OV08 TREATMENT OF THE INGUINAL HERNIA USING THE SHOULDICE REPAIR

Aim The Shouldice procedure is a layered reconstruction of the posterior wall in inguinal hernia repair and currently the preferred method if the layers of the abdominal wall are of good quality, the wish of the patient for a non-mesh repair and if a mesh method is not possible or available. The correct performance of the reconstruction of the posterior wall is essential part of the operation. Material and Methods A life educational video was made with the four-layer reconstruction in detail. The first layer of the reconstruction starts at the medial corner and the conjoint tendon is sutured to the caudal flap of the transversalis fascia using a continuous non resorbable suture. The second layer of the reconstruction is made by approximating the cranial flap of the transversalis fascia and the posterior part of the inguinal ligament. The third layer starts at the level of the deep internal inguinal ring and approximates the lower border of the internal oblique muscle with the inguinal ligament. The fourth and final layer approximates the internal oblique muscle again with the inguinal ligament. Results The four-layer reconstruction after splitting the transversalis fascia is shown in detail since treatment of the hernia sac is like the other techniques. Conclusions The instructional video can be used for the resident training as a start in a hernia course followed by the execution on a model before the actual execution on a patient.

Comparison among low intensity bridge exercises using suspension devices based on muscle activity and subjective difficulty

BACKGROUND: Recent clinical studies have revealed the advantages of using suspension devices. Although the supine, lateral, and forward leaning bridge exercises are low-intensity exercises with suspension devices, there is a lack of studies directly comparing exercise progression by measuring muscular activity and subjective difficulty. OBJECTIVE: To identify how the variations in the bridge exercise affects trunk muscle activity, the present study investigated changes in neuromuscular activation during low-intensity bridge exercises. We furthermore explored whether the height of the suspension point affects muscle activation and subjective difficulty. METHODS: Nineteen asymptomatic male participants were included. Three bridge exercise positions, supine bridge (SB), lateral bridge (LB), forward leaning (FL), and two exercise angles (15 and 30 degrees) were administered, thereby comparing six bridge exercise conditions with suspension devices. Surface electromyography and subjective difficulty data were collected. RESULTS: The rectus abdominis activity was significantly higher with the LB and FL exercises compared with the SB exercise (p< 0.05). The erector spinae muscle activity was significantly higher with the SB and LB exercises, compared with the FL exercise (p< 0.05). The LB exercise significantly increased the internal oblique muscle activity, compared with other exercise variations (p< 0.05). The inclination angle of the exercise only affected the internal oblique muscle and subjective difficulty, which were significantly higher at 30 degrees compared with 15 degrees (p< 0.05). CONCLUSIONS: Relatively higher inclination angle was not effective in overall activation of the trunk muscles; however, different bridge-type exercises could selectively activate the trunk muscles. The LB and SB exercises could be good options for stimulating the internal oblique abdominis, and the erector spinae muscle, while the FL exercise could minimize the erector spinae activity and activate the abdominal muscles.