BACKGROUND:The hernia sac to abdominal cavity volume ratio (VR) on abdominal CT was described previously as a way to predict which hernias would be less likely to achieve fascial closure.The aim of this study was to test the reliability of the previously described cutoff ratio in predicting fascial closure in a cohort of patients with large ventral hernias. METHODS:Patients who underwent elective, open incisional hernia repair of 18 cm or larger width at a single center were identified. The primary end point of interest was fascial closure for all patients. Secondary outcomes included operative details and abdominal wall-specific quality-of-life metrics. We used VR as a comparison variable and calculated the test characteristics (ie, sensitivity, specificity, and positive and negative predictive values). RESULTS:A total of 438 patients were included, of which 337 (77%) had complete fascial closure and 101 (23%) had incomplete fascial closure. The VR cutoff of 25% had a sensitivity of 76% (95% CI, 71% to 80%), specificity of 64% (95% CI, 54% to 74%), positive predictive value of 88% (95% CI, 83% to 91%), and negative predictive value of 45% (95% CI, 36% to 53%). The incomplete fascial closure group had significantly lower quality of life scores at 1 year (83.3 vs 52.5; p ¼ 0.001), 2 years (85 vs 33.3; p ¼ 0.003), and 3 years (86.7 vs 63.3; p ¼ 0.049). CONCLUSIONS: In our study, the VR cutoff of 25% was sensitive for predicting complete fascial closure for patients with ratios below this threshold. Although there is a higher likelihood of incomplete fascial closure when VR is ! 25%, this end point cannot be predicted reliably. Additional studies should be done to study this ratio in conjunction with other hernia-related variables to better predict this important surgical end point.

Intestinal lipomas can occur anywhere in the gastrointestinal tract, and these tumors are more frequent in the colon. By being largely asymptomatic, colonic lipomas are usually found incidentally, as findings in colonoscopy examinations, in association with biopsy. Endoscopic or surgical resection is the therapeutic option, depending on the size of the tumor, its location, and the presence or absence of symptoms. In this study, we present a case of a 59-year old woman, with a descending colon lipoma histologically diagnosed only after surgical resection of the lesion. The approach was adopted according to the patient's clinical picture (intestinal bleeding, vomiting and weight loss), in addition to the occlusion of 80% of the colonic lumen observed in a colonoscopy.

Highlights Pancreatic pseudocysts (PP) are known sequelae of acute and chronic pancreatitis. Pseudocyst extension into the psoas muscles have been rarely described. Pancreatic pseudocyst can also masquerade as complicated diverticulitis. This is a rare case of PP successfully managed with percutaneous drainage.

Posttransplant CourseImmediate graft function was present and length of stay was 4 d. Serum creatinine at discharge and 30 d was 7.92 and 1.38 5 mg/dL, respectively. During routine laboratory

No abstract