How I do it: using a hammock mesh in the reconstruction of inguinal ligament during a wide en-bloc resection of a groin mesenchymal tumor

PURPOSE

In case of soft tissue sarcomas (STS), an en-bloc resection with safe margins is recommended. To ensure safe removal without tumor rupture, STS of the groin area, retroperitoneal or pelvic mesenchymal tumors may require incision or resection of the inguinal ligament. Solid reconstruction is mandatory to prevent early and late postoperative femoral hernias. We present here a new technique of inguinal ligament reconstruction.

METHODS

Between September 2020 and September 2022, patients undergoing incision and/or resection of inguinal ligaments during a wide en-bloc resection of STS of the groin area in the Department of General Surgery in Strasbourg were included. All patients had an inguinal ligament reconstruction with biosynthetic slowly resorbable mesh shaped as a hammock, pre- or intraperitoneally, associated or not with loco-regional pedicled muscular flaps.

RESULTS

A total of 7 hammock mesh reconstructions were performed. One or several flaps were necessary in 57% of cases (4 patients): either for inguinal ligament reconstruction only (n = 1), for recovering of femoral vessels (n = 1), and for both ligament reconstruction and defect covering (n = 2). The major morbidity rate was 14.3% (n = 1), related to a thigh surgical site infection due to sartorius flap infarction. After a median follow-up of 17.8 months (range 7-31), there was neither early nor late occurrence of post-operative femoral hernia.

CONCLUSIONS

This is a new surgical tool for inguinal ligament reconstruction with the implementation of a biosynthetic slowly resorbable mesh shaped as a hammock, which should be compared to other techniques.

"Hammock" suspending the superior ophthalmic vein: a magnetic resonance imaging study

PURPOSE

The present study aimed to explore the hammock-like structure suspending the superior ophthalmic vein (SOV) using magnetic resonance imaging (MRI).

METHODS

Following conventional MRI examination, 93 outpatients underwent thin-sliced, coronal T2-weighted and contrast imaging of the orbit.

RESULTS

SOVs were consistently detected in all 93 patients. In 90.3% of patients, a hammock-like structure suspending the SOV was identified, which was present on both sides in 64.5% of patients. The structure was frequently located in the anterior and middle thirds of the retrobulbar orbit, suspended from the superolateral corner of the orbital walls. The medial edge of the hammocks did not reach the orbital walls; therefore, they partially encased the SOV. The morphology of the hammock was highly variable between patients, although none were tethered to the extraocular muscles. In addition, a septal band connecting the hammock and optic sheath was identified in 36.6% of patients, most frequently located in the posterior third of the retrobulbar orbit.

CONCLUSIONS

The hammock suspending the SOV and the septal band connecting the hammock and optic sheath may be structures that loosely anchor the SOV to the orbital fat to maintain a constant SOV flow, in addition to preventing excessive bends and obstructions.

Evaluation of the subscapularis split created with passive rotation during arthroscopic dynamic anterior stabilization (DAS): A cadaveric study

INTRODUCTION

The purpose of the present study was to analyze the ability to create a subscapularis split by passive rotation of the arm during dynamic anterior stabilization (DAS) and to analyze the new geometry of the long head of the biceps LHB.

HYPOTHESIS

The hypothesis was that this passive simple technique can create subscapularis split without additional dissection giving rise to new position of LHB with a new stabilization function.

MATERIAL AND METHODS

A technique of subscapularis split using the LHB was used in 12 fresh-frozen human cadaveric shoulders. A subscapularis split was created by passive rotation of the arm after the LHB is shuttled into the joint during DAS. The length of the subscapularis split, post-DAS position and length of the LHB, and the angulation of the LHB relative to bicipital groove were measured after DAS and if this new geometry can give a new dynamic effect on subscapularis muscle.

RESULTS

The mean length of the subscapular split after maximal rotation was 20.4±6.0mm (range: 10-32mm). The mean elongation of the LHB was 0.6±1.4mm (range: -1 to +3mm). The final angle of the LHB relative to the bicipital groove was 45±5 degrees (range: 41 to 55 degrees).

DISCUSSION

There is no need to create a distinct split prior to DAS. Additionally, DAS maintains the length-tension relationship of the LHB. The post-procedure medial angulation of the LHB relative to the bicipital groove may provide a lowering of the subscapularis, helping explain the anterior reinforcement of this technique.

LEVEL OF EVIDENCE

Basic science study, cadaver study.

Vestibular stimulation with Indian hammock versus music intervention in the prevention of infantile colic in term infants: An open-labelled, randomized controlled trial

BACKGROUND AND OBJECTIVES

To determine whether vestibular stimulation offered by Indian hammock and music intervention are useful in reducing the occurrence of infantile colic in term infants.

METHODS

This open-labelled randomized clinical trial was conducted among 465 term neonates who were randomly assigned to one of three groups: music group, hammock group and control group. The music intervention was given for a cumulative duration of at least 4 h a day with one stretch of at least 1 h. In the hammock group, babies were put to sleep inside the Indian hammock and were swung gently until they sleep, and were allowed to sleep in it, until they wake up. For the control group, routine pre-discharge counselling was given. All parents were provided a cry log and were instructed to record the log of cry events and duration. The primary outcome measure was occurrence of infantile colic episode as defined by ROME IV criteria. The infants were followed up from birth until the age of 3.5 months, and the cry log was collected during each follow-up visit.

RESULTS

Of the 435 term neonates who completed follow-up, 59 infants developed infantile colic (13.6%). The prevalence of infantile colic in the control group, music group and the Indian hammock group was 25.6%, 5.4% and 9.6% respectively; there was a significant reduction in the prevalence of infantile colic in the intervention groups as compared to the control group.

CONCLUSIONS

Vestibular stimulation by Indian hammock and music intervention individually reduced the occurrence of infantile colic.

Comparison and prediction of sleep quality in users of bed or hammock as sleeping device

OBJECTIVES

To compare and predict sleep quality between bed and hammock users .

DESIGN

Cross-sectional pilot study.

SETTING

Habitual hammock and bed users of southern Mexico.

PARTICIPANTS

Sixty-eight college students (53% female, mean age 21 ± 1.6 years); 33 usually sleep in bed and 35 in hammock.

INTERVENTION

Not applicable.

MEASUREMENTS

Objective sleep measures were obtained using an actigraphy device on 7 consecutive days. Questionnaires about sleep habits and sleepiness (Epworth scale) were completed. Body mass index (BMI) was obtained with a weighing machine and altimeter.

RESULTS

Subjective sleep measures between habitual hammock and bed users were not significant (P > .05). Differences were found on 2 objective sleep measures: (1) activity index, on which hammock users obtained 7.62 minutes more than bed users (M = 36.72, standard deviation [SD] = 10.86 vs. M = 44.34, SD = 13.08, P = .018) and (2) mean sleep episodes, on which hammock users had 19.67 minutes less than bed users (M = 71.52, SD = 34.37 vs. M = 51.85, SD = 24.29, P = .014). Hammock users had a higher BMI than bed users (M = 23.38, SD = 3.45 vs. M = 26.20, SD = 4.86, P = .010). Sex and BMI were included in the predictive model of linear regression (P < .05) of the sleep actigraphy parameters, the sleeping device was excluded of final model.

CONCLUSIONS

Hammock users show increased BMI, higher activity index and shorter mean sleep episodes than bed users. However, sex and BMI were stronger predictors of actigraphy parameters than bed type.

Novel Trocarless, Scarless Technique for Left Lobe Liver Retraction in Laparoscopic Upper Gastrointestinal Surgeries: Simple, Cost-effective and with Better Cosmesis

Surgeons always look for ways to reduce the size and number of ports in laparoscopy, where in today's era, we have single-incision laparoscopic surgery (SILS). While doing so, principal 'adequate exposure' should not be compromised. For upper gastrointestinal laparoscopic surgeries, we have adopted a novel technique for retraction of the left lobe of liver, which is described here. Device can be made both single sling and double sling, with help of an infant feeding tube and any routinely used suture material. Placement of device does not require any incision, special energy source, or instrument. It can help in SILS. Detailed technique is described in the text. Operative times did not change significantly. Exposure was excellent. No special instruments or energy devices are required; thus, it is cost-effective. Reducing one port for liver retraction gives better cosmetic results. No liver injury due to the device was noticed in any of the cases. This technique is simpler and cheaper and also gives reasonable cosmetic results compared to other techniques described in the literature.