VP026 LIRA-TAPE TECHNIQUE. A NEW PROCEDURE FOR RESTORING THE MIDLINE BY MIS IN SUPRAPUBIC AND MIDDLE SIZE MIDLINE HERNIAS

Aim LIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) was described in 2018 in order to reduce the tension in the midline as an alternative for Closing the defect (CD) during Laparoscopic Ventral Hernia Repair. TAPE (Transabdominal Partial Extraperitoneal) was described in 2011 in order to repair complex suprapubic hernias to reduce the recurrence rate. We present a case of suprapubic hernia associated to a medium-size midline hernia using LIRA combined with TAPE as a new procedure for abdominal wall reconstruction Material and Methods 50 years old female affected with a M5 W2 hernia associated to a M2-3 W2. (EHS Classification). Preoperative scan was performed. Results 3 Ports (2 of 5 mm, 1 of 12 mm) in the left mid axillary line for LIRA and supraumbilical (10 mm) and right paraumbilical (5mm) to assist TAPE were placed. A peritoneal flap is created to expose de pubic arch and the Coopeŕs Ligament. CD was performed in suprapubic defect using a barbed suture and continued for LIRA procedure in the posterior rectus sheath. An intraabdominal mesh was placed (Polyvinylidene fluoride (PVDF) mesh, Dynamesh (®)-IPOM (FEG Textiltechnik mbH, Aachen, Germany. The mesh overlapped the suprapubic arch and was fixed using helicoidal sutures and covered the whole incision in the midline. Pelvic flap covered partially the mesh. Patient was discharge in 72 h Conclusions Complex hernias close to bones, as suprapubic hernias, can be restored using a minimal invasive approach, even those associated to mid-line defects. LIRA-TAPE is a safe and reproducible association for restoring the midline with a low rate of complications.

Short-term outcome of fragility fractures of the pelvis in the elderly treated with screw osteosynthesis and external fixator

Background The treatment of fragility fractures of the pelvis is rising challenge for orthopedic trauma surgeons. Operative treatment should allow immediate full weight bearing and early mobilisation but should also be as minimal invasive as possible. Sacroiliac (SI) or transsacral transiliac screws (TSTI) alone or depending on the fracture in combination with an external fixator meets both of these criteria. Material and methods The outcome of 121 operatively treated patients with fragility fractures of the pelvis were evaluated in this retrospective study. Depending on the type of fracture the patients were treated with navigated SI screw or TSTI screw alone or in combination with an external fixator. All patients were operated in supine position in a hybrid-OR, which consists of a fixed robotic 3D flatpanel detector (Artis zeego, Siemens Healthineers, Germany) and a navigation system (BrainLab Curve, BrainLab, Germany). Results 37 patients were treated with either one or two SI screws and 57 with one TSTI screw. An additional external fixator was combined with SI screws in 17 patients and with TSTI screws in 10 patients. The preoperative pain score was significantly higher compared to the postoperative score (5.1 ± 2.5 vs 2.2 ± 1.9, p < 0.05). Follow-up at 6 month was possible for 106 patients which showed screw loosening in 16.3% of the SI Screws (n = 49) compared to only 5.2% of TSTI screws (n = 57). No screw loosening was seen in the combination of TSTI-screw and external fixator (n = 10). There were two septic and three aseptic pin loosenings of the external fixator. Overall only one patient needed revision surgery due to screw loosening and local irritation. Overall 75.2% (n = 91) of the patients could be released in their home or in a rehabilitation unit and only 14% (n = 17) were released to a nursing home due to immobility despite the operation. Non-surgical complications rate was 21.5%. Conclusion SI or TSTI screws with possible combination with an external fixator show early pain relief and allows most of the patients to keep their former level of independence. With an also low surgical complication rate, it proved to be a safe and reliable treatment for fragility fractures of the pelvis. Due the effective pain relief and the minimal invasive approach, early mobilisation is possible and might prevent typical non-surgical complications which are very common during conservative treatment.

Case Report – Direct Percutaneous Approach to Treat Peristomal Varices: A Simple and Effective Option

Introduction:Bleeding secondary to peristomal varices is a rare but potentially fatal complication of portal hypertension. TIPS is its first-line etiologic treatment in the setting of cirrhosis with portal hypertension. However, TIPS is not always feasible, especially in cases of contraindication or portal trunk occlusion.Case presentation: A patient of 63-year old male was referred for persistent peristomal variceal bleeding. He had a past history cirrhosis with portal hypertension due to alcohol consumption and more recently, rectal cancer with metachronous liver metastasis. He was treated by proctectomy with placement of a stoma in the left flank. An evaluation CT scan showed a tumour-like occlusion of the portal vein, the origin of which is uncertain.He was regularly referred to the emergency department for peristomal bleeding with anaemia, without haemodynamic instability. CT-scan angiogram confirmed ectopic peristomal varices without active bleeding. After multidisciplinary meeting, a minimal invasive approach was decided. Under local anaesthesia and ultrasoung guidance, the varicose vein was punctured by direct percutaneous access using a 22G-needle, and embolized using a mixture of N-Butyl-Cyanoacrylate and Lipiodol. The patient had no complication, and no recurrent bleeding occurred after more than 6 months of follow-up. He was discharged from the hospital 8 days later.Conclusion: The percutaneous approach is a simple and effective technique. This approach should be the first line treatment when TIPS is not indicated.

How I do it: the trans-laminar, facet-joint sparing minimal invasive approach for ventral dural repair in spontaneous intracranial hypotension—a 2-dimensional operative video

Background We describe the minimally invasive, facet-sparing postero-lateral approach to the thoracic spine for a ventral dural repair in a patient with intracranial hypotension secondary to a spontaneous dural breach. Methods We performed a minimally invasive approach using a short paramedian posterior skin incision followed by a 10 × 10 mm targeted trans-laminar approach, to achieve a microsurgical repair of a symptomatic ventral dural defect causing severe disability. Conclusion The facet-sparing postero-lateral approach is safe and effective in the surgical management of thoracic dural tears, even in the most anterior ones, and avoids the traditional costotransversectomy.

581 Renal Arteriovenous Fistula Percutaneous Embolization Using the Amplatzer Vascular Plug II

Introduction Renal arteriovenous fistula (AVF) is not considered a common condition; however, it can occasionally complicate with renal impairment and heart failure secondary to high cardiac output. Recently, percutaneous embolization has overcome traditional surgery as the first line of its management, because of better success rates as well as less morbidity and mortality. Case report A 68-year-old male who presented with a renal AVF post left partial nephrectomy associated with a large pseudoaneurysm. This was found on a computed tomography angiography (CTA) scan, a routine follows up for his endovascular aortic aneurysm repair. Due to the patient’s co-morbidities and to avoid the potentially fatal pseudoaneurysm rupture, a minimal invasive approach was agreed in the multidisciplinary meeting. He was treated by percutaneous transcatheter embolization using the Amplatzer Vascular Plug II (AVP-II) through a right femoral arterial access. The patient recovery was uneventful, following an overnight stay he was discharged home. CTA done four and ten months later showed the AVP-II device inside the left renal artery branch feeder with no artifacts seen. There was absence of recanalization of the AVF. In the literature, adopting the transarterial route for the renal AVF treatment with AVP-II device as a single embolotherapy device has not been reported before. Conclusions Our report display the feasibleness of AVP-II in renal AVF treatment by arterial feeder embolization, specifically in fistulas with high flow and short communication as our case in which it showed offered multiple advantages over coils and is more cost effective.

Symptomatic Nephroptosis of the Transplant: First Report of Diagnostic Workup and Successful Minimal-Invasive Treatment

The symptomatic nephroptosis of a kidney transplant is a rare and potentially fatal complication and requires fast diagnosis and treatment. In this report, we describe a case in which intermittent symptomatic hydronephrosis and an increase of the creatinine levels were the leading symptoms of nephroptosis. Moreover, we describe the diagnostic procedures and the successful minimal-invasive treatment. To our knowledge, this is the first report of a symptomatic transplant nephroptosis with consecutive intermittent hydronephrosis and without complications of perfusion solved with a minimal-invasive approach.

Resin Infiltration Technique as Minimal Invasive Approach Towards Mild to Moderate Dental Fluorosis in an Adolescent: a Case Report

Dental fluorosis can be defined as a developmental condition that affects dental hard tissue, mainly enamel characterised with white or yellowish lesions due to excessive fluoride exposure. Fluorosis can have a major impact on the appearance, structure and shape of the tooth which posed a significant aesthetic concern to individuals having this condition. There are several treatments recommended in treating dental fluorosis depending on the severity of the disease itself ranging from tooth bleaching to prosthetic crowns in severe cases. This case report describes the use of resin infiltration technique on a patient with mild to moderate severity of dental fluorosis of the upper anterior teeth which produce an acceptable improvement of the appearance of the affected tooth. Resin infiltration technique in this case provided a conservative and inexpensive approach in treating mild to moderate dental fluorosis for the patient, improving the aesthetic without significant loss of tooth structure.