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The short- and mid-term results of immediate endovascular repair of traumatic aortic injuries are promising, especially when compared with open surgical treatment, indicating that endovascular therapy is preferable in patients with multi-trauma and traumatic ruptures of the thoracic aorta. Nevertheless, long-term follow-up data are necessary to assess the overall durability of this procedure, considering the young age of these patients. The long-term follow-up results will determine whether endovascular treatment should replace open surgery as first-line therapy in thoracic aortic injuries.

Mesh positioning in sublay compartment was followed by increased adhesion development and provides a stronger mesh-tissue attachment, in addition, resulted in a different histological profile of the inflammation/repair substrate. The intensity of these findings was directly correlated, suggesting they could be the result of a common biological phenomenon. Our findings indicate that mesh placement following the retromuscular technique generates a superior repair response, and give clues to a better understanding of the superiority of sublay repair in achieving lower recurrence rates. Characterization of the cellular and molecular elements responsible for the superiority of this technique is in our view an essential prerequisite aiming for improvements in the therapeutic options for the treatment of this disease.

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Abbreviations: LLQ, left lower quadrant; RLQ, right lower quadrant; SMA, superior mesenteric artery LUQ, left upper quadrant ObjectivesTo present a case of left-sided acute appendicitis associated with intestinal malrotation in an adult patient, review the literature regarding the subject, and discuss the feasibility of laparoscopy for the surgical intervention. AbstractIntroduction: Acute appendicitis is among the leading causes of general surgery emergencies and requires prompt diagnosis and treatment. However, the diagnosis can be especially challenging when the patient presents with left-sided abdominal pain. True left side originated appendix can occur in the setting of two conditions: situs inversus and intestinal malrotation.Case Report: This article presents the case of a 31-year-old male with left lower quadrant (LLQ) abdominal pain, caused by left-sided acute appendicitis associated with intestinal malrotation. After confirmation of the diagnosis through radiologic studies, a laparoscopic appendectomy was performed, with adjustments to the position of the ports to allow for optimal access to the LLQ. There was no evidence of complications directly related to the malrotation, such as volvulus, small bowel obstruction or internal hernia. There were no complications in the intraoperative or postoperative period. Discussion:The various forms of intestinal malrotations compose a spectrum of bowel positional anomalies, caused by nonrotation or incomplete rotation of the primitive bowel loop. Acute appendicitis poses a great risk to patients with malrotation due to the atypical presentation and the difficulty in the interpretation of radiologic studies, which may cause a grave delay in the diagnosis and surgical intervention, potentially resulting in higher morbimortality. This is aggravated by the very scant number of studies comparing different approaches and analyzing outcomes, which in turn is caused by the rarity of cases with the two conditions associated. Conclusion:Although there is not enough evidence in the current literature to support the systematic use of laparoscopic approach in the treatment of appendicitis associated with intestinal malrotation, it is the opinion of the authors that the laparoscopic treatment, when performed by an experienced surgeon and with the proper adaptations arranged, can be feasible in those patients.