P-084 OPEN PARASTOMAL HERNIA REPAIR: STOMA RELOCATION WITH CST, MODIFIED RIVES SUBLAY MESH TECHNIQUE WITH CST OR MODIFIED SUGARBAKER INTRAPERITONEAL MESH TECHNIQUE WITH CST

Aim

To presents results of various open surgical techniques for parastomal hernia repair.

Material and Method

Between January 2014 and January 2020, 22 patients with parastomal hernias were treated by three various operative techniques: a) stoma relocation using component separation techniques (CST); b) modified Rives sublay mesh technique with CST; c) modified Sugarbaker intraperitoneal composite mesh repair with or withouth CST. Stoma relocation and CST was performed in two patients, modified Rives sublay technique and CST in 15 patients and modified Sugarbaker technique with or without CST in five patients.

Results

Hernia recurrence was developed in one of two patients treated by stoma relocation and CST and in two of 15 patients treated by modified Rives sublay mesh technique and CST. In five patients treated by modified Sugarbaker technique no complications occured. Mean follow up was 28 months.

Conclusion

Modified Rives sublay technique with CST and modified Sugarbaker technique with or withouth CST provide good results in treatment of patients with parastomal hernia.

P-088 HOW TO REPAIR A LATERAL INCISIONAL ABDOMINAL WALL HERNIA?

Aim

To present our original method for surgical treatment of patients with lateral incisional hernia (LIH)

Material and Method

Patients with LIH and simultaneous presence of a middle incisional hernia (MIH) were treated by our original technique based on the principles of anterior component separation technique and sublay technique: a) skin and subcutaneous tissue incision along the midline and MIH dissection; b) subcutaneous tissue dissection in the lateral direction to the Spiegel line or the LIH lateral edge on the side of the LIH; c) vertical incision of the external oblique muscle (EOM) lateral to the Spiegel line or the LIH; d) the rectus muscle (RM) dissection from its posterior sheath on the opposite side of the LIH; e) suturing the posterior rectus sheath on the opposite side of the LIH with RM on the side of the LIH; f) suturing of the internal oblique muscle with the lateral edge of the RM on the side of the LIH; g) onlay polypropylene mesh hernioplasty.

Results

Between January 2013 and May 2022, 44 consecutive patients with LIH+MIH underwent surgery. A median (range) LIH defect surface was 90 (20–270) cm2. During mean follow up of 14 months postoperative complications occured in seven (15,9%) patients: seroma in three, hematoma in two, mesh infection and hernia recurrence in one.

Conclusion

Our original method can be one of the good solutions for simultaneous treatment of LIH and MIH.

Sex Hormones in Men with Abdominal Aortic Aneurysm

BACKGROUND

Abdominal aortic aneurysm (AAA) primarily affects elderly men. The impact of sex on aneurysm development has been associated with an effect of sex hormones, through mechanisms that are not fully understood. This study aimed to examine the association between levels of sex hormones and the occurrence of AAA in elderly men.

METHODS

A prospective case-control study was conducted including 452, 65-year old men participating in screening for AAA, 2013-2019; 230 men with AAA and 222 men with an aortic diameter<30mm (controls). Questionnaires and blood samples were collected and stored consecutively. Serum levels of total testosterone, estradiol, progesterone, luteinizing hormone and sex hormone binding globulin were analyzed by electrochemiluminescent immunoassays. Multivariable logistic regression analysis was used to assess the association of sex hormones with AAA.

RESULTS

The median aneurysm diameter was 33mm. Men with AAA had higher estradiol and progesterone levels than controls (93pmol/L vs. 84pmol/L, p=.003 and 0.41nmol/L vs. 0.17nmol/L, p<.001). Testosterone levels were lower in men with AAA than in controls (13nmol/L vs. 14nmol/L, p=.026). AAA was associated with detectable levels of progesterone(OR 6.69, 95%CI 3.86-11.47), smoking(OR 5.26, 95%CI 3.12-8.85), coronary heart disease(OR 4.06, 95%CI 1.92-8.58) and body mass index>25(OR 2.26, 95%CI 1.34-3.82).

CONCLUSION

The observed higher levels of estradiol and progesterone in men with AAA, suggest an impact of sex hormones on aneurysm development. The association between progesterone levels and aortic diameter, stress the importance of focusing on the potential effect of this unconsidered female sex hormone on aneurysm formation.

Gabaculine does not inhibit cytokinin-stimulated biosynthesis of chlorophyll in Pinus nigra seedlings in the dark

Chlorophyll (Chl) accumulation was monitored during black pine (Pinus nigra L.) seed germination for 14 days in the light and in the dark in the presence of gabaculine (GAB) and cytokinin in order to elucidate the regulation of gymnosperm seedling greening in the dark, primarily at the level of aminolevulinic acid formation. In the light, GAB inhibited chlorophyll accumulation in a manner dependent on concentration and developmental stage, and in the dark it showed no effect. Cytokinin, 10(-5) M benzyl adenine (BA) partly overcame GAB-induced inhibition in the light, mainly during earlier developmental stages. In the seedlings grown in the dark, an equal quantity of Chl accumulated in the presence of cytokinin with and without GAB and it was approximately 20-40% higher than in the control seedlings or in the seedlings grown only in the presence of GAB. 5-Amino-levulinic acid (ALA) synthesis was equal in the light and in the dark in seedlings of the same age and seedlings treated with GAB grown in the dark. In the light, GAB inhibited ALA synthetic activity. The results indicate that ALA synthesis is not a rate-limiting step within Chl biosynthesis in pine seedlings grown in the dark.