P103 IS BOTULINUM TOXIN PRE-CONDITIONING & 3D PLANNING USEFUL IN A BILATERAL SUBCOSTAL EVENTRATION WITH LAPAROSTOME AND COLOSTOMY?

Aim To assess the usefulness of 3D Planning and preconditioning with botulinum toxin in a complex abdominal wall hernia. Material and Methods A 54-year-old man with sever alcoholic pancreatitis required surgery due to poor evolution, performing subtotal colectomy with a right colon colostomy and necrosectomy by bilateral subcostal laparotomy. After several operations and not being able to close the wall, the use of negative pressure therapy and subsequently skin grafting was required. Abdominal wall 3D Planning was performed and botulinum toxin injection was administered before definite surgery. During surgery, after digestive reconstruction, it was observed that wound’s edges did not approximate due to retraction of rectus in the cranial and caudal pole. Posterior layer was closed with running suture and double polypropylene mesh was placed. One year after surgery, patient remains without recurrences with a firm abdominal wall and recovery of life’s quality with radiologic confirmation images. Results Intestinal and Wall reconstruction in one step was feasible, although botulinum toxin injection did not provide benefits due a bilateral subcostal incision with significant muscle retraction. The 3D Planning allowed us to assess the degree of retraction of the musculature, much greater than what was appreciated in the physical examination. Conclusions The subcostal incision should be avoided in severe pancreatitis. Surgical planning with 3D technology is developing, allowing the entire anatomy to be assessed globally. 3D, useful tool for teaching, suggests that in subcostal laparotomies, it could help predicting that botulinum toxin would not be useful due to muscular retraction.

Left congenital diaphragmatic hernia and gastroschisis in a term male infant

A term male infant was born to a healthy 24-year-old mother with antenatally diagnosed liver-up, left congenital diaphragmatic hernia (CDH) and gastroschisis. The infant was stabilised in the neonatal intensive care unit and then underwent primary repair of the CDH via left subcostal incision and silo placement for the gastroschisis. Serial silo reductions were started postoperatively and umbilical flap closure for the gastroschisis was performed on day of life 6. The patient was weaned from respiratory support, started on enteral feeds, and discharged home at 1 month of age. He was weaned from supplemental nasogastric feeds by 6 weeks of age and is currently well and thriving at 11 months of age.

Adrenal Cavernous Hemangioma: A Rarely Perceived Pathology—Case Illustration and Review of Literature

Cavernous hemangiomas are endothelial tumors that rarely affect the adrenal glands. Most of these tumors remain silent and are incidentally found on abdominal imaging. Hardly ever, these tumors are endocrinologically functional. They may present as vague abdominal pain. Surgical resection remains the mainstay for large masses. In this paper, we are presenting a case of adrenal cavernous hemangioma in a 83-year-old male patient who initially presented for workup of vague abdominal and bilateral flank pain. A computed tomography scan of the abdomen showed an 8 cm right adrenal adenoma which was metabolically nonfunctional. The mass was completely resected through an open subcostal incision, with no encountered postoperative complications. A highlight of all published cases of adrenal hemangiomas since 1955 is also presented and reviewed.

Whether Superficial Abdominal Reflex is Affected by Subcostal Transverse Abdominal Incisions? A Prospective, Observational Early Experience

ABSTRACT Introduction: Superficial abdominal reflex (SAR) is an important part of the neurologic assessment. It is normally present and may be present or absent in various physiological as well as pathological conditions. The presence of an abdominal incision creates a dilemma in the mind of the clinician for it affecting this reflex. As there is no literature on this, we decided to study the effect of abdominal incisions on SAR. Materials and Methods: It was a prospective, observational study. We evaluated the patients requiring transverse subcostal incision (range 3–12 cm) both preoperatively and postoperatively, for their abdominal reflexes. Patients with preoperative normal and symmetrical abdominal reflexes were included in the study. Postoperatively, we compared the change of SAR with the preoperative status and analyzed the data. Results: A total of 94 patients underwent surgeries, out of which 54 patients came under inclusion criteria, comprising 36 males and 18 females. Subcostal transverse abdominal incisions were made for surgeries including both gastrointestinal and ventriculoperitoneal shunts. SAR was found unaffected by the incisions in all patients. Conclusions: Although the study was small, subcostal transverse abdominal incisions were not found to affect SAR.