Muscle Sheath Research Articles

Tumor suppressor miR-317 and lncRNA Peony are expressed from a polycistronic non-coding RNA locus that regulates germline differentiation and testis morphology.

This research focuses on investigating the impact of non-coding RNAs on stem cell biology and differentiation processes. We found that miR-317 plays a role in germline stem cell progeny differentiation. miR-317 and its neighbor, the lncRNA Peony, originate and are co-expressed from a singular polycistronic non-coding RNA locus. Alternative polyadenylation is implicated in regulation of their differential expression. While the increased expression of the lncRNA Peony results in the disruption of the muscle sheath covering the testis, the absence of miR-317 leads to the emergence of germline tumors in young flies. The deficiency of miR-317 increases Notch signaling activity in the somatic cyst cells, which drives germline tumorigenesis. Germline tumors also arise from upregulation of several predicted targets of miR-317 , among which are regulators of the Notch pathway. This implicates miR-317 as a novel tumor suppressor that modulates Notch signaling strength.

MORPHOLOGICAL JUSTIFICATION OF RETROMUSCULAR ALLOPLASTY IN DIASTASIS OF RECTUS ABDOMINAL MUSCLES

Background. Diastasis of the rectus abdominis muscles weakens the white line and contributes to the occurrence of defects with the formation of white line hernias and umbilical hernias. In our opinion, the study of the morphological features of the anterior and posterior aponeurotic walls of the rectus abdominis will make it possible to justify alloplasty, which will increase the effectiveness of surgical treatment of diastasis of the rectus abdominis. Aim: Justification of retromuscular alloplasty of diastasis recti abdominis by studying the morphological features of the anterior and posterior aponeurotic walls of the sheath of the rectus muscle Materials and methods. A comprehensive pathomorphological study of the anterior and posterior aponeurotic walls of the rectus abdominis muscles was conducted in 34 patients (the main group) with diastasis recti who underwent surgical treatment. The comparison group consisted of 32 patients with gallstone disease without diastasis recti who underwent laparoscopic cholecystectomy. The obtained material was examined using histological, histochemical, immunohistochemical, morphometric, statistic methods. Results. In a comparative analysis of the morphological indicators of the front sheet of the sheath of the rectus abdominis muscle with the corresponding indicators of the back sheet in the main group of patients with diastasis of the rectus abdominis, the specific volume of the vascular-fibrous component was more important, the specific volume of adipose tissue and the specific volume the volume of the cavities was less important. The obtained pathomorphological data emphasizes that the front sheet of the sheath of the rectus abdominis muscle in diastasis is mechanically stronger compared to the back sheet. The posterior aponeurotic sheet of the vagina of the rectus muscle in case of diastasis is more prone to ruptures, which is evidenced by the greater value of the specific volume of the cavities in the posterior sheet. Conclusions. Morphological changes of the aponeurotic leaves of the sheath of the rectus abdominis in patients of the main group with diastasis of the rectus muscles in comparison with the comparison group without diastasis differ significantly in the detected changes, the results of the morphological study of the anterior and posterior aponeurotic walls of the rectus muscle in their diastasis indicate the fact that the back walls are thinner, branched , with a decrease in the vascular-fibrous component compared to the front ones, which justifies the strengthening of the back aponeurotic walls by means of retromuscular alloplasty during the surgical treatment of diastasis.

FEATURES OF DEVELOPMENT AND FORMATION TOPOGRAPHIES OF THE VESICO-UMBILICAL TRIANGLE IN THE PRENATAL PERIOD OF HUMAN ONTOGENESIS

On the front abdominal wall, there is a section of the vesico- umbilical triangle, which is bounded on the sides by the umbilical arteries, and below by the bladder. In the available sources of scientifi c literature, there is practically no information on the patterns of prenatal morphogenesis and the formation of the topography of the area of the vesico- umbilical triangle of a person. However, accurate knowledge of the topography of the constituent formations of the vesico- umbilical triangle determines the choice of incision during operations and provides a theoretical explanation for the occurrence of various pathological conditions: umbilical, postoperative ventral hernias, abdominal cavity organ eventration, and the spread of purulent- infl ammatory processes.The purpose of the study was to clarify the features of prenatal morphogenesis and topographical- anatomical relationships of the vesico- umbilical triangle of a person.The study was conducted on the preparations of 7 embryos of 4-6 weeks, 14 pre-fetuses of 7-12 weeks, and 26 human fetuses aged from 4 to 10 months using the production of a series of histological sections, microscopy, macromicroscopic preparation, and injection of vessels.In embryos of 4.5-5.5 mm parietal- coccygeal length (PCL), the allantois is located in the direction of the abdominal wall, connecting with other structures in the area of the future umbilical ring. In the mesoderm of the allantois, there is a layer of vessels that form a system of umbilical vessels. On frontal sections of 10.5-12.0 mm PCL embryos, narrowing of the allantois duct is observed: a more gradual narrowing near the umbilical ring, and a sharper one closer to the cloaca. At this stage of embryogenesis, there is a clear division of the cloaca into ventral (urogenital sinus) and dorsal (rectal lining) sections.It was established that the bladder is formed from two sources – the body and top – from the caudal part of the allantois, the bottom, and neck – from the pelvic part of the genitourinary sinus. In the 3rd month of intrauterine development, the middle and deep layers of the vesico- umbilical triangle are formed, which are represented by the sheath of the rectus abdominis muscle, rectus and pyramidal muscles, prostatic and allantoic leaves. Fascial spurs, departing from the latter, divide the prostate space into four interfascial slits. The surface layer of the vesico- umbilical triangle is still poorly diff erentiated at this stage of intrauterine development. At the end of the 4th month of intrauterine development, the surface fascia of the vesico- umbilical triangle is formed as independent formations. During macro- microscopic dissection of the area of the vesico- umbilical triangle in 6-month-old fetuses, in addition to the fascial formations of the superfi cial layer, all the structures of the deep layer can be distinguished: the transverse fascia, the vestibular and allantoic fascial sheets, as well as two fascial spurs that divide the vestibular space into four interfascial gaps. From our point of view, it is appropriate to call the prostatic fascia and prostatic fi brous space vesico- umbilical.

СРАВНИТЕЛЬНАЯ ОЦЕНКА ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ РАНЕВОЙ БОЛИ С ПРИМЕНЕНИЕМ ТРАНСМЕМБРАННЫХ ТЕХНОЛОГИЙ ПОСЛЕ СРЕДИННОЙ ЛАПАРОТОМИИ

ntroduction. Pain syndrome remains an urgent problem for patients who have undergone median laparotomy in the early postoperative period. The use of modern opioid analgesics, in addition to effectively combating postoperative pain, has a number of negative systemic effects on the body, which requires the search for new methods of analgesia. Aim. To determine the effectiveness of the author’s device using semipermeable membranes for anesthesia of the median laparotomy wound in relation to the relief of pain syndrome in patients who have undergone abdominal surgery, in comparison with classical parenteral analgesia. Materials and methods. We analyzed the intensity of wound pain syndrome in 70 patients underwent a median laparotomy surgery for injuries and acute abdominal surgical diseases. A control group included 35 people. An experimental group had the similar number of patients. The control group received pain relief in the early postoperative period with systemic analgesics – opioid and non-steroidal anti- inflammatory drugs. In the study group, during the operation, the device was implanted in patients retromuscularly according to the author’s method using a semipermeable membrane, through which a transmembrane blockade of the sheaths of the rectus abdominis muscles was carried out with local anesthetics. Results and discussion. Opioid analgesics were not administered to all patients of the study group in the postoperative period due to a mild pain syndrome. Conclusion. The device for analgesia of the median laparotomy wound with the use of a semipermeable membrane provides relief of pain syndrome, which allows abandoning opioids and limiting the use of non-steroidal anti- inflammatory drugs significantly.

Pharmacokinetics of Orbital Topotecan After Ophthalmic Artery Chemosurgery and Intravenous Infusion in the Swine Model.

Surgery, multiagent systemic chemotherapy, and radiation are used for patients with orbital retinoblastoma but are associated with unacceptable short- and long-term toxicity (including death). We studied orbital and systemic exposure of topotecan in the swine model after ophthalmic artery chemosurgery (OAC) and intravenous (IV) delivery. Landrace pigs (n = 3) underwent 30-minute OAC of topotecan (4 mg), and samples were serially obtained from the femoral artery and from a microdialysis probe inserted into the lateral rectus muscle sheath of the infused eye as a surrogate of the orbital irrigation. Animals were recovered, and, after a wash-out period, plasma and microdialysate samples from the contralateral eye were collected after a 30-minute IV infusion of topotecan (4 mg). Samples were quantified by high-performance liquid chromatography, and population pharmacokinetic analysis was conducted using MonolixSuite. After OAC, median topotecan exposure in the orbit was 5624 ng × h/mL (range 3922-12531) compared to 23 ng × h/mL (range 18-75) after IV infusion. Thus, topotecan exposure in the orbit was 218-fold (range 75-540) higher after OAC than after IV infusion despite comparable systemic exposure (AUCpl) between routes (AUCpl, OAC: 141 ng × h/mL [127-191] versus AUCpl, IV: 139 ng × h/mL [126-186]). OAC was more selective to target the orbit because the median (range) orbital-to-plasma exposure ratio was 44 (28-65) after OAC compared to 0.18 (0.13-0.40) after IV infusion. OAC of topotecan resulted in higher orbital exposure than after IV infusion and was a more selective route for local drug delivery. Patients with orbital retinoblastoma may benefit from a multimodal treatment strategy including OAC therapy.

WTP4.1 Can Deep Stomal Fixation and Extraperitoneal Stoma Creation Improve Stoma Morbidity? Systematic Review and Meta-Analysis

Abstract Aim This systematic review evaluates the efficacy and safety of two operative techniques: deep stomal fixation (fixation of stoma to the sheath of abdominal wall muscles and/or peritoneum) and extraperitoneal approach of stoma creation. Method PubMed, Medline, Cochrane, and Google Scholar were searched for studies comparing stoma fixation to the sheath and/or peritoneum to the conventional skin-only fixation and extraperitoneal to transperitoneal approaches of stoma formation. Clinical endpoints included parastomal hernia (PSH), stoma prolapse, retraction and associated adverse effects. Results 2 randomised and 2 retrospective studies investigated deep stomal fixation. There was no statistically significant benefit of this technique in terms of PSH (OR 1.19, P=0.82), prolapse (OR 0.62, P=0.53) or retraction (OR 1.16, P=0.80). Some technical difficulties on stoma reversal were reported in one of the studies. As for extraperitoneal stoma creation, 2 randomised and 8 retrospective studies compared it to the conventional transperitoneal approach. A statistically notable reduction in PSH was identified in extraperitoneal stomas (OR 0.29, P=0.004). This technique showed statistically insignificant reduction in prolapse (OR 0.74, P=0.53) and retraction (OR 0.48, P=0.36). There was no significant difference in operative time (MD 3.45, P=0.71) or the associated risk of small bowel obstruction (OR 0.68, P=0.57). Conclusion Stoma fixation to the abdominal muscle sheath and/or peritoneum does not lower stomal complications, and conversely it may make stoma reversal technically challenging. Extraperitoneal approach minimises PSH occurrence with no remarkable adverse effects; yet more randomised trials are required for further evaluation.

A TRAM Flap Harvesting Technique for Breast Reconstruction Surgery after Mastectomy

Introduction. Currently, the best option for breast reconstruction surgery after mastectomy is TRAM-flap harvesting on a vascular pedicle from the inferior epigastric artery with taking one or two rectus abdominis muscles. However, it is widely reported about cases of marginal necrosis of the lower TRAM flap in the recipient zone. This is due to the area of obstructed blood flow "choke" at the site of anastomosis of the terminal muscular branches of the superior and inferior epigastric arteries.The aim of the study was to investigate the applied topographical features of the lower epigastric arteries in the thickness of the rectus abdominis muscles in women.Materials and methods. The main trunk of the inferior epigastric artery and its terminal branches (III and IV blood supply zones) were dissected on the muscular-aponeurotic flap of the anterior abdominal wall in the thickness of the rectus abdominis muscle in 18 non-fixed female corpses to identify the lower site of arterial anastomosis of the muscular branches. The authors measured the distance from the white line of the abdomen to the point of entry of the studied artery into the thickness of the rectus abdominis muscle, the length of the main trunk, and the vertical distance from the conditional horizontal line drawn through the upper semicircle of the umbilical ring to the beginning of the inferior epigastric artery branching (the "choke" zone). Research results. The length of the major trunk of the inferior epigastric artery from the level of perforation of the posterior wall of the aponeurotic sheath of the rectus abdominis muscle to the beginning of its division averaged 5.70.8 cm. The level of division of the major trunk into muscular branches of the inferior epigastric artery on the left and right, and, consequently, the choke zone, was always higher than the level of the umbilical ring. The distance from the conditional horizontal line drawn through the upper semicircle of the umbilical ring to the beginning of the branching of the major trunk averaged 1.40.9 cm.Conclusion. The data obtained on the typical anatomy of the inferior epigastric arteries in women may allow improving the TRAM flap harvesting on the musculovascular pedicle technique in order to reduce the risk of developing marginal skin necrosis in the recipient zone.

Ovariole-specific Yellow-g and Yellow-g2 proteins are required for fecundity and egg chorion rigidity in the red flour beetle, Tribolium castaneum

Most insects reproduce by laying eggs that have an eggshell/chorion secreted by follicle cells, which serves as a protective barrier for developing embryos. Thus, eggshell formation is vital for reproduction. Insect yellow family genes encode for secreted extracellular proteins that perform different, context-dependent functions in different tissues at various stages of development involving, for example, cuticle/eggshell coloration and morphology, molting, courtship behavior and embryo hatching. In this study we investigated the function of two of this family's genes, yellow-g (TcY-g) and yellow-g2 (TcY-g2), on the formation and morphology of the eggshell of the red flour beetle, Tribolium castaneum. Real-time PCR analysis revealed that both TcY-g and TcY-g2 were specifically expressed in the ovarioles of adult females. Loss of function produced by injection of double-stranded RNA (dsRNA) for either TcY-g or TcY-g2 gene resulted in failure of oviposition. There was no effect on maternal survival. Ovaries dissected from those dsRNA-treated females exhibited ovarioles containing not only developing oocytes but also mature eggs in their egg chambers. However, the ovulated eggs were collapsed and ruptured, resulting in swollen lateral oviducts and calyxes. TEM analysis showed that lateral oviducts were filled with electron-dense material, presumably from some cellular content leakage out of the collapsed eggs. In addition, morphological abnormalities in lateral oviduct epithelial cells and the tubular muscle sheath were evident. These results support the hypothesis that both TcY-g and TcY-g2 proteins are required for maintaining the rigidity and integrity of the chorion, which is critical for resistance to mechanical stress and/or rehydration during ovulation and egg activation in the oviducts of T. castaneum. Because Yellow-g and Yellow-g2 are highly conserved among insect species, both genes are potential targets for development of gene-based insect pest population control methods.

Minimally Invasive Peritoneal Dialysis Catheter Insertion with Intraoperative Ultrasound-Doppler Measurement of Rectus Muscle Width and Inferior Epigastric Artery Localization

Laparoscopic peritoneal dialysis catheter insertion is an established method for peritoneal dialysis catheter placement. One critical aspect of this procedure is rectus sheath tunneling. Proper peritoneal dialysis catheter incorporation within the abdominal wall is important for reducing pericatheter leaks and for proper peritoneal dialysis functioning. Particularly, accurate positioning of the internal cuff within the rectus muscle sheath is crucial to prevent potential dialysate fluid leakage. In the present report, we describe the utilization of intraoperative ultrasound as a valuable tool for determining the ideal location of the internal cuff and assessing the course of the inferior epigastric artery during rectus sheath tunneling. This technique aims to optimize the position of the internal cuff and minimize complications such as vessel injury and pericatheter leaks. Furthermore, we demonstrate that post-catheter insertion, ultrasound imaging offers valuable insights into evaluating the appropriate placement of the internal cuff, external subcutaneous cuff, and potential bleeding within the abdominal wall.

Abdominal wall defect repair with component separation technique for giant omphalocele with previous relaxing incisions on the abdominal skin

BackgroundThe repair of large abdominal wall defects that cannot be closed primarily is quite challenging. The component separation technique (CST) is a surgical approach using autologous tissue to close large abdominal wall defects. The CST requires extensive dissection between the abdominal skin and the anterior sheath of the rectus abdominis muscle. Subsequently, incisions are made at both sides of the external oblique aponeurosis, releasing the external oblique muscle from the internal oblique muscle, and then the right and left rectus abdominis muscles are brought together in the midline for defect closure. However, impairment of blood flow in the abdominal wall skin and necrotic changes are recognized as potential complications.Case presentationThe CST was performed in a 4-year-old boy with a large ventral hernia who had undergone skin closure with abdominal wall relaxing incisions for the primary treatment of giant omphalocele in the neonatal period. Given his history of incisions on the abdominal wall, he was speculated to be at high risk for postoperative skin ischemia. Dissection was therefore kept to a minimum to preserve the blood supply from the superior and inferior epigastric arteries and perforating branches of those arteries through the rectus abdominis muscle. In addition, care was taken to adjust the muscle relaxant dosage while monitoring the intravesical pressure, ensuring that it did not exceed 20 mmHg to avoid impaired circulation in the abdominal wall caused by abdominal compartment syndrome. He was discharged 23 days after the surgery without any complications, and neither recurrence of the ventral hernia nor bowel obstruction was observed in 4 years.ConclusionsA giant omphalocele with primary skin closure was treated by applying the CST. The procedure can be performed safely while preserving the blood flow to the abdominal wall, even in patients with a history of relaxing incisions on the abdominal skin. The CST is expected to be effective for repairing the large abdominal wall defects seen in giant omphalocele when primary closure is not possible.

V-004 ROBOTIC PARASTOMAL HERNIA REPAIR WITH RETROMUSCULAR MESH (PAULI TECHNIQUE)

Abstract Aim Parastomal hernia is a common complication of ostomy formation. We present a case of robotic parastomal hernia repair with retromuscular mesh (Pauli technique). Material and Methods Patient was 58 years-old man and had history of anterior resection of the rectum, terminal colostomy and onlay mesh parastomal hernia repair. After 2 months of parastomal hernia repair, the patient developed a recurrence (type III, European Hernia Society Classification). Results Robotic parastomal hernia repair was performed with transabdominal approach. Firstly, a small adhesiolysis of the colon to the stoma orifice was made. Then, the peritoneum and posterior sheath of the left rectus muscle was incised. The retrorectal space was dissected. The hernia sac was incised circumferentially. TAR dissection was launched lateral to the stoma. After the development of the landing zone for the mesh, the posterior retromuscular fascia was incised lateral to the stoma. The inner orifice of stoma was repositioned. A large-pore polypropylene mesh (20×28 cm) was placed in the retromuscular space and fixed it, lateral to the ostomy orifice. Finally, the retromuscular pocket was closed by suturing the posterior fascia to the linea alba. The patient was discharged on postoperative day 4 and had no complications. After 4 months of follow-up, no hernia recurrence had been recorded. Conclusions Robotic Pauli is a technique to repair parastomal hernias that provides wide coverage of the defect and avoids leaving mesh intraperitoneally. They could provide a secure repair and prevent postoperative complications (pain or intestinal ileus). It is technically challenging but feasible.

A COMPARISON OF PRE-EMPTIVE ANALGESIA WITH INTRAPERITONEAL INSTILLATION OF ROPIVACAINE VERSUS ULTRASOUND GUIDED RECTUS SHEATH BLOCK IN LAPROSCOPIC CHOLECYSTECOMY:

Background and Aims: Laparoscopic cholecystectomy replaced open surgery as preferred method. The largest component of pain is incisional pain (50 to 70%). Rectus sheath block acts at terminal branches of intercostal nerves in the space between rectus abdominis muscle and posterior rectus sheath resulting in anaesthesia of the midline. While intraperitoneal instillation blocks the visceral nociceptive conduction from area of tissue damage and peritoneum.The aim of this study was to evaluate the efficacy of intraperitoneal instillation versus rectus sheath block using ropivacaine for postoperative pain relief for laparoscopic cholecystectomy. After written informed consent 30 a Methods: dult ASA I,II patients were randomised into 3 groups of 10 patients. Group C (control) received only rescue analgesic on pain, Group I (Intraperitoneal instillation) received 0.25% ropivacaine 40 ml before surgery, Group R (Rectus sheath block) received bilateral block with 30 ml of 0.25% ropivacaine before surgery. -compare the VAS at Primary objective 2nd,4th,6th,12th,24th,48 hours. -assess time for 1st rescue analgesia and tramadol consumption Secondary objectives in first 6 hours. The demographic data were comparable. VAS scores at various intervals were lower Results: in both group R and group I compared to C ( p-<0.05). VAS in group R was significantly lower than group I (p value <0.05).Total tramadol consumption was lower in group R compared to I and C (p 0.0002). The first rescue analgesia was significantly later in group R (p 0.0005)

Design of motor cable artificial muscle (MC-AM) with tendon sheath–pulley system (TSPS) for musculoskeletal robot

AbstractIn an unstructured environment, the arm can perform complicated tasks with rapidity, flexibility, and robustness. It is difficult to configure multiple artificial muscles similar to an arm in the compact space of a robotic arm. When muscle tension is transferred, mechanisms like tendon-sheath/tendon-pulley may be installed in a compact space to develop musculoskeletal robots that are closer to the arm. However, handling variable frictional nonlinearity and elastic cable deformation is necessary for transmission stability. In this study, the modular artificial muscle system (MAMS), including motor cable artificial muscle and tendon sheath–pulley system (TSPS), that can be installed remotely and transmit muscle tension in narrow paths, is designed. The feed-forward multi-layer neural network (FF-MNN) approach is utilized to discuss the relationship between the measurable input tension of TSPS and the unmeasurable output tension and cable elongation. Subsequently, the lightweight musculoskeletal arm (LM-Arm) is built to verify the validity of MAMS. Through trials, the experiments of MAMS after friction compensating and the LM-Arm’s end-point 3D trajectory tracking are investigated. The results show that average errors of the active and passive muscles tension are 3.87 N and 3.51 N, respectively, under conditions of larger load and higher contraction velocity. The average muscle length error of trajectory tracking is 0.00078 m (0.72%). The suggested MAMS may successfully build a musculoskeletal robot that has similar flexibility and morphology to the arm. It can also be utilized to power various pieces of machinery, such as rescue robot, invasive surgical robots, dexterous hands, and wearable exoskeletons.

The technology of installation of breast implants in the subpectoral space while preservation attachment of the abdominal part of the pectoralis major muscle

The paper describes the technology of installing breast implants in the subpectoral cellular space while maintaining the attachment of the abdominal part of the pectoralis major muscle and evaluate the results of its application. A retrospective analysis of the results of primary breast augmentation in 762 patients operated by the authors in 2010–2020 was carried out.The space for the breast implant was formed following a certain sequence of actions. The boundaries of the receptacle were: inside – the place of attachment of the pectoralis major muscle to the sternum, outside – the abdominal part of the pectoralis major muscle and the pectoral fascia, passing to the bundles of the anterior serratus muscle, at the top – thoracoacromial vascular bundle, below – VI rib and fascial node, formed by the transition of the thoracic fascia and the aponeurosis of the abdominal part of the pectoralis major muscle to the anterior wall of the sheath of the rectus abdominis muscle. Conclusions. 1. The technology of installing implants in the subpectoral cellular space, while maintaining the distal attachment of its abdominal part, allows achieving the stability of the position of the implants and avoiding rotation and malposition of the implants. 2. In terms of up to 3–4 months after surgery, a higher location of implants on the chest is often observed. 3. The decision on the need and degree of mobilization of the abdominal part of the pectoralis major muscle should be made individually. 4. The technique cannot be used when the width of the implant base exceeds the width of the pectoralis major muscle at the level of the IV rib, and, therefore, limits the choice of larger implants.

Infiltrative Intramuscular Lipoma in the Antebrachium of a Dog

AbstractThis case report describes a dog with an infiltrative intramuscular lipoma in the antebrachium, presenting with chronic left forelimb lameness and altered posture of the digits. Computed tomography showed a fat-attenuating mass displacing the flexor tendons. The mass was surgically excised along with the affected muscle belly and tendon; histopathological examination revealed infiltration of adipose tissue cells within the muscle belly and tendon sheath of the deep digital flexor muscle. After removal of the lipoma, lameness resolved, full ambulatory function returned, without recurrence at 1 year follow-up.

A Modification of the Rectus Muscle Repair for Repair Ventral Hernias: Case Report

Background: In an attempt to avoid mesh-related complications, many authorities have described non-mesh repair of midline ventral hernias. We described rectus muscle repair (RMR) for ventral hernias in 1993, but we noticed that a limitation was the inability to repair large hernia defects. We now describe a modification of this technique that allows it to be used for larger defects. Methods: We report a case in which the modified RMR was used to repair a large ventral hernia. In the original RMR, sutures were placed through each rectus abdominis to approximate the muscles, thereby obliterating the linea alba and repairing the hernia. In this modification of the RMR, the hernia sac and the linea alba were imbricated and a vertical relaxing incision was made in each anterior rectus sheath, keeping the underlying muscle and posterior sheath intact. Results: This relaxing incision is a useful modification of the original RMR, especially where there is significant tension on the suture line. This patient had an uneventful recovery with no recurrence on clinical examination at his last clinical review 5 years post-operation. Conclusion: The modified RMR repair for ventral hernias is an acceptable alternative to mesh repair. It brings a low complication profile and avoids the burden of mesh-related complications.

New insights on the use of bill sheath as a biomonitoring tool for mercury in two kingfisher species: A comparison with different tissues

Bird species have been widely used as suitable bioindicators of environmental mercury (Hg). However, there is still some debate about the most suitable tissue to indicate Hg body burden in birds. For a long time, blood and feathers have proved to be relevant to monitor Hg at different time scales, and recently, bill sheath has been suggested as a potential tissue to this end. In the present study, we evaluated THg in muscle, liver, feathers, claws, and bill sheath in two waterbird species (i.e. the ringed and the Amazon kingfishers) from the Teles Pires, Juruena and Paraguay rivers. Considering all species and sites, feathers (5.47 ± 2.15 μg/g) and bill sheath (3.39 ± 1.37 μg/g) had mean THg concentrations about 2-, 3- and 10-times higher than claws, liver and muscle, respectively. When bird species were segregated, the ringed kingfisher showed THg values 1.8 times higher than the Amazon kingfisher in all tissues. Moreover, results showed that the Amazon kingfisher from the Juruena and Teles Pires rivers was clearly separated from the Paraguay River (control site), and was associated with higher THg values in the claws and feathers. Results obtained for the THg concentrations in bill sheath, muscle and liver tissues of the Amazon kingfisher using multivariate analysis of canonical variates (CVA) showed a pattern of segregation between the sampling areas, being the highest THg values in Teles Pires River samples. The largest bill sheath vector in the CVA suggests that this tissue is a key variable in the segregation of the samples. Overall, feathers may be useful for effects monitoring or spatial patterns, whereas bill sheath, which are more invasive, may be advantejous for temporal trends and retrospective studies of Hg pollution.

P-073 THE MODIFIED SUBLAY TECHNIQUE FOR THE MANAGEMENT OF MAJOR SUBCOSTAL INCISIONAL HERNIA: LONG-TERM FOLLOW-UP RESULTS OF 41 CONSECUTIVE PATIENTS

Abstract Aim To present the concept of original technique in the management of major incisional subcostal hernias bassed on sublay position of large haevy-weight polypropylene mesh between the two myofascial layers in the anterolateral abdominal wall. Material and methods Between January 2010 and May 2022, 41 consecutive patients underwent the modified sublay technique for major incisional subcostal hernia (minimal defect surface100 cm2 or minimal defect width or height 10 cm). The operative technique is: a) hernia sac dissetion and reposition into the abdominal cavity; b) rectus muscle and rectus muscle stump dissection from posterior rectus sheath, rectus muscle atachement dissection from thoracic wall and external oblique muscle dissection from internal oblique muscle around hernia defect at the side of the hernia defect; c) separate posterior and anterior rectus sheaths reconstruction at the midline; d) reconstruction of the posterior miofascial layer suturing internal oblique/transversal muscle and posterior rectus sheaths; e) large haevy-weight polypropilene mesh placement between posterior and anterior miofascial layer; e) reconstruction of the anterior miofascial layer by suturing external oblique muscle and anterior rectus sheaths. Results A median (range) hernia defect surface was 160 (100–500) cm2. A median operative time was 120 (90–330) minutes. The morbidity rate was 19.5%. A median (range) postoperative hospital stay was 7 (2–24) days. After the median follow-up of 50 (1–124) months, two patients (4,9%) developed recurrent hernia. Conclusions The modified sublay technique using large heavyweight polypropylene mesh provides good results in the management of major subcostal abdominal wall defects.

P-081 LAPAROSCOPIC RIVES-STOPPA ETEP FOR UMBILICAL HERNIA WITH RECTUS ABDOMINIS DIASTASIS: DOWN-TO-UP APPROACH

Abstract Aim The association of umbilical or epigastric hernia and diastasis is not uncommon.Classically, it was insisted on the repair only of hernial pathology and not of diastasis.However, according to the latest recommendations,the simultaneous treatment of both pathologies is a valid and effective option.In addition, with the rise of minimally invasive surgery(MIS) of the abdominal wall, more cases of simultaneous MIS repair of midline hernias and diastasis are being reported. Material & Methods 41-year-old female-patient with umbilical hernia of 3cm associated to diastasis with a distance of 4cm(post-pregnancy). MRI abdominal wall: umbilical hernia and diastasis, not other hernial defects. Laparoscopic management is decided by eTEP-approach . Results 4ports are used, a dissector-balloon was used to dissect the right retromuscular-space.Another 5mm-trocar is placed in LRQ, 5mm-trocar in LLQ and 12mm in suprapubic-midline.The surgery continues with the dissection of the left retromuscular-space, with the dissection of the umbilical hernial sac and reducing its contents, the section is performed at the medial level of both posterior sheaths of the rectus abdominis muscle until reaching the xiphodeal region.Later we continue with the closure of the anterior wall of the rectums by replicating the diastasis with Stratafix-0.Then the posterior sheath was closed with V-Lock 2–0.A PVDF-mesh of 16×26cm was placed.The patient presented a favorable postoperative evolution and was discharged on 1°-POD. Conclusions The laparoscopic-Rives-Stoppa-eTEP-approach for hernia-pathology of the midline associated with diastasis is a valid, efficient, effective and safe option, offering the advantages of MIS:less postoperative pain, less morbidity, early return to routine daily activities with lower healthcare-spending.

Septic Tenosynovitis of the Lower Extremity: A Case Report

Category: Other Introduction/Purpose: Tibialis anterior rupture is an exceptionally rare complication of septic tenosynovitis. One case of septic tenosynovitis of TA has been previously documented by Lowell et al. 2020 It is worth noting in this case, that TA was unruptured. In this abstract, we present a case of TA rupture secondary to septic tenosynovitis. Methods: A 46-year-old female with a past medical history of depression, HIV, HCV, Diabetes Mellitus, medication noncompliance and current heroin abuse presented with 2 days of right ankle pain. She also reported fever, chills, diaphoresis, nausea and vomiting. She was diagnosed with right foot cellulitis based on clinical findings of erythema, induration and tenderness. She underwent computed tomography (CT) with contrast of her right lower extremity which showed a peripherally enhancing fluid collection surrounding the tibialis anterior tendon consistent with tenosynovitis. There appeared to be medial extension beyond the tendon sheath (Figure 1). A sagittal view is provided in Figure 2, which further demonstrates the fluid collection. Results: She had an I&D of the fluid collection and started on IV vancomycin. After admission to the medical floor, blood cultures were drawn. The patient failed to improve after 2 days of vancomycin therapy. The blood cultures were negative. She subsequently had MRI of her right lower extremity that showed a persistent peripherally enhancing fluid collection anterior to the tibialis anterior tendon and high-grade partial tear of the tibialis anterior tendon (Figure 3). She was then taken to the operating room for a repeat incision and drainage where the tendon sheath of the tibialis anterior was incised and the tendon was exposed with washout. Wound cultures were drawn, and afterward, her antibiotic regimen was broadened with Piperacillin-Tazobactam. She was taken back to the operating room a third time for primary closure of the wound. Wound cultures grew methicillin- sensitive Staphylococcus Aureus resistant to clindamycin and she was discharged on Bactrim. Conclusion: Septic or suppurative tenosynovitis is the infection and inflammation of the closed synovial sheath of a tendon. These infections typically involve the tendons and tendon sheaths of the flexor muscles in the hand. The potential spaces of tendon sheaths create a walled-off environment ideal for pathogens to grow in isolation from host defenses. he pathogenesis of septic tenosynovitis typically involves trauma from a laceration, puncture or bite but other cases of disseminated hematogenous spread have been reported (Newman et al., 1989). Both medical and surgical management is recommended for the best possible outcome.