Second Look After Retromuscular Repair With the Combination of Absorbable and Permanent Meshes.

Objective: The aim of this study is to describe the macroscopic features and histologic details observed after retromuscular abdominal wall reconstruction with the combination of an absorbable mesh and a permanent mesh. Methods: We have considered all patients that underwent abdominal wall reconstruction (AWR) with the combination of two meshes that required to be reoperated for any reason. Data was extracted from a prospective multicenter study from 2012 to 2019.Macroscopic evaluation of parietal adhesions and histological analysis were carried out in this group of patients. Results: Among 466 patients with AWR, we identified 26 patients that underwent a reoperation after abdominal wall reconstruction using absorbable and permanent mesh. In eight patients, the reoperation was related to abdominal wall issues: four patients were reoperated due to recurrence, three patients required an operation for chronic mesh infection and one patient for symptomatic bulging. A miscellanea of pathologies was the cause for reoperation in 18 patients. During the second surgical procedures made after a minimum of 3 months follow-up, a fibrous tissue between the permanent mesh covering and protecting the peritoneum was identified. This fibrous tissue facilitated blunt dissection between the permanent material and the peritoneum. Samples of this tissue were obtained for histological examination. No case of severe adhesions to the abdominal wall was seen. In four cases, the reoperation could be carried out laparoscopically with minimal adhesions from the previous procedure. Conclusions: The reoperations performed after the combination of absorbable and permanent meshes have shown that the absorbable mesh acts as a protective barrier and is replaced by a fibrous layer rich in collagen. In the cases requiring new hernia repair, the layer between peritoneum and permanent mesh could be dissected without special difficulty. Few intraperitoneal adhesions to the abdominal wall were observed, mainly filmy, easy to detach, facilitating reoperations.post-print6360 K

Stepwise transversus abdominis muscle release for the treatment of complex bilateral subcostal incisional hernias.

Background Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior component separation through the same previous incision as a safe and reproducible technique for these complex cases. Methods We present a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. Results A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 patients (15%) requiring procedural intervention. During a mean follow-up of 18 (range, 6–62), 1 (2%) case of clinical recurrence was registered. In addition, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative compared with the preoperative scores. Conclusion Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients’ reported outcomes.pre-print371 K

Multidata study to evaluate the impact of submarine outfall in a beach sedimentary dynamic: The case of Samil Beach (Galicia, Spain)

The Ria de Vigo (NW Iberian Peninsula) is one of the most impacted coastal areas of Galicia, due to demographic and industrial pressure. One of the main consequences of this pressure is the need to extend the current wastewater treatment plant of the city of Vigo (295,000 inhabitants). This extension includes a new submerged pipeline construction to discharge the treated water in the central channel of the Ria. The new planned pipeline must cross Samil Beach, the most important urban beach of the city. Based on a multitool strategy, this work characterizes the interactions between the new pipeline route alternatives and the sediment dynamics of Samil Beach. This approximation improves the reliability of the results in the subtidal area of the beach, where studies are scarce due to the complexity of the data acquisition. The present study is based on high resolution bathymetry data, seabed physical characterization, a granulometric study of the superficial sediment, and a numerical simulation of the tide, wave climate, and sediment transport in low and high energy conditions using open source Delft3D software. The results showed that the area of interest is a low energy area, which is significantly shielded from wave attack, where fine sand predominates. However, the field data indicated an interaction (accretion-erosion) in the submerged obstacles between 0 and 12 m deep. The model revealed that there is significant sediment movement above a 7.4 m isobath, and that the pipeline would not alter the general transport dynamics of the beach, but would interact in the shallowest section. The main conclusion of this work states that the future structure would not alter the global sediment dynamics of the beach. In addition, in order to guarantee the safety of the new pipeline, it should emerge above an 8 m isobath. The multiapproach methodology presented can be applied to other studies of the interaction between coastal structures and the environment.Aguas de las Cuencas de España S.A. (Acuaes)FAREWELP CGL2015-66681-R

Multidisciplinary Approach to Treating Severe Acute Pancreatitis in a Low-Volume Hospital.

Background Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality. Methods We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis. Results Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis. Sixteen patients underwent surgery: six patients for septic abdomen, four patients for pancreatic necrosis and two patients due to abdominal compartment syndrome. Four patients had a combination of surgical procedures for pancreatic necrosis and for abdominal compartment syndrome. Overall mortality was 9.1%. Conclusion Severe acute pancreatitis represents a complex pathology that requires a multidisciplinary approach. Establishing best practice treatments and evidence-based guidelines for severe acute pancreatitis may improve outcomes in low-volume hospitals.pre-print158 K

Agreement in the assessment of metastatic spine disease using scoring systems

Licensed under the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0

EnREDate en el Ribera

Se desarrolla un proyecto de innovación educativa que pretende conectar con el profesorado e implicarlo en la utilización de las Tecnologías de la Información y la Comunicación para aplicarlas en sus asignaturas y repercutir en la formación del alumnado para que igualmente utilicen las Nuevas Tecnologías como complemento a su formación. EnREDate consiste en la divulgación de una forma atractiva y puesta en práctica de una herramienta telemática de trabajo cooperativo desarrollado para centros de enseñanza. Dicha herramienta permite al profesorado y al alumnado colocar sus apuntes, trabajos y sugerencias, y un medio de comunicación La realización del proyecto se ha dividido en tres partes. En la primera parte se ha realizado la formación del profesorado en el uso de la herramienta informática Claroilex en dos turnos de formación, uno de mañana y otro de tarde. El profesorado ha recibido la información necesaria en el uso de Intranet, incidiendo especialmente en la subida de apuntes al servidor para que el alumnado pueda consultarlo, para la realización de exámenes, para la entrega de trabajos y para la comunicación de incidencias. En la segunda fase se ha informado al alumnado sobre la utilización de los recursos a través de regalos con información sobre el funcionamiento del recurso. Se distribuyen dípticos con información sobre el uso de Intranet y carpetas dónde en su portada se narra las posibilidades que pueden realizarse en la plataforma. En tercer lugar se realiza una campaña de concienciación para el uso de esta herramienta informática por parte del profesorado y del alumnado. Finalmente se desarrolla y se lleva a cabo el proyecto de Intranet, siendo exclusivo para el IES Ribera de Castilla y utilizado principalmente por el profesorado y el alumnado de conocimientos centrados en ciencias.Castilla y LeónConsejería de Educación. Dirección General de Universidades e Investigación; Monasterio de Nuestra Señora de Prado, Autovía Puente Colgante s. n.; 47071 Valladolid; +34983411881; +34983411939ES