Complex ventral hernia repair in a child : an association of botulinumtoxin, progressive pneumoperitoneum and negative pressure therapy : a case report on an arising surgical technique

INTRODUCTION: The purpose of this manuscript is to report the management of a child born with giantomphalocele (GO) that developed a complex ventral hernia secondary to an unsuccessful attempt ofclosing the primary defect. PRESENTATION OF CASE: The patient underwent a one-step surgery to correct a ventral hernia associatedwith a largely prolapsed enteroatmospheric fistula (EAF) along with an ileostomy. It was managed bya pre-operative association of botulinum toxin agent (BTA) application with preoperative progressivepneumoperitoneum (PPP) and trans-operative negative pressure wound therapy (NPWT) dressing withstaged abdominal closure. The patient needed 4 reoperations due to enteric fistulas. Nine days after thefirst surgery, it was possible to completely close the abdominal wall without mesh substitution. No signsof hernia in 9 months of follow-up. DISCUSSION: This is the second report in the literature and it reinforces the safety and effectiveness ofthe BTA injection associated with PPP in children. CONCLUSION: The use of BTA in association with PPP should be encouraged and best investigated inpatients with GO. The fistulas were not attributed to the negative pressure. Maybe it is time to startdefining better criteria to categorize GO in order to choose the best management for each patient

Primary closure of a sternal cleft in the neonatal period

Sternal cleft is a rare malformation of the midline fusion of the sternal bars; the most common form is the superior partial defect. Surgical correction with primary closure is the gold standard. It is recommended that the procedure be performed before 3 months of age because of the greater compliance and maximal flexibility of the thoracic wall. These features ensure a safer repair with a low risk of complications and allow for a less extensive procedure that does not require the use of additional techniques. A midline incision is performed in the anterior thoracic wall, and the major pectoralis flaps are raised. The main surgical goal is to change the remaining sternum from a U to a V shape. Transfixing interrupted sutures are placed in the cartilaginous borders for midline closure. Hemodynamics and ventilation are monitored at this time. Closure is performed by layers.Vídeo: Não é possível instalar um arquivo de vídeo. Apenas transfira-o para seu computador e abra como um arquivo comum. Arquivos de vídeo não podem ser editados, mas podem ser visualizados em players como o VLC Media Player (que é gratuito), o Windows Media Player ou o QuickTime. Os formatos mais comuns de vídeo serão executados normalmente por estes players (avi, mpeg e mp4). PDF: Estes arquivos não podem ser editados, pois é um formato fechado. Este formato permite que sejam feitas edições — como marcação de texto e comentários, além de preenchimento de formulários — caso o autor permita. Este arquivo pode ser visualizado em leitores de PDF como o Adobe Acrobat Reader ou em navegadores da web.VídeoTo illustrate the technique for primary closure of an upper portion Sternal Cleft in the neonatal period

Laparoscopic gonad-sparing procedure in ovotesticular disorder of sex development case video technique

Introduction Ovotesticular disorder of sex development (OTD) is a rare condition. There’s a lack of literature addressing gonad-sparing surgery for OTD. Objective Report the laparoscopicpartial gonadectomy technique e gonad-sparing surgery e in an 11-year-old child, 46, XX karyotype with OTD with atypical genitalia. Material and methods After a complete diagnostic evaluation the patient underwent feminizing genitoplasty followed by laparoscopic partial gonadectomy (gonad-sparing surgery). The patient was positioned on supine position and Trendelenburg. One 5 mm port was placed on the umbilicus and two 3 mm ports in both flanks. A gonadal wedge biopsy was performed to achieve histopathological confirmation before resection. The testicular component of the ovotestis is clearly identified based on macroscopic aspects, and resected with laparoscopic scissors and limited use of electrocautery. Discussion This case was classified as bipolar or terminal ovotestis. At the 5-month follow-up, the patient attained menarche. No adverse outcomes have been recorded. Postoperative third year follow-up hormone evaluation revealed aZ female pattern characteristic and ultrasound demonstraed uterine volume increase, as well as bilateral ovarian tissue development with follicles. Conclusions Gonad-sparing procedure is feasible and desirable whenever possible, especially in 46, XX patients with female sex of rearing, since it preserves the fertility potential. The risk of malignancy must be monitored