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Objetivos: Reportar un caso de diagnóstico prenatal de riñón ectópico intratorácico (REI) con hernia diafragmática y manejo quirúrgico neonatal, y hacer una revisión de la literatura sobre diagnóstico prenatal de REI y el pronóstico perinatal. Materiales y métodos: Se reporta el caso de un feto de 28 semanas en el que se observó imagen ecográfica sugestiva de masa en hemitórax derecho que desplazaba corazón y pulmón; se confirmó que correspondía a un riñón intratorácico. Por laparoscopia, al recién nacido se le colocó una malla en continuidad con el diafragma dejando el riñón en el abdomen, con buena evolución. Se realizó una búsqueda bibliográfica en PubMed, Embase y Cochrane. Se buscaron cohortes, reportes y series de caso de gestaciones con diagnóstico prenatal de riñón intratorácico fetal. Se extrajo información del diseño, la población, el diagnóstico por imágenes, el tratamiento y el pronóstico. Resultados: En la búsqueda se identificaron 8 estudios que cumplieron con los criterios de inclusión y que informan en total ocho casos. El diagnóstico ecográfico mostró REI asociado a hernia diafragmática en todos los sujetos. Se utilizó también la RM fetal en cinco casos. Seis neonatos sobrevivieron sin complicaciones, en uno hubo interrupción voluntaria del embarazo, y otro presentó sepsis y dificultad respiratoria, finalmente fue dado de alta en buenas condiciones. Conclusiones: El REI es una anomalía congénita susceptible de diagnóstico prenatal. La sobrevida a la cirugía correctora en el periodo neonatal es frecuente. La literatura disponible en torno al diagnóstico prenatal de REI es escasa y se limita a reportes de casos.

Objectives: To report a case of prenatal diagnosis of ectopic intrathoracic kidney with diaphragmatic hernia managed surgically after birth, and to conduct a review of the literature on prenatal diagnosis of ectopic intrathoracic kidney and perinatal prognosis. Material and methods: We report the case of a 28-week fetus in which, on ultrasound imaging, a mass was observed displacing the heart and lung in the right hemithorax, which was was confirmed by magnetic resonance (MR) to be an ectopic intrathoracic kidney. After birth, the neonate was approached by laparoscopy to place a mesh in continuity with the diaphragm, leaving the kidney in the abdomen, with good evolution. A search was conducted in the PubMed, Embase and Cochrane databases for cohorts, case reports and case series of prenatal diagnosis of intrathoracic kidney in the fetus. Information was retrieved regarding design, population, imaging diagnosis, treatment and prognosis. Results: The search identified 8 studies that met the inclusion criteria, reporting a total of 8 cases. Ultrasound diagnosis showed ectopic intrathoracic kidney associated with diaphragmatic hernia in all the subjects. Fetal magnetic resonance imaging (MRI) was also used in 5 cases. Conclusions: Ectopic intrathoracic kidney is a congenital abnormality amenable to prenatal diagnosis. Survival after corrective surgery performed in the neonatal period is common. There is a paucity of publications, limited to case reports, regarding the prenatal diagnosis of this condition.

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Introducción: La hernia de Morgagni es una anomalía congénita rara, responsable del 3 por ciento de las hernias diafragmáticas, que provoca opacidades radiológicas paracardíaca y retroesternal que suelen confundirse con otras afecciones. Objetivo: Notificar el caso de un paciente adulto diagnosticado con hernia de Morgagni en el Hospital General Docente Dr. Antonio Luaces Iraolade Ciego de Ávila. Caso clínico: Se presenta el caso de un varón de 28 años de edad con antecedentes de contusión torácica severa, que presentó dolor abdominal, dispepsias, dolor recurrente en región baja posterior del hemitórax derecho, falta de aire ligera y tos seca. Con la aplicación de un correcto método clínico se excluyeron otros posibles diagnósticos planteados previamente y se concluyó con estudios imagenológicos como una hernia de Morgagni. Se realizó tratamiento quirúrgico mediante laparotomía convencional. La evolución fue favorable, sin complicaciones posoperatorias y con egreso hospitalario precoz. Conclusiones: Se notificó el caso de un paciente diagnosticado con hernia de Morgagni que constituyó un tipo raro de hernia en adultos, cuyo diagnóstico se debe tener en cuenta en pacientes con manifestaciones clínicas digestivas o respiratorias, que presentan radiopacidad paracardíaca en la radiografía de tórax. Es necesario realizar tratamiento quirúrgico oportuno para prevenir posibles complicaciones(AU)

Introduction: Morgagni's hernia is a rare congenital anomaly, responsible for 3percent of diaphragmatic hernias, which causes paracardiac and retrosternal radiological opacities that are often confused with other conditions. Objective: To report the case of an adult patient diagnosed with Morgagni's hernia at Dr. Antonio Luaces Iraola General Teaching Hospital from Ciego de Avila. Clinical casereport: We report the case of a 28-year-old man with history of severe chest contusion, who showed abdominal pain, dyspepsia, recurrent pain in the lower posterior region of the right hemithorax, slight shortness of breath, and dry cough. With the use of the correct clinical method, other possible diagnoses were excluded from what was previously raised. Imaging studies concluded to be a Morgagni hernia. Surgical treatment was performed by conventional laparotomy. The evolution was favorable, without postoperative complications and with early hospital discharge. Conclusions: The case of a patient diagnosed with Morgagni's hernia was reported. It constituted a rare type of hernia in adults. Its diagnosis should be taken into account in patients with digestive or respiratory clinical manifestations, showing paracardiac radiopacity on chest X-ray. Timely surgical treatment is necessary to prevent possible complications(AU)

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La hernia diafragmática congénita es un defecto en el diafragma que lleva a la herniación del contenido abdominal a la cavidad torácica durante el período intrauterino. La morbimortalidad está determinada por la asociación con otras malformaciones, el grado de hipoplasia pulmonar y la presencia de hipertensión pulmonar secundaria. Presenta una incidencia estimada de 1 cada 2.500-3.000 recién nacidos vivos, constituyendo en un 60% una malformación aislada. Es una patología evolutiva que puede ser diagnosticada a partir de la semana 20-24, la ubicación más habitual es la posterolateral izquierda. Se trata de una patología que requiere ingreso a cuidados intensivos al nacimiento y luego de lograda la estabilización del paciente es de sanción quirúrgica. Los objetivos de este trabajo son conocer las características generales de la patología para sistematizar el manejo logrando así un óptimo asesoramiento de los padres a nivel prenatal y seguimiento postnatal del recién nacido.

Congenital diaphragmatic hernia is a defect in the diaphragm that leads to herniation of theabdominal contents of the thoracic cavity during the intrauterine period. Morbidity and mortality are determined by the association with other malformations, the degree ofpulmonary hypoplasia and the presence of secondary pulmonary hypertension.It has an estimated incidence of 1 every 2,500-3,000 live newborns, and in 60% of the cases it is an isolated malformation. It is an evolutionary pathology that can be diagnosed from week 20-24; it is most commonly located in the left posterolateral. It is a pathology that requires intensive care at birth and after delivery and once the patient has been stabilized, surgical action is required. The objectives of this work are to understand the general characteristics of the pathology in order to refine its manipulation and achieve optimal counseling for parents at the newborn's prenatal and postnatal stages.

A hérnia diafragmática congênita é um defeito no diafragma que leva à herniação doconteúdo abdominal para a cavidade torácica durante o período intrauterino. A morbimortalidade é determinada pela associação com outras malformações, pelo grau de hipoplasia pulmonar e pela presença de hipertensão pulmonar secundária. Apresenta uma incidência estimada de 1 a cada 2.500-3.000 nascidos vivos, constituindo-se em 60% uma malformação isolada. É uma patologia evolutiva que pode ser diagnosticada a partir da semana 20-24 e a localização mais comum é o póstero-lateral esquerdo. É uma patologia que requer internação em terapia intensiva ao nascimento e após o parto. Uma vez que o paciente for estabilizado, é necessária ação cirúrgica. Os objetivos deste paper são conhecer as características gerais da patologia para melhorar o seu manejo, obtendo assim um aconselhamento ideal para os pais no nível pré-natal e no acompanhamento do crescimento pós-natal do recém-nascido.

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Late-presenting or "Adult-Onset" Diaphragmatic Hernia is uncommon, especially in individuals with no history of trauma. The non-traumatic diaphragmatic hernia may be a Congenital Diaphragmatic Hernia [CDH] lately manifested as a sequela to an iatrogenic intervention or prolonged infections. We aim to explore the genetic correlations in "adult-onset" CDH, with an insight into the indirect contribution of the COVID-19 pandemic towards the fatal outcome.In this report, we present a case of an adult female who died from the complications of an undiagnosed adult-onset diaphragmatic hernia, deemed completely preventable, if not for the global COVID-19 pandemic. There was no prior history of physical trauma or medical history of any relevance.Early diagnosis and rapid surgical intervention remain the keystone management for successfully treating individuals affected by this entity. The decedent in question presented with symptoms demanding hospital stay for investigations that would have aided in timely diagnosis and prevented death. However, the excessive fear of COVID-19 prevented the patient from undergoing hospitalization and follow-up, delaying the diagnosis and leading to death.

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Abstract Objective Antenatal recognition of severe cases of congenital diaphragmatic hernia (CDH) by ultrasound (US) and magnetic resonance imaging (MRI) may aid decisions regarding the indication of fetal endoscopic tracheal occlusion. Methods An integrative review was performed. Searches in MEDLINE and EMBASE used terms related to CDH, diagnosis, MRI, and US. The inclusion criteria were reviews and guidelines approaching US and MRI markers of severity of CDH published in English in the past 10 years. Results The search retrieved 712 studies, out of which 17 publications were included. The US parameters were stomach and liver positions, lung-to-head ratio (LHR), observed/expected LHR (o/e LHR), and quantitative lung index. The MRI parameters were total fetal lung volume (TFLV), observed/expected TFLV, relative fetal or percent predicted lung volumes, liver intrathoracic ratio, and modified McGoon index. None of the parameters was reported to be superior to the others. Conclusion The most mentioned parameters were o/e LHR, LHR, liver position, o/e TFLV, and TFLV.

Resumo Objetivo A identificação pré-natal de casos graves de hérnia diafragmática congênita (HDC) por ultrassonografia (US) e ressonância magnética (RM) pode ajudar a decidir sobre a indicação de oclusão traqueal endoscópica fetal. Métodos Uma revisão integrativa foi realizada pesquisando nas bases MEDLINE e EMBASE comtermos relativos a HDC, diagnóstico, RM, e US. Os critérios de inclusão foram revisões e diretrizes abordando marcadores ultrassonográficos e de ressonância para a gravidade de HDC publicados em inglês nos últimos 10 anos. Resultados Foram obtidos 712 estudos, dos quais 17 foram incluídos. Os parâmetros de US foram posições do estômago e do fígado, relação pulmão-cabeça (LHR, na sigla em inglês), LHR observada/esperada (o/e LHR), e índice pulmonar quantitativo (QLI, na sigla em inglês). Os parâmetros de RM foram volume pulmonar fetal total (TFLV, na sigla em inglês), o/e TFLV, volume pulmonar fetal relativo e porcentagem predita, razão do fígado intratorácico (LiTR, na sigla em inglês) e índice de McGoon modificado. Nenhum dos parâmetros foi mencionado como superior aos demais. Conclusão Os parâmetros mais citados foram o/e LHR, LHR, posição do fígado, o/e TFLV, e TFLV.

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Introducción: La hernia lumbar es un tipo muy infrecuente de hernia de la pared abdominal con un reducido número de casos publicados. Puede producirse a través de dos triángulos anatómicos: uno superior o triángulo de Grynfelt-Lesshaft y uno inferior o triángulo de Petit. Presentación del caso: Presentamos el caso de una mujer de 64 años con una tumoración blanda y reductible en la región posterolateral izquierda de la pared abdominal. La tomografía computarizada confirmó la existencia de una hernia lumbar a través del triángulo superior o Grynfelt-Lesshaft. Fue intervenida mediante un abordaje laparoscópico transabdominal en el que tras la reducción del contenido herniario (tejido graso) se colocó una malla de doble capa en posición intraperitoneal. Fue dada de alta a las 24 horas de la intervención sin observarse complicaciones inmediatas. Discusión: Se trata de un tipo muy infrecuente de hernia de la pared por lo que su diagnóstico requiere una alta sospecha clínica y a menudo una confirmación radiológica mediante tomografía computarizada. Conclusiones: La reparación de la hernia lumbar está indicada para evitar posibles complicaciones y puede realizarse tanto por vía abierta como laparoscópica, debiendo incluir la colocación de material prótesico en forma de malla para reducir el riesgo de recidiva.

Introduction: Lumbar hernia is a very rare type of abdominal wall hernia with a small number of published cases. It can occur through two anatomical triangles: an upper one or Grynfelt-Lesshaft triangle and a lower one or Petit triangle. Case presentation: We present the case of a 64-year-old woman with a soft and reducible tumor in the left posterolateral region of the abdominal wall. Computerized tomography confirmed the existence of a lumbar hernia through the superior triangle or Grynfelt-Lesshaft triangle. Patient was operated through a transabdominal laparoscopic approach in which after reduction of hernial content (fatty tissue) a double-layer mesh was placed in an intraperitoneal position. She was discharged 24 hours after the intervention and no immediate complications were observed. Discussion: Lumbar hernia is a very rare type of abdominal wall hernia and its diagnosis requires high clinical suspicion and often radiological confirmation by computerized tomography. Conclusion: Lumbar hernia repair is indicated to avoid possible complications and can be performed with an open or laparoscopic approach. Repair should include a mesh to reduce the risk of recurrence.

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Abstract Objective To compare the perinatal outcomes of fetuses with isolated congenital diaphragmatic hernia after fetal endoscopic tracheal occlusion (FETO) and antenatal expectant management. Data sources In this rapid review, searches were conducted in the MEDLINE, PMC, EMBASE and CENTRAL databases between August 10th and September 4th, 2020. Randomized controlled trials (RCTs), quasi-RCTs or cluster-RCTs published in English in the past ten years were included. Study selection We retrieved 203 publications; 180 studies were screened by abstract. Full-text selection was performed for eight studies, and 1 single center RCTmet the inclusion criteria (41 randomized women; 20 in the FETO group, and 21 in the control group). Data collection Data collection was performed independently, by both authors, in two steps (title and abstract and full-text reading). Data synthesis There were no cases of maternal mortality. The mean gestational age at delivery was of 35.6±2.4 weeks in the intervention group, and of 37.4±1.9 weeks among the controls (p<0.01). Survival until 6 months of age was reported in 50% of the intervention group, and in 5.8% of the controls (p<0.01; relative risk: 10.5; 95% confidence interval [95%CI]: 1.5-74.7). Severe postnatal pulmonary hypertension was found in 50% of the infants in the intervention group, and in 85.7% of controls (p=0.02; relative risk: 0.6; 95%CI: 0.4-0.9). An analysis of the study indicated some concerns of risk of bias. The quality of evidence was considered moderate to low. Conclusion Current evidence is limited but suggests that FETO may be an effective intervention to improve perinatal outcomes.

Resumo Objetivo Comparar os resultados perinatais de fetos com hérnia diafragmática congênita após oclusão traqueal endoscópica fetal (OTEF) e conduta expectante pré-natal. Fontes dos dados Nesta revisão rápida, pesquisas foram conduzidas nas bases de dados MEDLINE, PMC, EMBASE e CENTRAL entre 10 de agosto de 2020 e 4 de setembro de 2020. Ensaios clínicos randomizados (ECRs), quase-ECRs e ECRs em cluster publicados em inglês nos últimos dez anos foram incluídos. Seleção dos estudos Foram recuperadas 203 publicações; 180 destas foram triadas pelo resumo. Fez-se a leitura do texto completo de 8 estudos, e 1 ECR cumpriu os critérios de inclusão (41 mulheres aleatorizadas; 20 no grupo OTEF e 21 no grupo de controle). Coleta de dados A coleta de dados realizada independentemente pelos dois autores, em duas etapas (título e resumo, e leitura do texto completo). Síntese dos dados Não houve casos de mortematerna. A idade gestacionalmédia no parto foi de 35,6±2,4 semanas no grupo de intervenção, e de 37,4±1,9 semanas entre os controles (p<0,01). A sobrevida até 6 meses de idade foi relatada em 50% do grupo de intervenção, e em 5,8% dos controles (p<0,01; risco relativo: 10,5; intervalo de confiança de 95% [IC95%]: 1,5-74,7). Hipertensão pulmonar grave ocorreu em 50% dos lactentes do grupo de intervenção, e em 85,7% dos controles (p = 0.02; risco relativo: 0,6; IC95%: 0,4-0,9). Uma análise do estudo indicou algumas preocupações quanto ao risco de viés. A qualidade da evidência foi considerada de moderada a baixa. Conclusão As evidências atuais são limitadas,mas sugeremque a OTEF pode ser uma intervenção eficaz para melhorar resultados perinatais.

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ABSTRACT Late-presenting or "Adult-Onset" Diaphragmatic Hernia is uncommon, especially in individuals with no history of trauma. The non-traumatic diaphragmatic hernia may be a Congenital Diaphragmatic Hernia [CDH] lately manifested as a sequela to an iatrogenic intervention or prolonged infections. We aim to explore the genetic correlations in "adult-onset" CDH, with an insight into the indirect contribution of the COVID-19 pandemic towards the fatal outcome.In this report, we present a case of an adult female who died from the complications of an undiagnosed adult-onset diaphragmatic hernia, deemed completely preventable, if not for the global COVID-19 pandemic. There was no prior history of physical trauma or medical history of any relevance.Early diagnosis and rapid surgical intervention remain the keystone management for successfully treating individuals affected by this entity. The decedent in question presented with symptoms demanding hospital stay for investigations that would have aided in timely diagnosis and prevented death. However, the excessive fear of COVID-19 prevented the patient from undergoing hospitalization and follow-up, delaying the diagnosis and leading to death.

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Las guías de profilaxis antibiótica alrededor del mundo señalan que la selección del antibiótico debe basarse en los microorganismos según el tipo y sitio de operación. Objetivo: Determinar la aplicación de las recomendaciones de las guías nacionales de profilaxis antibiótica perioperatoria y comparar con el protocolo de uso en cirugías electivas tipo hernias en el Departamento de Cirugía General en el "Hospital Militar Universitario Dr. Carlos Arvelo" en el período marzo 2019 - marzo 2020. Metodología: Tipo de investigación no experimental longitudinal bajo el modelo de estudio documental con enfoque descriptivo y cuantitativo. Resultados: Muestra de 73 pacientes, de los cuales un 64,98 % no tuvo una selección del antibiótico recomendado, el tiempo de colocación del antibiótico no estuvo adherido en 69,89 %, el intervalo de dosis no fue adherido con un 84,93 % y la vía de administración fue la correcta con 100 %. Se evidenciaron infección de sitio quirúrgico en 11 pacientes en su mayoría no adheridos a la guía de la SVI. Conclusión: La evaluación del consenso de la SVI fue baja. La profilaxis antibiótica se ha convertido en una herramienta esencial para la disminución de infecciones del sitio quirúrgico, el conocimiento de consenso y uso correcto de la norma es de suma importancia.

Antibiotic prophylaxis guidelines around the world indicate that antibiotic selection should be based on microorganisms according to the type and site of operation. Objective: To determine the application of the recommendations of the national guidelines for perioperative antibiotic prophylaxis and to compare with the protocol for use in elective hernia-type surgeries in the Department of General Surgery at the "Hospital Military Universitario Dr. Carlos Arvelo" in the period March 2019 - March 2020. Methodology: Type of longitudinal non-experimental research under the documentary study model with a descriptive and quantitative approach. Results: Sample of 73 patients, of which 64.98 % did not have a recommended antibiotic selection, the antibiotic placement time was not adhered in 69.89 %, the dose interval was not adhered with 84.93 % and the route of administration was correct with 100 %. Surgical site infection was evidenced in 11 patients, most of who did not adhere to the IVS guideline. Conclusion: The consensus assessment of the SVI was low. Antibiotic prophylaxis has become an essential tool for reducing surgical site infections, knowledge of consensus and correct use of the standard is of utmost importance

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Introducción: Las clasificaciones de las hernias de la pared abdominal nos permiten agruparlas homogéneamente y comparar así resultados de diferentes estudios. Numerosas han sido descritas con el uso de diversas variables, pero ninguna logra cubrir todas las expectativas para lo cual fueron creadas. Objetivo: Presentar nuestra modificación a la clasificación original de Lloyd Milton Nyhus al añadir la variable reductibilidad para la estratificación de las hernias inguinocrurales. Métodos: Se realizó un trabajo descriptivo y prospectivo de 449 pacientes con hernia de la región inguinocrural atendidos en el Hospital Universitario "Dr. Juan Bruno Zayas Alfonso", de Santiago de Cuba, en el periodo comprendido de enero de 2018 a diciembre de 2019. Los datos fueron extraídos del Registro Electrónico de Hernias creado en el procesador estadístico Epi info versión 3.5.4 y presentados en tablas y porcientos. Resultados: Se presentó la nueva nomenclatura para identificar los diferentes subgrupos de hernias y se obtuvo que el 85,3 por ciento presentaban hernias reductibles, el 1,5 por ciento incarceradas, el 9,3 por ciento atascadas y el 1,7 por ciento estranguladas. Con esta nueva clasificación, disponemos en nuestro Registro de Hernias, de todos los subgrupos clínicos de hernias de la región inguinocrural. Conclusiones: La nueva modificación, nos permite estratificar y comparar homogéneamente por subgrupos a los pacientes, es sencilla de usar y de gran valor asistencial, docente y científico(AU)

Introduction: Classifications of abdominal wall hernias allow us to group them homogeneously and thus compare the results of different studies. Many have been described with the use of several variables, but none can meet all the expectations for which they were created. Objective: To present our modification to the original Lloyd Milton Nyhus's classification by adding the variable reducibility for the stratification of inguinocrural hernias. Methods: A descriptive and prospective study was carried out, in the period from January 2018 to December 2019, in 449 patients with hernia of the inguinocrural region treated at Dr. Juan Bruno Zayas Alfonso University Hospital of Santiago de Cuba. The data were obtained from an Electronic Registry of Hernias created in the statistical processor Epi info (version 3.5.4), as well as presented then in tables and percentages. Results: The new nomenclature to identify the different subgroups of hernias was presented. It was obtained that 85.3 percent had reducible hernias, 1.5 percent had incarcerated hernias, 9.3 percent had stuck hernias and 1.7 percent had strangulated hernias. With this new classification, we have, in our Hernia Registry, all the clinical subgroups of hernias in the inguinocrural region. Conclusions: The new modification allows us to stratify and compare patients homogeneously by subgroups; it is easy to use and of great care-related, teaching and scientific value(AU)

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Abdominal wall hernias are common and can present as technical challenges to surgeons. When large, hernias diminish quality of life. Various classifications of incisional hernias have been proposed; however, there are many terms, sometimes causing confusion (1). Radiologists must know the normal anatomy of the abdominal wall, the CT protocol, and what if any maneuvers can be performed to better identify an abdominal wall defect. The description of the radiological approach for primary and incisional wall hernias is based on the 2007 European Hernia Society classification, with particular emphasis on presurgical and postsurgical imaging findings. This classification provides a simple and reproducible method to describe hernias to offer proper surgical management. We highlight this classification so that radiologists and surgeons can have a unified language.

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INTRODUCTION: Morgagni hernia is a relatively uncommon anterior diaphragmatic defect, particularly in adults. We describe the case of a patient who presented with an incarcerated Morgagni hernia and was repaired by an Acute Care Surgery service. DESCRIPTION: The patient is a 29 year old male who presented with a picture of bowel obstruction. CT scan revealed a Morgagni hernia with incarcerated stomach and colon. He was taken to the operating room for robotic repair. The hernia was reduced. The defect measured 10 x 7cm, a composite mesh was interposed, and sutured in place. The patient was discharged on postoperative day 5 and has done well at 1 year follow up. CONCLUSION: Robotic surgery offer the chance to apply minimally invasive techniques for urgent surgical care. This is the first reported case of an incarcerated Morgagni hernia repaired urgently using robotic techniques, and performed by acute care surgeons.

Introducción: La hernia de Morgagni es un defecto diafragmático, infrecuente en adultos. Aquí describimos el caso de un paciente presentándose con una hernia de Morgagni atascada, reparada bajo el servicio de cirugía de urgencias. Descripción: Varón de 29 años quien se presentó con un cuadro de oclusión gastrointestinal. La tomografía demostró una hernia de Morgagni atascada conteniendo estómago y colon. Fue llevado al quirófano para reparación asistida por robot. Una vez reducida la hernia, el defecto midió 10 x 7 cm, se interpuso una malla compuesta. El paciente fue dado de alta al quinto día post-quirúrgico, y al año de seguimiento, continua sin inconvenientes. Conclusión: La cirugía robótica ofrece la ventaja de aplicar técnicas mini-invasivas en el tratamiento de urgencias quirúrgicas. Este es el primer caso reportado de una hernia de Morgagni atascada reparada de manera urgente utilizando tecnología robótica, por cirujanos de urgencias.

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Abstract Objective: To describe and analyze the prognosis of children during the first year of life with a diagnosis of congenital diaphragmatic hernia admitted between the years 2005 and 2015 in the Neonatal Intensive Care Unit. Method: In a retrospective cohort, 129 children with a diagnosis of congenital diaphragmatic hernia were studied. The prognostic factors were analyzed, whereupon prenatal, delivery, and postnatal exposure variables were associated with death during the first year of life. The odds ratio and the confidence interval (95% CI) were calculated for all the studied variables, using the chi-squared test and Student's t-test. Results: The study included 129 children hospitalized from January of 2005 to December of 2015. Seventy-nine (61%) patients died, 50 survived, and 33 had other associated malformations. Among the prognostic factors, the following were significant and increased the chance of death: polyhydramnios (p = 0.001), gestational age of the earliest diagnosis (p = 0.004), associated congenital abnormalities (OR: 3.013, p = 0.022), pO2 of the first gasometry (p = 0.000), pCO2 of the first gasometry (p = 0.000), presence of pulmonary hypoplasia (OR: 3.074, p = 0.000), use of preoperative vasoactive drugs (OR: 2.881, p = 0.000), and use of nitric oxide (OR: 1.739, p = 0.000). The presence of only intestines in the hernia content was a protective factor (OR: 0.615, p = 0.001). Conclusion: The mortality in the first year of life in patients with congenital diaphragmatic hernia in this study was 61% in the years 2005-2015. Among the prognostic factors that demonstrated a significant effect, pulmonary hypoplasia had the greatest impact.

Resumo Objetivo: Descrever e analisar o prognóstico de crianças ao longo do primeiro ano de vida com diagnóstico de hérnia diafragmática congênita admitidas entre 2005 e 2015 na Unidade de Terapia Intensiva Neonatal. Método: Em uma coorte retrospectiva estudamos 129 crianças com diagnóstico de hérnia diafragmática congênita. Foram analisados os fatores prognósticos onde as variáveis de exposição do pré-natal, parto e pós-natais foram associadas ao óbito no primeiro ano de vida. Calculamos a odds ratio (OR) e o intervalo de confiança (IC95%) para todas as variáveis estudadas, sendo utilizados os testes de qui-quadrado e o teste T Student. Resultados: Foram incluídos no estudo 129 crianças, internados de janeiro/2005 a dezembro/2015. Foram a óbito 79 (61%) pacientes, 50 sobreviveram e 33 tinham outras malformações associadas. Entre os fatores prognósticos foram significativos e aumentaram a chance de óbito a polidrâmnia (p = 0,001), idade gestacional do diagnóstico mais precoce (p = 0,004), anomalias congênitas associadas (OR: 3,013, p = 0,022), pO2 da primeira gasometria (p = 0,000), pCO2 da primeira gasometria (p = 0,000), presença de hipoplasia pulmonar (OR: 3,074, p = 0,000), uso de drogas vasoativas pré-operatórias (OR: 2,881, p = 0,000) e o uso de oxido nítrico (OR:1,739, p = 0,000). A presença de apenas intestinos no conteúdo da hérnia foi um fator protetor (OR: 0,615, p = 0,001). Conclusão: A mortalidade no primeiro ano de vida em portadores de hérnia diafragmática congênita, neste estudo, foi de 61% de 2005 a 2015. Entre os fatores prognósticos que demonstraram um efeito significativo, a hipoplasia pulmonar foi o de maior impacto.

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RESUMO O objetivo deste estudo é analisar o perfil clínico-hospitalar de neonatos com o diagnóstico de hérnia diafragmática congênita (HDC), no período de 2008 a 2018 em um hospital de referência materno-infantil. Trata-se de um estudo transversal e analítico descritivo, que incluiu principalmente dados de prontuários com os códigos Q79.0, Q79.1, J986, K44 e K44.0 da Classificação Internacional de Doenças (CID-10). Os critérios de exclusão de prontuários foram o diagnóstico de outros tipos de hérnia diafragmática, sem o aspecto congênito; a internação em unidades que não fossem UTI Neonatal; e a idade no ato de internação igual ou superior a 29 dias. Analisou-se um total de 25.602 prontuários, dos quais 14 corresponderam a HDC. O acometimento por gênero foi de 71,43% masculino (10 casos) e 28,57% feminino (4), com 21,34% das localizações de HDC tipo Bochdalek à direita (3) e 78,57% à esquerda (11). Todos os neonatos deste estudo passaram por ventilação mecânica invasiva (VMI) 9,21 ± 5,55 dias. A cirurgia foi indicada em 11 casos (78,57%), com vias de acesso por toracotomia em 4 (36,36%) e por laparotomia subcostal em 7 (63,64%), todos com uso de dreno torácico homolateral ao hemitórax. O tempo total de internação foi de 19,42 ± 15,36 dias. Observou-se a evolução de alta melhorada em oito pacientes (57,14%) e o óbito de seis (42,86%), com idade de 6,19 ± 4,79 dias, sem referência de acompanhamento do desenvolvimento neuropsicomotor posteriormente. Ocorreram baixas incidências de casos por ano, e o gênero de acometimento, as malformações associadas e o tempo de VMI foram semelhantes a outras populações no mundo.

RESUMEN El objetivo de este estudio es analizar el perfil clínico-hospitalario de neonatos diagnosticados con hernia diafragmática congénita (HDC) en el período de 2008 a 2018 en un hospital de referencia materno-infantil. Este es un estudio transversal, analítico-descriptivo, realizado con base en datos de historias clínicas con los códigos Q79.0, Q79.1, J986, K44 y K44.0 de la Clasificación Internacional de Enfermedades (CIE-10). Los criterios de exclusión de las historias clínicas fueron el diagnóstico de otros tipos de hernia diafragmática sin el aspecto congénito; hospitalización en unidades que no sean UCI neonatales; y edad de ingreso igual o mayor a 29 días. Se analizaron un total de 25.602 registros, de los cuales 14 correspondían a HDC. Entre el género afectado, el 71,43% fue el género masculino (10 casos) y el 28,57% el femenino (4), con un 21,34% de las ubicaciones de la HDC de tipo Bochdalek a la derecha (3) y un 78,57% a la izquierda (11). Todos los recién nacidos en este estudio estuvieron bajo ventilación mecánica invasiva (VMI) por 9,21±5,55 días. La cirugía estuvo indicada para 11 casos (78,57%), con vías de acceso por toracotomía para 4 (36,36%) y laparotomía subcostal para 7 (63,64%), todos con sonda torácica homolateral al hemitórax. La estancia hospitalaria total fue de 19,42±15,36 días. Se observó una mejor evolución del alta en ocho pacientes (57,14%) y muerte de seis (42,86%) con 6,19±4,79 días de edad, sin referencia de seguimiento del desarrollo neuropsicomotor posteriormente. Hubo baja incidencia de casos por año; y el género que acomete, las malformaciones asociadas y el tiempo de VMI fueron similares a otros estudios de la literatura.

ABSTRACT The aim of this study is to analyze the clinical and hospital profile of newborns diagnosed with Congenital Diaphragmatic Hernia (CDH) from 2008 to 2018 in a maternal and child reference hospital. It is a cross-sectional and descriptive analytical study, which mainly included data from medical records with the codes Q79.0, Q79.1, J98.6, K44 and K44.0 of the International Classification of Diseases (ICD-10). The exclusion criteria of medical records were the diagnosis of other types of diaphragmatic hernia, without the congenital aspect; hospitalization in units that were not Neonatal ICUs; and the age at admission equal to or greater than 29 days. A total of 25,602 records were analyzed, of which 14 corresponded to CDH. The gender involvement was 71.43% male (10 cases) and 28.57% female (4), with 21.34% of Bochdalek-type CDH located on the right (3) and 78.57% on the left (11). All newborns in this study underwent invasive mechanical ventilation (IMV) 9.21 ± 5.55 days. Surgery was indicated in 11 cases (78.57%), with thoracotomy access routes in four (36.36%) and subcostal laparotomy in seven (63.64%), all using a chest tube homolateral to the hemithorax. The total hospital stay was 19.42 ± 15.36 days. There was an improved discharge evolution in eight patients (57.14%) and the death of six (42.86%), with ages around 6.19 ± 4.79 days, with no follow-up of neuropsychomotor development afterwards. There were low incidences of cases per year, the gender involvement, the associated malformations and the IMV time were similar to other populations in the world.

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Resumen Introducción: Las hernias son patologías muy frecuentes en un Servicio de Cirugía General (SCG); su tratamiento y costes son muy diferentes, dependiendo del cirujano, si hay hospitalización (CH) o cirugía mayor ambulatoria (CMA). Objetivo principal es el estudio de costes-resultados y de coste-efectividad de las hernias de pared abdominal (no pericolostómicas) realizadas por el SCG. Materiales y Método: Estudio descriptivo, longitudinal, observacional y retrospectivo. Intervenidas 370 hernias de pared abdominal, del 1 de octubre de 2015 al 30 de septiembre de 2016; seguimiento postquirúrgico hasta el 30 de octubre 2016 (1 a 12 meses). Resultados: 79,4% varones, media 59,95 años, 51,90% ASA II, 55,8% anestesia local, 59,72% hernias inguinales, 36,94% hernias inguinales unilaterales indirectas, 55,17 minutos por intervención, 54,44% por CMA, 4,77 días de estancia media en ingresados. Complicaciones perioperatorias 2,3%, tempranas 4,8% (5 reintervenciones) y tardías 12,8% (3 reintervenciones por recidiva). Altas 95,41%, tiempo medio 6,59 semanas. Coste de material de 109,87 € (hernia inguinal simple) hasta 370,41 € (eventración). Coste mediana quirófano 338,80 €. Coste/día CMA 807,30 € y con ingreso 1056,03 €. Mediana coste de hernia inguinal simple 422,69 € y de eventración 709,89 €. Mediana coste por complicación de hernia inguinal 1405,81 € y de eventración 8350,88 €. Mediana coste por proceso con CMA 1213,98 € y con ingreso 3689,80 €. Conclusión: Intervenciones de hernia inguinal unilateral simple, crural y umbilical, con técnica libre de tensión, material protésico, sin drenaje, CMA, anestesia local (con/sin sedación) y sin complicaciones resultan las más coste-efectivas (mejor relación coste-benefcio y coste-efectividad).

Introduction: Hernias are very frequent pathologies in a General Surgery Service (GSS); its treatment and costs are very different, depending on the surgeon, if there is admission (SH) or major outpatient surgery (MOS). A) Main objective. Study costs of (non-pericolostomic) abdominal wall hernia surgical procedures in the GSC (cost-outcome ratio and the cost-efectiveness). Materials and Method: Descriptive, longitudinal, observational and retrospective study. Abdominal wall hernias treated between 1st October, 2015 and 30th September, 2016; after surgery follow up until 30th October, 2016 (1 to 12 months). In total 370 hernia surgeries were performed. Results: 79.4% of males, mean 59.95 years, 51.90% of ASA II, 55.8% local anesthesia, 59.72% inguinal hernias, 36.94% indirect unilateral inguinal hernias, 55.17 minutes for surgeon, 54.44% for MOS, 4.77 days of average stay in admitted patients. Perioperative complications 2.3%, early 4.8% (with 5 reoperations) and late 12.8% (3 reinterventions due to relapse). 95.41% discharge, mean time 6.59 weeks. Material costs vary from €109.87 (simple inguinal hernia) to €370.41 (eventrations). Median surgery room cost €338.80. Cost/day MOS €807.30 and with income €1056.03. Median cost of simple inguinal hernia €422.69 and eventration €709.89. Median cost due to inguinal hernia complication €1405.81 and eventration €8350.88. Median cost per process MOS € 1213.98 and that of SH €3689.80. Conclusion: The interventions of simple unilateral inguinal hernia, crural and umbilical, using a tension-free technique, prosthetic material, without drainage, MOS, local anesthesia (with/without sedation) and without complications are the most cost-efective (better cost-beneft and cost-efectiveness ratio).

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OBJECTIVE: To describe and analyze the prognosis of children during the first year of life with a diagnosis of congenital diaphragmatic hernia admitted between the years 2005 and 2015 in the Neonatal Intensive Care Unit. METHOD: In a retrospective cohort, 129 children with a diagnosis of congenital diaphragmatic hernia were studied. The prognostic factors were analyzed, whereupon prenatal, delivery, and postnatal exposure variables were associated with death during the first year of life. The odds ratio and the confidence interval (95% CI) were calculated for all the studied variables, using the chi-squared test and Student's t-test. RESULTS: The study included 129 children hospitalized from January of 2005 to December of 2015. Seventy-nine (61%) patients died, 50 survived, and 33 had other associated malformations. Among the prognostic factors, the following were significant and increased the chance of death: polyhydramnios (p=0.001), gestational age of the earliest diagnosis (p=0.004), associated congenital abnormalities (OR: 3.013, p=0.022), pO2 of the first gasometry (p=0.000), pCO2 of the first gasometry (p=0.000), presence of pulmonary hypoplasia (OR: 3.074, p=0.000), use of preoperative vasoactive drugs (OR: 2.881, p=0.000), and use of nitric oxide (OR: 1.739, p=0.000). The presence of only intestines in the hernia content was a protective factor (OR: 0.615, p=0.001). CONCLUSION: The mortality in the first year of life in patients with congenital diaphragmatic hernia in this study was 61% in the years 2005-2015. Among the prognostic factors that demonstrated a significant effect, pulmonary hypoplasia had the greatest impact.

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Abstract Purpose: To evaluate the vascular ventilatory response in different stages of lung development and to compare them to the neonates with congenital diaphragmatic hernia (CDH) in a rabbit model. Methods: New Zealand rabbits were divided into 8 groups (n=5): E25, E27, E30, and CDH. All groups were ventilated on a FlexiVent (Scireq, Montreal, QC, Canada), compounding the other 4 groups. The CDH surgery was performed at E25 and the harvest at E30. Dynamic compliance (CRS), dynamic elastance (ERS) and dynamic resistance (RRS) were measured every 4 min/24 min. Median wall thickness (MWT) and airspace were measured. ANOVA Bonferroni tests were used to perform statistical analysis. Significance was considered when p<0.05. Results: CRS was higher in E30 compared to all other groups (p<0.05). CRS and RRS of CDH and E27 were similar and were higher in E25 (p<0.05). MWT was decreased according to the gestational age, was increased in E27V and E30V (p<0.05) and decreased in CDHV (p<0.05), airspace was decreased in E25 and increased in all ventilated groups (p<0.05). Conclusions: The ventilation response of congenital diaphragmatic hernia is like the pseudoglandular stage of the lung development. These findings add information about the physiology of pulmonary ventilation in CDH.

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Purpose: To evaluate the vascular ventilatory response in different stages of lung development and to compare them to the neonates with congenital diaphragmatic hernia (CDH) in a rabbit model. Methods: New Zealand rabbits were divided into 8 groups (n=5): E25, E27, E30, and CDH. All groups were ventilated on a FlexiVent (Scireq, Montreal, QC, Canada), compounding the other 4 groups. The CDH surgery was performed at E25 and the harvest at E30. Dynamic compliance (CRS), dynamic elastance (ERS) and dynamic resistance (RRS) were measured every 4 min/24 min. Median wall thickness (MWT) and airspace were measured. ANOVA Bonferroni tests were used to perform statistical analysis. Significance was considered when p 0.05. Results: CRS was higher in E30 compared to all other groups (p 0.05). CRS and RRS of CDH and E27 were similar and were higher in E25 (p 0.05). MWT was decreased according to the gestational age, was increased in E27V and E30V (p 0.05) and decreased in CDHV (p 0.05), airspace was decreased in E25 and increased in all ventilated groups (p 0.05). Conclusions: The ventilation response of congenital diaphragmatic hernia is like the pseudoglandular stage of the lung development. These findings add information about the physiology of pulmonary ventilation in CDH.(AU)

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Introducción: Las hernias perineales son excepcionales y predominan ampliamente en el sexo femenino. Se clasifican en anteriores o posteriores según su localización con respecto al músculo transverso del periné. Etiológicamente pueden ser primarias (congénitas o adquiridas), de las cuales se han descrito alrededor de 100 casos, y secundarias sobre todo a operaciones previas (resección adbominoperineal). Objetivo: Actualizar los conocimientos sobre las hernias perineales por lo infrecuente de este padecimiento. Métodos: Se realizó una revisión bibliográfica a partir de la consulta de artículos relacionados con el tema, publicados en Pubmed, Hinari, SciELO y Medline mediante el localizador de información Endnote. Se utilizaron 51 citas para la revisión, 41 de ellas de los últimos cinco años. Se incluyeron tres libros y una cita del propio autor. Conclusiones: Las hernias perineales son extremadamente raras. Existe poca experiencia reportada en la bibliografía, por lo que aún no es posible determinar la mejor forma terapéutica. Pueden abordarse por vía abdominal, perineal o combinada. Las técnicas empleadas son: cierre simple, transposición de colgajos musculares, colocación de mallas y retroflexión del útero o vejiga para cerrar el defecto. Aunque no existe suficiente experiencia, la cirugía laparoscópica se ha utilizado en algunos casos y podría ser la vía de elección en el futuro(AU)

Introduction: Perineal hernias are exceptional and predominate widely in the female sex. They are classified into anterior or posterior, based on their location with respect to the transverse muscle of the perineum. Etiologically speaking, they can be primary (congenital or acquired), of which about 100 cases have been described, and secondary above all to previous operations (abdominoperineal resection). Objective: To update the knowledge about perineal hernias, due to the infrequent nature of this condition. Methods: A literature review was carried out in the articles about the topic and published in Pubmed, Hinari, SciELO and Medline using the Endnote information locator. We used 51 citations for the review, 41 of which belonged to the last five years. Three books and a citation by the author were included. Conclusions: Perineal hernias are extremely rare. There is little experience reported in the literature, so it is not yet possible to determine the best therapeutic form. They can be treated by an abdominal or perineal approach, or combined. The techniques used are: simple closure, transposition of muscle flaps, placement of meshes, and retro-flexion of the uterus or bladder to close the defect. Although there is not enough experience, laparoscopic surgery has been used in some cases and could be the gold standard in the future(AU)

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RESUMEN El epónimo hernia De Garengeot queda reservado para describir la presencia del apéndice cecal dentro de un saco herniario crural. Es infrecuente el hallazgo del apéndice dentro del canal femoral, situación que se presenta en el 0.9 % de las hernias femorales. La presencia de apendicitis dentro del canal femoral es una rareza, representando del 0.13 a 0.8% de todos los casos de apendicitis aguda. Se presenta un caso, se describe el cuadro clínico y el tratamiento quirúrgico (AU).

ABSTRACT The eponym De Garengeot´s hernia is reserved to describe the presence of the cecal appendix inside a crural hernia sac. It is infrequent to find the appendix inside the femoral canal, location presented in 0.9 % of femoral hernias. The presence of appendicitis inside the femoral canal is a rarity representing from 0.13 to 0.8 % of all the cases of acute appendicitis. A case is presented, and the clinical characteristics and the surgical treatment are described (AU).

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