BACKGROUND: Fascial dehiscence (FD) occurs in up to 14.9% of high-risk patients undergoing emergency laparotomy. Although prophylactic mesh can prevent FD, its use in emergency operations remains controversial. STUDY DESIGN: A prospective randomized clinical trial was conducted at the Hospital das Clínicas from Faculdade de Medicina da Universidade de São Paulo in Brazil. It was performed among highrisk patients, defined according to Rotterdam risk model, undergoing midline emergency laparotomy. The patients were randomized into the suture group (SG), with slowly absorbable running sutures placed with a 36-mm-long needle at a suture-to-wound length ratio of 4:1, and the prophylactic mesh group (PMG), with fascial closure as in the SG but reinforced with onlay polypropylene mesh. The primary end point was incidence of FD at 30 days post operation. RESULTS: We analyzed 115 patients; 52 and 63 were allocated to the SG and PMG, respectively. In all, 77.4% of the cases were for colorectal resection. FD occurred in 7 (13.5%) patients in the SG and none in the PMG (p ¼ 0.003). There was no difference between the groups in number of patients with surgical site occurrence (SSO) or SSO requiring procedural intervention. However, some specific SSOs had higher incidences in the mesh group: surgical site infection (20.6% versus 7.7%; p ¼ 0.05), seroma (19.0% versus 5.8%; p ¼ 0.03), and nonhealing incisional wound (23.8% versus 5.8%; p ¼ 0.008). Of SSOs in the PMG and SG, 92.3% and 73.3%, respectively, resolved spontaneously or with bedside interventions. CONCLUSIONS: Prophylactic onlay mesh reinforcement in emergency laparotomy is safe and prevents FD. Surgical site infection, seroma, and nonhealing incisional wound were more common in the mesh group, but associated with low morbidity within 30 days post operation.

PURPOSE:To compare the inflammatory response of three different meshes on abdominal hernia repair in an experimental model of incisional hernia. METHODS:Median fascial incision and skin synthesis was performed on 30 Wistar rats. After 21 days, abdominal hernia developed was corrected as follows: 1) No mesh; 2) Polypropylene mesh; and, 3) Ultrapro ® mesh. After 21 days, the mesh and surrounding tissue were submitted to macroscopic (presence of adhesions, mesh retraction), microscopic analysis to identify and quantify the inflammatory and fibrotic response using a score based on a predefined scale of 0-3 degrees, evaluating infiltration of macrophages, giant cells, neutrophils and lymphocytes. RESULTS:No significant difference was seen among groups in adherences, fibrosis, giant cells, macrophages, neutrophils or lymphocytes (p>0.05). Mesh shrinkage was observed in all groups, but also no difference was observed between polypropylene and Ultrapro mesh (7.0±9.9 vs. 7.4±10.1, respectively, p=0.967). Post-operatory complications included fistula, abscess, dehiscence, serohematic collection and reherniation, but with no difference among groups (p=0.363). CONCLUSION:There is no difference between polypropylene (high-density) and Ultrapro ® (low-density) meshes at 21 days after surgery in extraperitoneal use in rats, comparing inflammatory response, mesh shortening, adhesions or complications.

Purpose COVID-19 is associated with high morbidity and mortality in patients undergoing surgery. Contrary to elective procedures, emergency operations should not be postponed. We aim to evaluate the profile and outcomes of COVID-19 patients who underwent emergency abdominal surgery. Methods We performed a retrospective analysis of perioperative data of COVID-19 patients undergoing emergency surgery from April 2020 to August 2020. Results Eighty-two patients were evaluated due to abdominal complaints, yielding 22 emergency surgeries. The mean APACHE II and SAPS were 18.7 and 68, respectively. Six patients had a PaO 2 /FiO 2 lower than 200 and more than 50% of parenchymal compromise on chest tomography. The most common indications for emergency surgery were hernias (6; 27.2%). The median length of stay was 30 days, and only two patients required reoperation. Postoperatively, 10 (43.3%) patients needed mechanical ventilation for a mean of 6 days. The overall mortality rate was 31.8%. Conclusion Both postoperative morbidity and mortality are high in COVID-19 patients with respiratory compromise and abdominal emergencies. Supplementary Information The online version contains supplementary material available at 10.1007/s13304-021-01007-5.

Objetivos: verificar o efeito do óleo de copaíba no colo uterino de ratas ooforectomizadas. Métodos: foram utilizadas 120 ratas adultas distribuídas em 4 grupos: as que receberam aplicação de óleo de copaíba, óleo de milho, água e um grupo sem tratamento. Todos os animais foram submetidos a ooforectomia bilateral e posteriormente mantidos em gaiolas por um período de 20 dias antes de iniciar a aplicação das substâncias. Estas foram administradas via vaginal na dose de 0,3 ml, diariamente, uma vez ao dia até os dias determinados para o sacrifício (7 o , 14 o e 21 o), sendo sacrificados de cada grupo 5 animais por dia. Resultados: todos os animais do grupo copaíba apresentaram epitélio exuberante, estratificado pavimentoso queratinizado, em torno de 10 fileiras de células epiteliais, e lâmina própria com tecido conjuntivo denso, rico em fibroblastos, fibras colágenas, inúmeros vasos sanguíneos e alguns leucócitos. Conclusões: o óleo de copaíba utilizado neste modelo experimental promoveu espessamento do epitélio do colo uterino, que se apresentava pavimentoso estratificado com queratinização, além do espessamento progressivo deste epitélio no decorrer dos dias de estudo.

HighlightsThe rarity of these finding as a important differential diagnosis in groin and femoral hernia repair.Diagnosis made at operative field with possibility of preoperative diagnosis with duplex ultrasonography.The treatment well illustrated in figures by the simple ligation of the feeding vessel.Great review about the venous aneurysms and the treatment options.