in the structure of polytrauma, which causes a high frequency of complications – 33-72% and a mortality rate of up to 34%. The purpose of the study was to ensure the quality of the provision of medical services to victims with combined abdominal and thoracic trauma, through clinical assessment of the most significant symptoms and systematization of their manifestations aimed at justifying diagnostic and treatment measures. We conducted a prospective analysis of clinical manifestations in 44 victims with combined abdominal and thoracic trauma, who were treated at the city clinical hospital 16 of Dnipro in the period from 2019 to 2023. The average age of the victims was 41.5±2.4 years, men predominated – 40 (90.9%) people. In 40 (90.9%) victims, only 2 anatomical sites were damaged, 3 anatomical sites were damaged in 3 (6.8%) victims, 4 or more anatomical sites were damaged in 1 (2.3%) injured person. All victims were operated on. Multiple injuries of abdominal organs were observed in 14 (31.2%) victims. Among the injuries of the chest cavity, the most common cause was a lung contusion – 36.4% of cases. Exclusion criteria from the study were craniocerebral injury and contusion or injury to the heart as components of a combined injury. Also, the study did not include victims who received resuscitation measures during admission or at the stage of emergency care. Collection of complaints and anamnesis, examination, palpation, percussion and auscultation were used as research methods. The obtained information made it possible to determine the sequence of use of hardware and instrumental diagnostic methods. For better systematization of clinical symptoms, the latter were divided into three components – abdominal, thoracic and hemodynamic. The most frequent complaint was pain in the abdomen and in the chest area, respectively 75.6% and 82.9%. In the structure of the hemodynamic component, the victims most often complained of a feeling of general weakness – 73.2%. The accuracy of the symptoms detected during the diagnosis of damage to the abdominal organs ranged from 6.8% (Kulenkampf's symptom) to 93.2% pain of the abdominal wall. The diagnostic accuracy of Rozanov's symptom, which indicated damage to the spleen was 68.2%. Despite the fact, that such a symptom as pain during palpation of the chest occurred in 81.8% of victims, its diagnostic efficiency remains quite low – 54.5%. On the other hand, such a symptom as bone crepitation, with an accuracy of 95.5%, allowed us to assert the presence of rib fractures in the victims and hint at the probability of injury to the chest or abdominal organs, which we observed in 44.4% and 88.9% of cases, respectively. Damage to the lungs was also ascertained due to the sufficiently high diagnostic accuracy of the auscultatory symptom – weakening of breathing – 70.5%. Hypotension below 90 mm Hg. (45%; 50%), tachycardia (81.8%; 59.1%) and pallor of the skin (56.8%; 65.9%) showed sufficiently high diagnostic accuracy during the diagnosis of possible intraabdominal and intrapleural bleeding, respectively. The combination of damage to the organs of the abdominal and thoracic cavities was characterized by multifaceted clinical manifestations and signs of multisymptoms. Most of the symptoms taken separately had low accuracy regarding the presence or absence of a certain intracavitary post-traumatic pathology (from 6.8% to 43.2%); however, the combination of several of them indicated the multiplicity of damage to the organs of the abdominal cavity (from 41.7% to 100%). The best diagnostic accuracy was shown by Rozanov's symptoms – 68.2%, which indicated damage to the spleen and crepitation of rib fragments – 95.5%, as well as auscultatory weakening of breathing – 70.5%, which indicated lung damage. [ABSTRACT FROM AUTHOR]

Background: Chronic abdominal pain in children is occasionally caused by anterior cutaneous nerve entrapment syndrome (ACNES). Diagnosing and treating this typical peripheral abdominal wall neuropathy is challenging. Management usually starts with minimally invasive tender point injections. Nevertheless, these injections can be burdensome and might even be refused by children or their parents. However, a surgical neurectomy is far more invasive. Treatment with a Lidocaine 5% medicated patch is successfully used in a variety of peripheral neuropathies. Aims: This single center retrospective case series aimed to evaluate the effectiveness and tolerability of lidocaine patches in children with ACNES. Methods: Children aged under 18 diagnosed with ACNES who were treated with a 10 day lidocaine patch treatment between December 2021 and December 2022 were studied. Patient record files were used to collect treatment outcomes including pain reduction based on NRS and complications. Results: Twelve of sixteen children (mean age 13 years; F:M ratio 3:1) diagnosed with ACNES started the lidocaine patch treatment. Two patients achieved a pain free status and remained pain free during a 4 and 7 months follow‐up. A third child reported a lasting pain reduction, but discontinued treatment due to a temporary local skin rash. Five additional patients reported pain reduction only during application of the patch. The remaining four children experienced no pain relief. No adverse effects were reported. Conclusion: Lidocaine patches provides pain relief in a substantial portion of children with ACNES. [ABSTRACT FROM AUTHOR]

Background: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is traditionally a maximally invasive operation with a large abdominal incision and multi‐visceral resections. However, to minimize abdominal wall morbidity and improve functional recovery, some centres have adopted a minimally invasive (MI) approach in select cases. The primary aim of this systematic review and meta‐analysis was to assess the evidence for safety and patient selection for minimally invasive approaches to CRS and HIPEC with curative intent. Methods: A PRISMA‐compliant systematic review was performed using three electronic databases: Ovid MEDLINE, EMBASE and Web of Science. Data regarding postoperative morbidity was meta‐analysed. Results: Thirteen studies met the inclusion criteria (N = 462 MI patients), all of which were retrospective in design. Six studies included an open comparison group. Pseudomyxoma peritonei, mesothelioma and ovarian carcinoma made up the majority of cases (>90%), with a PCI < 10 listed as a prerequisite to selection across all studies. On pooled analysis there was no difference in major morbidity between MI and open groups (OR 0.52 95% CI 0.18–1.46, P = 0.33). There was one perioperative death reported in the MI group. Length of stay appeared shorter in the MI group (median range MI: 4–11 v Open: 7–13 days). Short‐term recurrence and overall survival between both groups also appeared no different. Conclusion: Minimally invasive CRS and HIPEC appears feasible and safe in appropriately selected patients. Clear histological stratification and longer term follow up is required to determine oncological safety, particularly in more aggressive tumours such as colorectal peritoneal metastases. [ABSTRACT FROM AUTHOR]

Background: The current literature supports the closure of trocar sites ≥10‐mm for the risk of developing incisional hernias, while there is no need to suture the abdominal fascia when using 5‐mm trocars. To date, evidence regarding the closure of 8‐mm trocars that are use by new robotic systems is weak. The aim of our study was to investigate the incidence of incisional hernia for 8‐mm trocars. Methods: We prospectively collected data on all patients undergoing robotic‐assisted abdominal wall surgery from 2020 to 2023, in whom the abdominal fascia of all 8‐mm trocars was not closed. The enrolled patients underwent a follow‐up visit during which we conducted clinical and sonographic evaluations of all 8‐mm trocars, in addition to assessing the satisfaction levels of the patients. The primary outcome was the incidence of port‐site hernia. Results: We enrolled 166 patients, 155 men and 11 women, for a total of 513 trocars accessed. Mean age was 61.1 ± 14.0 years, and mean BMI was 27.0 ± 3.9 kg/m2. The follow‐up visits were carried out after a median follow‐up of 14.5 (9.0–23.2) months. Only one case developed an asymptomatic 1 × 1 cm supra‐umbilical hernia that was not treated. Patient reported a satisfaction regarding the 8‐mm trocars and skin sutures of 9.8 ± 0.5 out of 10 points. Conclusions: The occurrence of a trocar‐site hernia after 8‐mm robotic access is extremely low. Hence, the fascia closure may not be necessary. [ABSTRACT FROM AUTHOR]

Background: Penetrating abdominal trauma in patients is associated with severe morbidity and sometimes death. The incidence of penetrating trauma varies widely over the world. Similarly, the global experience with laparoscopy in trauma patients varied. Many recent investigations have indicated that laparoscopy plays a useful function in such cases. Objective: This study aimed to assess the diagnostic and therapeutic utility of laparoscopy in penetrating abdominal trauma (PAT) patients with respect to the precision and effectiveness of care and the avoidance of needless laparotomy. Patients and methods: This prospective study was conducted at Sohag University Hospitals, Sohag, Egypt. We included all patients with penetrating anterior abdominal wall injuries who were vitally stable. Results: We involved 60 patients who were admitted to the Emergency Room after suffering from penetrating abdominal injuries. The patients' mean age was 37.4 years and the percentage of male patients was higher (81.67%). Stab wounds accounted for 60% of injuries while gunshot wounds accounted for 40%. Hospital stay in laparoscopy was longer due to gastric, small intestinal, and colonic injuries. The average operation time in laparoscopy was 2.5 hours and about 2.25 hours in laparotomy. There were no post-operative complications in the form of postoperative leakage or wound infection found in the studied patients. Conclusion: Stab wounds were more common than gunshot wounds and the laparoscopic approach proved to be accurate and effective in the management of PAT and led to successful avoidance of unnecessary laparotomy. The patients experienced an uncomplicated course, with no postoperative complications and relatively short hospitalization. Further research and studies should be conducted to evaluate the long-term outcomes and potential benefits of laparoscopy in PAT cases, including larger sample sizes and comparative analyses. [ABSTRACT FROM AUTHOR]

Background: Myofascial plane block has recently replaced central neuraxial analgesia as the preferred method of effective, opioid-sparing pain treatment. The use of external oblique intercostal (EOI) nerve blocks to treat postoperative pain has increased recently because they can relieve pain in the upper midline and upper lateral abdominal wall. Objectives: To evaluate the effect of external oblique intercostal plane block (EOIPB) on the postoperative pain that was evaluated by visual analogue pain scale (VAS) as a primary objective. Time to first rescue analgesia, 24 hours' postoperative consumption of analgesia, perioperative hemodynamics, postoperative anesthetic care unit (PACU) stay, patient satisfaction, and postoperative complications were the secondary objectives. Patients and Methods: This prospective and randomized controlled study was conducted on fifty patients with ASA I and II, aged ≥ 20 to ≤ 70 years, scheduled for upper abdominal surgeries. Patients were divided equally into two groups, group (A) Patients received US-guided EOIB with 20 ml of 0.25% bupivacaine on each side after induction, and group (B) Patients received postoperative morphine on patient request. Results: The EOIPB group showed a significantly lower VAS score than the control group at 0 time, 1h, 2h, 4h, 8h and 12h postoperatively (p<0.001), but there was no significant difference at postoperative 24h between the two groups (p>0.05). Postoperative 24-hour morphine consumption was significantly lower in the EOIPB group than in the control group (9.8±2.4 (6-15) mg vs. 19.4±2.7 (15-25) mg respectively, P<0.001). Similarly, the time until the first required analgesia was significantly longer in EOIPB group (8.1 ±0.8(7-9) vs. 4.1 ±0.8(3-5) in hours, respectively, P<0.001). Conclusion: We concluded that EOIPB resulted in decreased postoperative pain, morphine, and fentanyl usage while increasing patient satisfaction. [ABSTRACT FROM AUTHOR]

Background: One of the most often performed operations and a pillar of a general surgery practice is inguinal hernia repair. Objective: The study aimed to report our experience in tension-free repair of inguinal hernia using Desarda technique. Patients and methods: 179 out of 216 patients with 1ry inguinal hernia repaired with Desarda and who completed at least five years of follow-up and underwent analysis were included. The current retrospective analysis was conducted between December 2013 and December 2023. Recurrence, chronic pain, abdominal wall stiffness was the main follow up corners. Results: The mean age of the included patients was 44.76 ± 7.88 years. There was a statistically significant decrease in the testicular edema, hematoma, seroma, and surgical site infection after 1-month follow-up when compared to the incidence by the 1st week (P < 0.001). There was a statistically significant decrease in the incidence of loss of sensation, abdominal wall stiffness and FB sensation by time. The recurrence rate was 1.7% after 5 years follow. Conclusion: Desarda technique is an easy, effective and reliable method in treatment of inguinal hernia repair with favorable long-term outcome. [ABSTRACT FROM AUTHOR]

Introduction. Postoperative hernias occur in 10–15% of patients. Considering the increase in the incidence of complications with the number of operations it is crucial to choose the optimal surgical technique in order to control the complications rate. This literature review summarizes previous studies on the treatment of postoperative hernias with mesh, comparing complication and recurrence rates according to surgical technique and mesh position. Methods. A thorough search was conducted on the PubMed database to retrieve literature on recurrence, chronic pain, haematoma, seroma, and surgical site infections rates. The results were meticulously summarised and used to confidently compare open and laparoscopic surgical techniques, as well as “sublay” and “onlay/inlay” mesh positions in more than 5-year follow-up. Results. The analysis was conducted on five publications that met the selection criteria. The results showed that laparoscopically treated hernias had lower recurrence and chronic pain rates, but more frequent haematomas. The presence of wound infections, BMI >30, treatment of recurrent postoperative hernias, multiple fascia lesions, enterotomy, larger abdominal wall defect and longer operative time were observed to be associated with higher recurrence rates. The position of the sublay mesh is associated with less frequent seromas, surgical infections, and recurrence compared to the onlay/inlay position. Studies have reported the superiority of largepore lightweight polypropylene multifilament mesh over the same heavyweight mesh in managing postoperative hernias. Lightweight mesh is linked to a lower risk of hernia recurrence and higher compliance with the abdominal wall. Conclusion. Laparoscopic surgery is associated with lower rates of recurrence and chronic pain, but a higher frequency of haematomas. The sublay mesh position is associated with lower rates of seromas, surgical infections, and recurrence. [ABSTRACT FROM AUTHOR]

Chronic pain emanating from the abdominal wall is frequently unrecognized or confused with visceral pain, often leading to extensive diagnostic testing before an accurate diagnosis is established. Anterior cutaneous nerve entrapment syndrome (ACNES) is one of the most frequent causes of chronic abdominal wall pain. [ABSTRACT FROM AUTHOR]

Purpose: Despite the widespread of ventral hernia repairs globally, the approach method, dissection planes, defect closure, and the choice and placement layer of mesh are an ongoing debate. We reported the details of surgical techniques, safety and feasibility for robot‐assisted transabdominal transversalis fascial and preperitoneal repair (R‐TATFPP) for small ventral hernia. Methods: This study included 5 cases of R‐TATFPP repair among 22 cases performed by robot‐assisted ventral hernia repair from 2018 to 2023 with the approval of the Institutional Review Board at St. Luke's International University and clinical ethical committee at St. Luke's International Hospital (19‐R147, 22–012). Results: There were four males and one female, with mean age of 64.4 ± 10.0 years, inclusive of two umbilical and three incisional hernias. Mean height, weight, body mass index (BMI), hernia defect length, width, operation time, console time, and hospital stay were 171.2 ± 11.8 cm, 82.4 ± 13.4 kg, 28.0 ± 2.1 kg/m2, 2.8 ± 1.4 cm, 3.0 ± 1.3 cm, 180 min, 133.8 min, and 2.4 days, respectively. No conversion nor complication was observed except for one acute urinary retention. Conclusion: Robot‐assisted transversalis fascial and preperitoneal repair was safe and feasible for small ventral hernia with the minimal disruption to the abdominal wall architecture and structures. [ABSTRACT FROM AUTHOR]

INTRODUCTION Systemic targeted therapy options are commonly used in patients with metastatic renal cell carcinoma (mRCC). Histological verification is crucial for treatment of mRCC. AIM Our aim was to evaluate an optimal location for percutaneous computed tomography-guided biopsy in a diagnosis of suspected mRCC. MATERIALS AND METHODS A total of 138 percutaneous biopsies for tumors ranging from 21 to 133 mm in diameter (median, 72 mm) were carried out in 134 patients with suspected mRCC over a 5-year period. The biopsy location was variable, with kidney biopsy performed in 77 cases (55.8%), and other localizations (retroperitoneum, peritoneal cavity, liver, pelvis, pleural space, lung, mediastinum, chest or abdominal wall, and pancreas) in 61 cases (44.2%). RESULTS As many as 288 biopsies (97.1%), yielded true-positive results, and 4 procedures (2.9%) yielded histologically false-negative results that required confirmation through extended rebiopsy. RCC was the most common individual diagnosis (85.5%), with non-RCC histology verified in 14.5% of cases. In total, 32 complications (23.2%) were confirmed, 2 of which were pneumothoraces, 29 were minor bleeding that needed only conservative management, and 1 case required angiography and embolization for hemorrhage treatment. While no significant relationship between the biopsy success and lesion localization (renal vs other) was found (P = 0.13), the relationship between complication rate and biopsy localization (renal vs other) was significant (P = 0.01). CONCLUSIONS Lesion localization (renal vs other) was not relevant to histological accuracy of the biopsies performed in patients with suspected mRCC. However, the biopsies of lesions outside the kidney had a lower complication rate. [ABSTRACT FROM AUTHOR]

Focal demal hypoplasia is an X-linked dominant inherited skin disorder caused by mutations in the PORCN gene. A 1-day-old female neonate presented with a chief complaint of skin lesions after birth. She was born at 37- and 2/7-weeks' gestation via vaginal delivery after the pregnancy was complicated by fetal growth restriction, chronic maternal hypertension, diet-controlled gestational diabetes mellitus, and maternal group B streptococcus colonization treated with ampicillin and gentamicin. Initial examination revealed multiple gestational abnormalities, including a severe chest and abdominal wall defect with an associated omphalocele, and bilateral oligosyndactyly affecting the patient's feet. Here, we present her case, diagnostic evaluation, and the steps that led to the diagnosis of focal dermal hypoplasia. [ABSTRACT FROM AUTHOR]

Although many studies reported the safety and efficacy of high-intensity focused ultrasound (HIFU) therapy, there are still worries about internal organ injury. However, reports of abdominal wall hernias after HIFU therapy are rare. We present three cases of abdominal wall hernias without skin injury after HIFU therapy in uterine adenomyosis or fibroids. The diagnosis was often delayed because of vague symptoms, inadequate clinical suspicion, and delayed proper image studies. Abdominal wall hernia should be recognized as a possible complication after HIFU and be suspected when the patient presents with unordinary abdominal swelling and/or pain that lasts for more than a few months after the procedure. [ABSTRACT FROM AUTHOR]