ABSTRACT Objective To evaluate the functionality and quality of the anatomical representation of the hernia 3D training model. Methods A model was created based on subtraction data derived from computed tomography scans of the pelvic bones and lumbar spine using the Blender 3.2.2 software program. Images were modeled and reconstructed in 3D to display the male inguinal region, typically viewed using a laparoscopic approach. Polylactic acid plastic was used to print the model. Some structures were made using ethylene vinyl acetate to enable possible material replacement and model reutilization. Thirty surgeons with various training levels were invited to use the model. Transabdominal inguinal hernioplasty was performed by simulating the same steps as those of a laparoscopic surgery, and the surgeons answered a questionnaire regarding the simulation. Results Twenty-eight surgeons responded, seven of whom were experts in the treatment of abdominal wall hernias. The model was deemed easy to use, realistic, and anatomically precise, establishing it as a valuable supplement to minimally invasive surgery training. Conclusion The evaluation of this 3D model was favorable, as it accurately depicted the inguinal region anatomically, while also proving to be cost-effective for training purposes. The model could be a good option, particularly beneficial for training surgeons at the beginning of their careers. D 322 3 2 3.2. program approach reutilization simulation Twentyeight Twenty eight responded hernias realistic precise favorable costeffective cost effective purposes option careers 32 3.2 3.

Abstract Purpose: Incisional hernia (IH) is a frequent complication of median laparotomy. The use of prophylactic mesh to reduce IH incidence has gained increasing attention. We hypothesized that in an animal model, linea alba prophylactic reinforcement with a three-dimensional T-shaped polypropylene mesh results in greater abdominal wall resistance. Methods: Study was performed in 27 rabbits. After abdominal midline incision, animals were divided into three groups according to the laparotomy closure method used: (1)3D T-shaped coated mesh; (2)3D T-shaped uncoated mesh; and (3) closure without mesh. After 4 months, each animal’s abdominal wall was resected and tensiometric tests were applied. Results included IH occurrence, adhesions to the mesh, and wound complications. Results: There was no significant difference between the groups in maximum tensile strength (p=0.250) or abdominal wall elongation under maximum stress (p=0.839). One rabbit from the control group developed IH (p=1.00). Small intestine and colon adhesions occurred only in the uncoated mesh group (p<0.001) and the degree of adhesions was higher in this group compared to the coated mesh group (p<0.05). Conclusion: Use of the current 3D T-shaped prophylactic mesh model did not result in a significant difference in tensiometric measurements when compared with simple abdominal wall closure in rabbits.

OBJETIVO: Estudar a viabilidade de aponeurose heteróloga para fechar parede abdominal de coelhos, com ênfase no processo de rejeição. MÉTODOS: Este projeto foi aprovado pelo Comitê de Cuidados Animais da Faculdade de Ciências Médicas da Santa Casa de São Paulo e realizado na Unidade Técnica e Cirurgia Experimental. Quatro coelhas vermelhas trocaram aponeurose da parede abdominal com outros quatro animais machos brancos. Em dois coelhos, foi retirada e substituída a aponeurose como controle do processo cicatricial. Eles foram avaliados 1 vez por dia e sacrificados após 7 dias. Foi realizada a imunoistoquímica com CD20 e CD79. RESULTADOS: Os animais não tiveram celulite, abscesso, hematoma, deiscência da ferida ou hérnia. O local do enxerto mostrou hiperemia intensa. A análise histológica mostrou um processo inflamatório, com a presença de miofibroblastos em amadurecimento e colágeno, que variou de incipiente a moderado. O número de vasos estava reduzido e as células inflamatórias foram, em sua maioria, células plasmáticas e macrófagos. Não havia sinais morfológicos da rejeição aguda com a agressão do endotélio vascular. O músculo adjacente mostrou sinais de degeneração, com reação inflamatória dos núcleos e condensação do citoplasma. A análise imunoistoquímica (CD20 e CD79) mostrou que o processo inflamatório não foi mediado por linfócitos. O teste não paramétrico de Mann-Whitney mostrou que não se pode rejeitar a hipótese de igualdade (p>0,05). CONCLUSÃO: Não houve complicações pós-operatórias (fístulas, deiscência etc.) e a análise histológica revelou processo inflamatório inespecífico. A análise imunoistoquímica mostrou que o processo inflamatório não foi em razão de uma possível rejeição.

OBJECTIVE: To study the feasibility of heterologous aponeurosis to close the abdominal wall of rabbits emphasizing the rejection process. METHODS: This project was approved by the Animals Care Committee of the Faculdade de Ciências Médicas da Santa Casa de São Paulo, and it was carried out at the Experimental Surgery and Technical Unit. Four red female rabbits exchanged abdominal wall aponeurosis with other four white male animals. Two rabbits just had it removed and replaced to be the control group for the healing process. Animals were evaluated once a day, and after 7 days they were sacrificed. Immunohistochemical analysis with CD20 and CD79 was done. RESULTS: The animals did not have cellulitis, abscess, hematoma, wound dehiscence or herniation. The graft site showed intense hyperemia. The histological analysis showed an inflammatory process with maturing myofibroblasts and collagen ranging from incipient to moderate. The number of vessels was reduced and the inflammatory cells were most plasma cells and macrophages. There were no morphological signs of acute rejection with aggressive vascular endothelial damage. The adjacent muscle showed signs of degeneration with inflammatory centralization of nuclei and cytoplasmic condensation. The immunohistochemical analysis (CD20 and CD79) showed that the inflammatory process was not mediated by lymphocytes. Mann-Whitney nonparametric test showed that the hypothesis of equality (p>0.05) should not be discarded. CONCLUSION: There were no postoperative complications (fistulas, dehiscence etc.) and the histological analysis showed nonspecific inflammatory process. The immunohistochemical analysis showed that the inflammatory process was not due to a possible rejection.

OBJETIVO: Apresentar uma nova técnica de alongamento intestinal usando enxerto gástrico em suínos. MÉTODOS: Quatro porcos machos large white pesando de 15 a 20 kg. foram submetidos ao alongamento intestinal utilizando enxerto gástrico. Os porcos foram reoperados para observação do aspecto da operação, neste momento, fragmentos intestinais contendo as linhas de sutura, respeitando uma margem de 5 cm, foram removidos e enviados para análise histológica. RESULTADOS: O estômago residual estava dilatado no momento da necrópsia, recuperando aproximadamente 50% do seu tamanho original aproximadamente 15 dias após a operação de alongamento. Somente atrofia intensa da mucosa gástrica foi observada no estudo histológico de todas as amostras, sem sinais de necrose. CONCLUSÃO: O alongamento com enxerto gástrico é tecnicamente viável, comprovado pela viabilidade do enxerto. Estudos com suínos com o SIC em uma maior cohort, serão necessários para analisar a função do enxerto gástrico. No futuro, essa técnica pode ser uma ponte para o transplante intestinal.

OBJECTIVE: Novel experimental technique of intestinal lengthening with a gastric graft in swines is proposed. METHODS: Four male large white swines, weighing 15 to 20 kg and aging 50 to 60 days were underwent an intestinal lengthening using a gastric graft (Figure 1). Swines were re-operated to check the aspect of the lengthening surgery. At this time intestinal fragments of suture lines, respecting a 5 cm margin, were removed and sent to histological analysis. RESULTS: There wasn't any graft ischemia or necrosis, residual stomach was already dilated by the time of relaparotomies, regaining 50% of its original size. Only an intense atrophy of the gastric graft mucosa with no signs of necrosis at histological study (Figure 2). CONCLUSION: Lengthening using a gastric graft is technically feasible, with viability of the graft. Studies with swines with SBS in a larger co-hort will be necessary to analyze stomach graft function. In the future, this technique can be a bridge to intestinal transplantation.

OBJETIVO: Comparar a sutura e não sutura do peritônio parietal nas laparotomias medianas em ratos, quanto à formação de aderências. MÉTODOS: Foram operados 40 ratos albinos Wistar (20 machos e 20 fêmeas), adultos, pesando entre 350 e 400 gramas. Após a anestesia, foi realizada laparotomia mediana seguida de fechamento da cavidade com sutura do peritônio e sem sutura do peritônio. Após 40 dias, os animais foram re-operados para a inspeção do peritônio e a constatação da presença ou não de aderências e, em seguida, sacrificados. RESULTADOS: A análise estatística demonstrou que não houve diferença significativa entre a ocorrência ou não de aderências com sutura e não sutura do peritônio, nem com relação ao sexo dos animais operados. CONCLUSÃO: O fechamento ou não do peritônio não interfere na formação de aderências após laparotomias medianas em ratos de ambos os sexos.

PURPOSE: Compare the parietal peritoneum suture and nonsuture in midline laparotomies in rats, as for the formation of adhesions. METHODS: 40 adult albino Wistar rats (20 males and 20 females) underwent a surgery, weighing between 350 and 400 grams. After anesthesia, a midline laparotomy was performed, followed by cavity closure with and without peritoneum suture. After 40 days, the rats underwent a new surgery in order to verify the peritoneum and check if there were any adhesions, and the rats were then sacrificed. RESULTS: Statistical analysis showed there was no significant difference between the adhesions occurring or not with peritoneal suture or nonsuture, including in relation to the rats' gender. CONCLUSION: Closing the peritoneum or not does not interfere with the formation of adhesions after midline laparotomies in rats from both genders.