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IntroductionOmentum can secrete out biological agents like different growth factors, cytokines, and antimicrobial peptides. The aim of our study was to determine the expression of antimicrobial peptides and cytokines in human omentum tissue and its response to intra-abdominal infection. MethodologyOmentum tissue was obtained from 60 patients: control (n=20) and cases (n=40). mRNA expression of antimicrobial peptides (LL-37, HBD-1, HBD-2, HNP1-3) and cytokines (TNFα, IL-8, IL-10, IL1β) was evaluated using Real-Time PCR. Protein quantification was done by Immunoblotting and ELISA. ResultsSignificantly higher expression of antimicrobial peptides (LL-37, HBD-1, HBD-2, HNP1-3) and cytokines (TNFα, IL-8, IL-10, IL1β) was observed in cases as compared to control at both the transcriptional and translational level (p<0.0001). ConclusionOmentum governs a population of antimicrobial peptides with potent immunologic functions. The expression of antimicrobial peptides and cytokines is inducible and increases with the severity of infection. Omentum is thus an immunologically active and adaptable organ but its complete regulatory mechanism is still elusive.

See video on DCR YouTube Channel at https:// youtu.be/VKTNzGwA1ykBACKGROUND : We describe a natural orifice technique for simultaneous endoluminal lateral suspension of apical vaginal wall and rectal prolapse fixation with ultrasound and fluoroscopic assistance. IMPACT OF INNOVATION:The technique is minimally invasive, can be performed under regional anaesthesia, and avoids laparotomy or use of a mesh in addition to preserving the uterus. TECHNOLOGY MATERIALS AND METHODS:This technique involves suprapubic transvaginal ventral suture colposuspension, fixation of the anterior rectal wall to the undersurface of the anterior abdominal wall and tack fixation of the posterior rectal wall to the underlying sacral promontory through a submucosal tunnel performed endoscopically with fluoroscopic and ultrasound assistance.PRELIMINARY RESULTS: Seven patients with a mean age of 63 years were followed between 3 to 11 months.CONCLUSIONS: This is a novel minimally invasive transluminal procedure that repairs concomitant rectal and vaginal prolapse in the same sitting.Funding/Support: None reported.

BACKGROUND: Endoluminal surgery for the management of rectal prolapse remains largely experimental. OBJECTIVE: To evaluate the evolution and short-term outcomes of a new endoluminal technique for the management of complete rectal prolapse. DESIGN: This was a prospective study. SETTINGS: This study was conducted at a single tertiary care teaching center. PATIENTS: A total of 29 patients were included. The first 12 patients underwent the procedure with our initial technique, and the last 17 patients were subjected to the new modified procedure. The follow-up duration was 3 years for the older technique and 26 months for the newer technique. INTERVENTION: This technique involves: 1) ventral “suture” rectopexy: rectum is fixed anteriorly to the anterior abdominal wall using percutaneously placed sutures. 2) Posterior rectum is fixed to the sacral promontory using tackers through a submucosal tunnel. MAIN OUTCOME MEASURES: Safety, recurrence, functional outcomes, morbidity, and mortality were the main outcome measures. RESULTS: There were improvements in constipation and incontinence scores, anal manometric pressures, anorectal angle, anorectal descent, and quality of life postoperatively in both groups. In patients undergoing the modified procedure, there was a significant decrease in duration of surgery (220 ± 48.89 vs 110 ± 12.51 min), shortened hospital stay (4.6 ± 1.71 vs 2.6 ± 0.65 d), decreased recurrence (25% vs 5.8%), and complications (surgical-site infection and retrorectal abscess). LIMITATIONS: Short follow-up, small sample size, and single-center study were the limitations. CONCLUSION: This is a novel endoluminal technique for treating rectal prolapse obviating perirectal dissection, abdominal incisions, or a mesh. This can now be performed under complete endoscopic and fluoroscopic vision. It avoids general anesthesia and therefore can be an alternative for patients with comorbid conditions in whom the standard abdominal procedure may not be well tolerated. Larger randomized multicentric studies with longer follow-ups are warranted. See Video Abstract at http://links.lww.com/DCR/C59. RECTOPEXIA ENDOSCÓPICA TRANSANAL POR ORIFICIO NATURAL PARA EL PROLAPSO RECTAL COMPLETO: EVOLUCIÓN PROSPECTIVA DE UNA NUEVA TÉCNICA Y RESULTADOS A CORTO PLAZO ANTECEDENTES: La cirugía endoluminal para el tratamiento del prolapso rectal ha permanecido en gran parte experimental. OBJETIVO: Este estudio tiene como objetivo evaluar la evolución y los resultados a corto plazo de una nueva técnica endoluminal para el manejo del prolapso rectal completo. DISEÑO: Estudio prospectivo. ÁMBITOS: Único centro docente de tercer nivel de atención. PACIENTES: Se incluyeron un total de 29 pacientes (19 hombres y 10 mujeres) con prolapso rectal completo. Los primeros 12 pacientes fueron sometidos al procedimiento con nuestra técnica anteriormente descrita y los últimos 17 pacientes fueron sometidos al nuevo procedimiento modificado. La duración del seguimiento es de 3 años para la técnica más antigua y de 26 meses para l...