Posterior Wall Defect Research Articles

Container Plasty in Advanced Painful Osteolytic Vertebral Metastases With Posterior Wall Defect

Study Design: Review of mesh-container plasty (MCP) in osteolytic vertebral metastases. Objective: This study aims to assess the efficacy and safety of MCP in treating advanced vertebral metastases with posterior wall defects. Background: Diagnosis of vertebral metastases typically relies on the patient’s tumor history, bone scans, or vertebral MRI. Surgical intervention often involves sampling vertebral body tissue for pathologic diagnosis. The revised Tokuhashi score is commonly used to predict survival time in patients with bone metastases. Outcome evaluation frequently employs the visual analog scale (VAS) and the Oswestry disability index (ODI) in assessing spinal surgery outcomes. Methods: A retrospective analysis included 111 patients treated between January 2014 and January 2018 in our hospital. Patients were categorized into 2 groups: MCP group (n=51) and PVP group (n=60). Grades based on the percentage of posterior wall defect area were established: grade I (≤25%), grade II (26% to 50%), grade III (51% to 75%), and grade IV (76% to 100%). Efficacy was assessed using VAS and ODI. Results: Both MCP and PVP groups exhibited significant pain relief and improved motor function. No significant differences were observed in VAS and ODI scores at any follow-up point (P>0.05). In the MCP group, bone cement leakage occurred in 13 cases, with a leakage rate of 25.49%. However, none of the patients experienced clinical or neurological symptoms. In the PVP group, bone cement leakage occurred in 50% of patients, with 6 patients developing neurological symptoms. Significant differences between the groups were observed in major complications related to bone cement leakage (P=0.03). Conclusion: MCP demonstrates efficacy in pain relief and safety in treating vertebral metastases with deficient posterior walls. It represents a promising option for spinal surgeons managing vertebral metastases with posterior wall deficiencies.

Introducing an innovative surgical technique: gluteal turnover flap for posterior vaginal wall reconstruction: a case series

Four patients with rectal cancer required reconstruction of a defect of the posterior vaginal wall. All patients received neoadjuvant (chemo)radiotherapy, followed by an en bloc (abdomino)perineal resection of the rectum and posterior vaginal wall. The extent of the vaginal defect necessitated closure using a tissue flap with skin island. The gluteal turnover flap was used for this purpose as an alternative to conventional more invasive myocutaneous flaps (gracilis, gluteus, or rectus abdominis). The gluteal turnover flap was created through a curved incision at a maximum width of 2.5 cm from the edge of the perineal wound, thereby creating a half-moon shape skin island. The subcutaneous fat was dissected toward the gluteal muscle, and the gluteal fascia was incised. Thereafter, the flap was rotated into the defect and the skin island was sutured into the vaginal wall defect. The contralateral subcutaneous fat was mobilized for perineal closure in the midline, after which no donor site was visible.The duration of surgery varied from 77 to 392 min, and the hospital stay ranged between 3 and 16 days. A perineal wound dehiscence occurred in two patients, requiring an additional VY gluteal plasty in one patient. Complete vaginal and perineal wound healing was achieved in all patients. The gluteal turnover flap is a promising least invasive technique to reconstruct posterior vaginal wall defects after abdominoperineal resection for rectal cancer.

A retrospective cohort study on the efficacy and safety of percutaneous vertebroplasty combined with bone-filling mesh container in vertebral metastases with posterior wall defect.

To evaluate the clinical safety and efficacy of percutaneous vertebroplasty (PVP) combined with bone-filling mesh containers (BFMCs) for vertebral metastases with posterior wall defect. From January 2019 to December 2021, patients with vertebral metastases and posterior wall defect who received BFMCs combined with PVP were included. The visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were evaluated before and 72 hours after the operation, respectively. Post-operational X-ray and computed tomography (CT) scans were conducted to observe bone cement leakage, and complications were recorded. Follow-up CT and magnetic resonance imaging (MRI) were conducted to evaluate the condition of the operated vertebrae and the recurrence or progression of other bone metastases. A total of 43 patients with 44 operated vertebrae were included. All patients successfully completed the surgery. The average VAS score decreased from 7.35 ± 0.78 to 1.63 ± 0.93 (p < 0.05), and the ODI score decreased from 80.06 ± 8.91 to 32.5 ± 4.87 (p < 0.05). Bone cement leakage was observed in 18 operated vertebrae, which were all asymptomatic. No intraspinal leakage, post-operative spinal nerve compression, pulmonary embolism, or other serious complications were recorded. A total of 21 patients had a follow-up of more than 1 year, with no operated vertebral progression, 13 target vertebrae showed obvious sclerosis and necrosis, and no adjacent pathological fracture occurred. Of these patients, 16 had different degrees of bone metastasis of other sites other than the operated vertebrae. For spinal metastases with posterior wall defect, PVP combined with BFMCs was highly safe and can effectively relieve pain for patients. A 1-year follow-up showed a local antitumor effect.

CT-Guided Microwave Ablation with Vertebral Augmentation for Spinal Metastases with Posterior Wall Defects.

To evaluate the efficacy and safety of combined microwave ablation (MWA) and vertebral augmentation (VA) in the treatment of spinal metastases with posterior wall defects. A retrospective review was conducted for 67 patients (42 men, 25 women) with painful spine metastases and posterior wall defects who underwent MWA combined with VA. Among these patients, 52 vertebrae had no epidural invasion and 33 had mild invasion but did not compress the spinal cord. Procedural effectiveness was determined by comparing visual analog scale (VAS) scores and Oswestry disability index (ODI) scores before the procedure and during the follow-up period. The procedure was technically successful in all patients. The mean VAS score declined significantly from 6.85 ± 1.81 before the procedure to 3.27 ± 1.97 at 24 h, 1.96 ± 1.56 at 1 week, 1.84 ± 1.50 at 4 weeks, 1.73 ± 1.45 at 12 weeks, and 1.71 ± 1.52 at 24 weeks post-procedure (p < 0.01). The mean ODI score was lower post-procedure than before the procedure (p < 0.001). Transient nerve injury occurred in two patients (SIR classification D), and the incidence of asymptomatic bone cement (SIR classification A) was 43.5% (37/85). MWA combined with VA is an effective and safe treatment for painful spine metastases with posterior wall defects.

Assessment of dural invasion in complex cases operated on by collaborative efforts of neurosurgery and otolaryngology for pathologies associated with the frontal sinus

Purpose: The aim of this study was to evaluate the common interventions performed by neurosurgery and otolaryngology in dural invasion in frontal sinus related pathologies.&#x0D; Materials and Methods: A comprehensive study involving 45 patients who underwent surgical interventions for frontal sinus-associated pathologies between January 2018 and July 2023 was conducted collaboratively by otorhinolaryngology and neurosurgery departments. Patient data, including demographics, pathology types, and surgical approaches, were collected from medical records, surgical reports, imaging studies, and videos. Interdisciplinary surgical teams executed tailored interventions with documented techniques. &#x0D; Results: Among 45 patients, 31 were female (68.8%) with a mean age of 44. Posterior wall defects were detected in 13 (28.8%) patients, and intervention was necessary for only 8 of them. Among the 8 (17.7%) patients with identified dural invasion, pathological dural tissue was excised, and duraplasty was performed in 5 (11.1%) cases. There were no neurological complications observed in patients during the postoperative period.&#x0D; Conclusion: Despite limitations, the findings contribute to evolving knowledge and highlight the need for prospective studies to optimize patient care strategies.

Incarcerated left-sided Amyand’s hernia and synchronous ipsilateral femoral hernia: first case report

BackgroundThe finding of a vermiform appendix within the peritoneal sac of an inguinal hernia is called Amyand’s hernia. The reported incidence of Amyand’s hernia and femoral hernia is 1% and 3.8%, respectively. To our knowledge, no cases have been reported in the literature that associate these two entities. We present the first case of incarcerated left-sided Amyand’s hernia and synchronous ipsilateral femoral hernia found during emergency surgery.Case presentationA 72-year-old woman was admitted to the Emergency Department for a complicated left inguinal hernia. An inguinotomy was performed that detected a large direct hernial sac and a synchronous femoral hernia. The opening of the inguinal hernia showed the presence of the cecum and the appendix, both without signs of inflammation. The femoral space was evaluated transinguinally, identifying the larger omentum that had slipped into the femoral canal. The primary closure of the posterior wall defect was performed with the McVay technique due to its large size, and then the hernioplasty was completed with a polypropylene mesh. No postoperative complications were reported.ConclusionsIn the context of an incarcerated Amyand’s hernia, the decision to perform an appendectomy in addition to hernia repair with or without mesh will depend on intraoperative findings.

ISOLATED POSTERIOR TRACHEAL WALL DEFECT RECONSTRUCTION USING NOVEL TECHNIQUE

Tracheal tumors are rare, with more than 90% of tumors being malignant in nature. The most common types of primary malignant tracheal malignancies are squamous cell carcinoma and adenoid cystic carcinoma. The mainstay of treatment, when possible, is surgical resection. Unresectable tumors generally have a poor prognosis. Here we are providing case report of posterior tracheal wall adenoid cystic carcinoma resection and defect reconstruction.

V-036 LAPAROSCOPIC MANAGEMENT OF ATYPICAL PRESENTATION OF PRIMARY GRYNFELTT HERNIA

Abstract The rarest posterior abdominal wall defect with retro and intra peritoneal contents through the upper lumbar posterolateral wall associated with weakening of the triangle is grynfeltt -lesshaft hernia. Lumbar hernia is initially small and asymptomatic and expands over time and may lead to mild symptoms gradually leading definitely grave complications. Grenynfeltt –lesshaft triangle is quite often missed due to unfamiliar nature . Correcting surgically is the only treatment option. Performing early elective management preferred to avoid grave complications. Lumbar hernia presentations are very limited in number and its laparoscopic hernioplasty was shown in very minimal series. Laparoscopic lumbar hernioplasty with principle similarity to inguinal hernioplasty is undoubtedly the best treatment modality with minimal complications. Presentation of case A 50 yrs healthy male without any past surgical history and nil comorbidities presented with a swelling in the right loin region gradually progressive swelling and is more prominent on the cough. Diagnosis confirmed by ultrasonography. The hernia was repaired by laparoscopic Trans abdominal pre-peritoneal approach. It was successfully completed laparoscopically and no conventional method was used. On follow up patient doing well without any signs of infection or any seroma formation noted. Discussion Laparoscopic approach is far more advanced and superior to the open approach with adequate long-term results.

Bone Cement and Pedicle Screw for the Treatment of Spinal Tumors with Spinal Cord Compression and Posterior Wall Defects.

ObjectiveTo compare the safety and efficacy of posterior internal fixation with open vertebroplasty (VP) and posterior internal fixation with open kyphoplasty (KP) in the treatment of metastatic epidural spinal cord compression (MESCC) with posterior wall destruction.MethodsThis retrospective study, conducted between January 2016 and May 2019, equally divided 60 patients with MESCC and posterior wall destruction into two groups based on the surgical method: open vertebroplasty with pedicle screw fixation (VP group) and open kyphoplasty with pedicle screw fixation (KP group). Visual analogue scale (VAS), SF‐36 scores, middle vertebral height (MVH), and posterior vertebral height (PVH) were evaluated for the two groups preoperatively, postoperatively, and 1 year after surgery. Spinal Instability Neoplastic Score, Frankel grades and complications were recorded and evaluated.ResultsFive patients were excluded from the analysis, and our study cohort consisted of 55 adult patients who met the inclusion criteria. The VAS and SF‐36 scores of these two groups of patients significantly improved, when compared with those before the surgery (P < 0.05). There were significant differences in total cost (8835 ± 1468 vs 9540 ± 053 USD) and cement volume (4.51 ± 0.96 ml vs 6.35 ± 1.09 ml) between two groups (P < 0.05). The MVH and PVH of these two groups of patients significantly improved, when compared with those before the surgery (P < 0.05). The MVH was significantly larger in the KP group than in the VP group postoperatively (20.15 ± 4.86 vs 17.70 ± 3.78, P < 0.05) and at the final follow‐up (20.42 ± 5.59 vs 17.28 ± 3.23, P < 0.05). However, the PVH of the two groups did not significantly differ at the two postoperative follow‐ups (P > 0.05). No significant differences were found in surgery time, time from surgery to discharge, blood loss and complications between both groups postoperatively (P > 0.05).ConclusionIn the short term, both approaches are effective and safe in patients with MESCC and posterior wall destruction. The posterior internal fixation with open VP may be a good choice of surgical method in patients with MESCC and posterior wall defects.

Acetabular morphological variation in Asian patients with femoral neck fracture: A three-dimensional CT-based study

AimsThe acetabular morphology varies greatly among individuals, and hypoplasia is more common in Asia than in Europe. Dislocation after bipolar hip arthroplasty (BHA) for femoral neck fracture occurs at a constant rate, and is affected by the acetabular morphology. This study aimed to clarify individual differences in the acetabula of Asian patients with displaced femoral neck fractures. Patients and methodsFifty patients with displaced femoral neck fractures were assessed (50 fractured hips, 50 non-fractured hips). On CT corrected by the anterior pelvic plane, the 100 hips were assessed regarding acetabular coverage (six parameters), acetabular depth (two parameters), and acetabular opening angle (four parameters). Additional parameters related to the fracture and sex were examined. The percentile of each parameter was shown for all hips. ResultsThere was no patient with hip dysplasia defined as superior acetabular sector angle (SASA) less than 110° Compared with men, women had a significantly smaller anterior acetabular sector angle (AASA) (p = 0.016), and significantly larger acetabular inclination angle (p = 0.006) and acetabular index angle (p = 0.034). In the group with a normal SASA, seven hips (7.3%) had an anterior wall defect (AASA<50°) and five hips (5.2%) had a posterior wall defect (posterior acetabular sector angle<90°). ConclusionOlder adults with femoral neck fractures can have anterior wall and posterior wall defects, even if their SASA is normal. Hidden acetabular dysplasia may be related to post-BHA dislocation. So, our results suggest that is important to accurately evaluate the acetabulum of patients with femoral neck fracture before surgery.

Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective study of risk factors and clinical outcomes

ObjectiveThe objective of this research was to investigate the risk factors of cement leakage in patients with metastatic spine tumors following percutaneous vertebroplasty (PVP).MethodsSixty-four patients with 113 vertebrae were retrospectively reviewed. Various clinical indexes, including age, sex, body mass index (BMI), smoking history, drinking history, chemotherapy history, radiotherapy history, primary cancer, location, other metastases, collapse, posterior wall defects, the laterality of injection, and the injected cement volume were analyzed as potential risk factors. Multivariate analyses were conducted to identify the independent risk factors.ResultsThe cement leakage was found 64 in 113 treated vertebrae (56.63%), in which the incidence of each type was shown as below: spinal canal leakage 18 (15.93%), intravascular leakage around the vertebrae 11 (9.73%), and intradiscal and paravertebral leakage 35 (30.97%). Tomita classification (P = 0.019) and posterior wall destruction (P = 0.001) were considered strong risk factors for predicting cement leakage in general. The multivariate logistic analysis showed that defects of the posterior wall (P = 0.001) and injected volume (P = 0.038) were independently related to the presence of spinal canal leakage. The postoperative visual analog scale (VAS) and activities of daily living (ADL) scores showed significant differences compared with the pre-operative parameters (P < 0.05). No significant differences were found in every follow-up time between the leakage group and the non-leakage group for pain management and improvement of activities in daily life.ConclusionIn our study, Tomita classification and the destruction of the posterior wall were independent risk factors for leakage in general. The defects of the posterior wall and injected volume were independently related to the presence of spinal canal leakage. The PVP procedure can be an effective way to manage the pain.

351 Anterior Ethmoid Artery Septal Flap for Endoscopic Reconstruction of Frontal Sinus CSF Leak

Abstract Introduction Anterior skull base cerebrospinal fluid (CSF) leaks are managed successfully with endonasal surgery. Endoscopic closure of CSF leaks from posterior table of the frontal sinus remains challenging. Vascularized Hadad-Bassagasteguy flap (HBF) reconstruction of the skull base has increased CSF closure rates but does not extend to frontal sinus. We describe our technique using septal flap pedicled by anterior ethmoid artery (AEA) for repairing frontal defects. Method Retrospective review of cases of frontal CSF leak repair using the AEA flap reconstruction. Flap design: an anterior vertical septal mucosa incision at posterior border of the frontal sinusotomy is made and extended to nasal floor. Posterior vertical incision is made 1 cm posterior to the projection of the axilla of the middle turbinate on the septum and extended to nasal floor. A horizontal incision along the nasal floor joins the two incisions. The flap is raised and rotated into the frontal sinus over the posterior table reconstructed defect. Results Three patients identified. Two males, one female, aged 11, 33 and 56. Patient histories included recurrent bacterial meningitis following head trauma, recurrent sinusitis and fronto-ethmoidal osteoma, with intraoperative CSF leak and CSF rhinorrhea due to meningoencephalocele. The three posterior wall defects were successfully repaired endoscopically with multilayer reconstruction and the AEA septal flap. Conclusions The anterior ethmoid artery septal flap can be successfully utilised for frontal CSF leak repair. Flap is conveniently located for frontal sinus defects. When the septum is intact it provides an excellent final layer as part of multilayer reconstruction.

Island sternocleidomastoid myocutaneous flap for posterior pharyngeal wall defect repair after anterior cervical spine surgery.

Injuries and tumours of the cervical spine represent therapeutic challenges to the treating surgeon due to the complex anatomical relationships and biomechanical features. The anterior cervical midline (ACM) and anterior cervical retropharyngeal (ACR) approaches are effective and safe surgical approaches for certain cervical spine lesions, such as cervical spine neoplasms, atlantoaxial subluxation, and certain odontoid fractures. Posterior pharyngeal wall defects (PPWDs) is one of the most frequently encountered surgical morbidities after anterior cervical spine surgery (ACSS). However, limited information has been published concerning effective approaches for PPWD reconstruction after ACSS. The manuscript aimed to describe a novel application of the island sternocleidomastoid myocutaneous flap (ISMF) in the management of PPWDs after ACSS, including surgery with the ACM approach and ACR approach. From April 2015 to November 2019, the clinical data of three patients with PPWDs repaired using the ISMF in Peking university third hospital were retrospectively analysed. The observational indexes are as follows: postoperative survival of the flap, wound healing 2 weeks after surgery, eating and pronunciation function 2 months after surgery. The above indexes of these three cases recovered well. Three patients did not have any persistent PPWD after repair with the ISMF and did not require any further surgical procedures related to the cervical spine.

To study the outcome of vaginal reconstructive surgery for isolated rectocele

Aim: To study the symptomatic relief of local and bowel symptoms after vaginal reconstructive surgery for isolated rectocele. Introduction: Isolated posterior compartment defect as isolated rectocele is on the raise due to multi parity and chronic constipation, sedentary and faulty lifestyle. The term rectocele means herniation of rectum into vaginal canal. The posterior wall defect presented with difficult defecation, constipation, incomplete evacuation, pressure in recto vaginal area, manual vaginal replacement during evacuation.The cases with isolated rectocele were evaluated and relief of local and bowel functions before and after the pelvic repair were assessed. Materials and Methods: A prospective study was done between August 2016-August 2018, for the period of 2 years at IIMSR, Dasauli, dept. of OBG, Lucknow wherein cases with isolated rectocele were identified and pelvic repair of the rectocele was done by repair of pararectal fascia without mesh along with pelvic floor repair wherein the medial fibres of levator ani was approximated. Out of 426 cases presenting to the gynaecology OPD with mass per vagina, local pressure symptoms, after detailed history and examination, 25 cases of isolated rectocele were included in the study. Result: A total of 25 cases out of 426(5.86%) were with isolated rectocele.25 cases underwent pelvic repair of the rectocele by repair of pararectal fascia without mesh,excision of redundant vagina along with pelvic floor repair with approximation of medial fibres of levator ani muscles. There was significant association between isolated rectocele, chronic constipation and multi parity. The statistical analysis was done using chi square and pvalue. Keywords: Isolated rectocele, Chronic constipation, Pelvic repair.

Resection of deep-infiltrating endometriosis could be a risk factor for uterine rupture: a case series with review of the literature

ObjectiveTo highlight the possible correlation between deep-infiltrating endometriosis (DIE) resection and subsequent uterine rupture.DesignCase series and review of the literature.SettingEndometriosis referral hospitals.Patient(s)Seven young women who underwent laparoscopic resection of DIE, six of whom had uterine rupture before or during labor; the seventh patient had a posterior wall defect that placed her at increased risk of future uterine rupture.Intervention(s)Diagnosis of uterine rupture before or during labor in patients with a history of prior resection of DIE, leading to delivery by emergency delivery section or emergency laparotomy for exploration and repair.Main Outcome Measure(s)Immediate neonate and maternal salvaging caesarean delivery or laparotomy followed by surgical correction of the rupture.Result(s)As of 2019, no publications in the literature had considered uterine rupture among the obstetric complications of endometriosis. The reporting of such findings is crucial because of the increase in surgical management of endometriosis. We report seven cases of uterine rupture in pregnancy in women who had undergone resection of DIE. In six patients, surgeons found uterine rupture at the level of the previous resected endometriosis and diagnosed a posterior wall defect at the same level in one patient.Conclusion(s)Our case series sheds light on the potential increased risk of uterine rupture during pregnancy among women who have had a prior resection of DIE. In future, if these patients are considered high-risk pregnancy cases, their care should be managed by high-risk obstetric specialists.

Minimally Invasive Pedicle Screw Fixation Combined with Percutaneous Kyphoplasty Under O-Arm Navigation for the Treatment of Metastatic Spinal Tumors with Posterior Wall Destruction.

ObjectiveTo evaluate the safety and efficacy of O‐arm‐guided minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for metastatic spinal tumors with posterior wall destruction.MethodsPatients who underwent minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for pathological vertebral fractures with posterior wall defects from January 2015 to December 2017 were followed up for 1 year. Visual analogue scale (VAS), SF‐36 scores, middle vertebral height, posterior vertebral height, and the accuracy of pedicle screws were assessed preoperatively, postoperatively, and 1 year after surgery. The operation time, time from operation to discharge, blood loss, volume of bone cement, and leakage of bone cement were recorded.ResultsTwenty‐three patients (13 females and 10 males) who met our criteria were followed up for 1 year. The operation time of these patients was 162.61 ± 33.47 min, the amount of bleeding was 230.87 ± 93.76 mL, the time from operation to discharge was 4.35 ± 2.42 days, and the volume of bone cement was 3.67 ± 0.63 mL. The VAS score decreased from 7.04 ± 1.07 to 2.65 ± 0.93 before surgery (P = 0.000) and remained at 2.57 ± 0.79 1 year after surgery. Compared with the preoperative SF‐36 scores for physical pain, physiological function, energy, and social function, the postoperative scores were significantly improved (P = 0.000). The height of the middle vertebral body increased from 14.47 ± 2.96 mm before surgery to 20.18 ± 2.94 mm (P = 0.000), and remained at 20.44 to 3.01 mm 1 year after surgery. The height of the posterior vertebral body increased from 16.56 ± 3.07 mm before operation to 22.79 ± 4.00 mm (P = 0.000), and 22.45 ± 3.88 mm 1 year after surgery. The 23 patients had a total of 92 pedicle screws; 85 screws were Grade A and 7 screws were Grade B. There was no leakage of bone cement after surgery.ConclusionIn the short term, O‐arm‐guided minimally invasive pedicle screw fixation combined with kyphoplasty is safe and effective in the treatment of metastatic spinal tumors with posterior wall destruction.

Comparative study of collagen and elastin content of abdominal wall fascia in inguinal hernia and non-hernia patients in an African population.

Altered composition of collagen and elastin in abdominal fascia has been linked with the pathogenesis of hernias. This has not been studied amongst Africans who have hernia presentations which vary significantly from Caucasian cohorts. The aim of this study was to determine, and compare, the collagen and elastin contents of the transversalis fascia and rectus sheath of inguinal hernia patients with non-hernia controls. Twenty-five patients with solitary, primary, uncomplicated inguinal hernia and twenty-five non-hernia controls were evaluated. Biopsies of the transversalis fascia and anterior rectus sheath were stained with Masson Trichrome and Verhöeff van-Gieson to isolate collagen and elastin respectively, which were quantified using the ImageJ/Fiji® image analysis software. Inguinal hernia patients were aged 19-85years with a mean age of 45.2years, mean body mass index (BMI) of 23.3kg/m2 and mean duration of hernia of 42.5months. Lateral hernias with no hernia defect or posterior wall defect [PL0] were the predominant clinical type. There were significantly lower collagen and higher elastin content in the transversalis fascia and rectus sheath of inguinal hernia patients [P < 0.001]. Regression analysis identified smoking and long duration of hernias as independent predictors of low collagen levels in this study CONCLUSION: Inguinal hernia patients in the study population demonstrated depleted collagen in the connective tissue of the inguinal canal. This might justify the routine use of prosthetic mesh for the reinforcement of the posterior wall during hernia repair.

Butterfly tragal cartilage for repair of focal canal wall defects

BackgroundMeato-mastoid fistula is a connection between the external auditory canal and the mastoid cavity. It may be iatrogenic or pathological. The repair of these focal canal wall defects is necessary to prevent retraction pockets or sequential cholesteatoma and attain relief from otorrhoea. Aim/objectiveTo study the effectiveness of an innovative technique for repair of meato-mastoid fistula (less than or equal to 10mm in size) in the bony external auditory canal. Material and methodsWe performed a retrospective review of 5 surgeries performed in our hospital between January 2017 and December 2017 for the repair of posterior bony canal wall defects. Active ear disease was ruled out before the repair. We used full-thickness butterfly tragal cartilage graft for the repair of these fistulae. All our surgeries were endoscopic and sutureless. ResultsThe butterfly tragal cartilage graft was in situ at the repair site and viable on examination at 2 years follow-up, in all our cases. Conclusion and significanceSmall posterior canal wall defects can be successfully repaired using this technique. The method is minimally invasive and cosmetic, with good patient compliance. The curling property of the cartilage graft is exploited effectively in this method of repair.

Laparoscopic Transabdominal Repair for Lumbar Hernia: A Familiar Procedure for a Rare Problem

Lumbar hernia is a protrusion of intraperitoneal or extraperitoneal tissues through posterior abdominal wall defect and is considered to be a rare condition. We present a case of 65-year-old lady with primary spontaneous superior lumbar hernia treated laparoscopically, with the detailed operative steps and post-operative follow-up. With the growing experience in laparoscopic inguinal hernia repair, same technique, instruments and device used in transabdominal preperitoneal (TAPP) repair can be applied to treat selected cases of lumbar hernia with good outcome.

Posterior Wall Defect of Sacrum: An Anatomical Study of Sacral Spina Bifida.

To investigate the incidence, types, morphological and morphometric properties of spina bifida on dry sacral bones. 110 dry adult sacrums gathered from the bone collections of the Laboratory of the Anatomy Department of Dokuz Eylul University School of Medicine were examined. The parameters analysed were: 1) results of parameters related to the posterior sacral wall; 2) classification and rate of the closure defects; 3) classification of the top sacral vertebrae according to the shape of its superior surface; 4) presence of sacralisation and lumbalisation among sacrums with dorsal wall defects; 5) vertebral levels of apex of the sacral hiatus; and 6) vertebral levels of closure defects of the sacrums. We determined 22/110 (20%) sacrums demonstrated spina bifida. Of these 22 sacrums, 4 (18.18%) showed complete and 18 (81.82%) showed incomplete spina bifida. We noted the coexistence of spina bifida with sacralisation (6/22 [27.27%]) and lumbalisation (5/22 [22.73%]). The types of defects were described and grouped as ?V? (Type 1), inverse ?V? (Type 2), window (Type 3), foramen (hole) (Type 4), sand watch (Type 5), narrow linear (Type 6), wide linear (Type 7), and bridged (Type 8). The shape of upper surfaces of the sacrums with spina bifida was grouped as: cavity (20/22, 90.9%), hump (1/22, 4.5%), and flat (1/22, 4.5%). A precise definition of the anatomical variations of sacrums is essential for surgeons, particularly when operating using endoscopic techniques and for anaesthesiologists applying caudal epidural block.