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Experimentally contaminated reabsorbable meshes: their evolution in abdominal wall defects.

Contamination by septic materials may represent an important handicap in evaluating the tolerance of reabsorbable prostheses, increasing the possible onset of abdominal fistulae. This is also the case when these materials are used in the treatment of abdominal wall defects. Nevertheless, reabsorbable meshes exist that allow visceroprosthetic contact without risk, thus making it possible to use them in spite of the presence of infection. We have performed this experimental study with the aim of evaluating the behaviour and evolution of polyglycolic acid reabsorbable meshes contaminated by septic materials in the treatment of abdominal wall defects. For this purpose, 40 Wistar rats were operated and distributed into two series of 20 animals each. Massive mesh contamination by fecaloid material did not jeopardise the fact that prostheses were well tolerated in experimental animals throughout the reabsorption process, without increasing the incidence of infection.

Abdominal Muscles↗

[Long-term results of 186 patients with large incisional abdominal wall hernia treated by intraperitoneal mesh].

Massive incisional abdominal wall hernias are frequent and difficult to repair, especially when they are large, multiply recurrent and when associated high with risk factors. We report the long-term results of 192 hernia repairs (in 186 patients) by non-resorbable mesh placed intraperitoneally and fixed by fascia stapler. We describe the details of the technique. There were no deaths. Early and late wound infections occurred in 11.7%, late occlusions in 6.3% and recurrence in 16%. Four percent of patients required removal of the mesh. The main caracteristic of this study was the long follow-up period (mean duration = 77 months). In view of the good results (70%), simplicity and quite execution of this technique, intraperitoneal mesh placement should be considered in the repair of large hernias when a prothesis is required.

Adolescent↗

[Isolated traumatic lesions of the abdominal wall musculature].

Six cases of isolated traumatic lesions of the abdominal wall muscles (2 ruptures of the right abdominal muscle and 4 of the anterolateral muscles) are reported. The presence of a "fixed" hematoma or even of a true subcutaneous eventration, the case history (for finding out the injury mechanism or unusual muscular effort), the X-ray examination of the abdomen and especially the ultrasonography can establish the diagnosis. The treatment of this lesion is usually conservative, surgery (performed in 3 cases) being indicated only in those ruptures with large parietal defects or hematomas or in case of diagnostic doubts.

Abdominal Muscles↗

[Endometriosis in postoperative abdominal wall scar after cesarean section].

Endometriosis in postoperative abdominal wall scar after cesarean section is rarely observed. In professional literature, only single cases are reported. The author presented 27 cases of this diseases. The women were treated in the Gynaecology and obstetrics Department of Medical School in Lódź, in 1985-1994. Because of the small response to pharmacological treatment, the treatment of choice was surgical of the lesion. In the article, the literature concerning the disease is presented.

Adult↗

[Reconstruction of incisional hernias with defined tensiometrically controlled tension--a possibility for anatomically correct reconstruction of the abdominal wall].

The repair of incisional hernias of the abdominal wall is characterized by high rates of recurrence if arbitrary tension is applied. A rationale for selecting the appropriate reconstruction technique as defined by intraoperative tension measurements has proven effective and successful. Here, the inlay/onlay technique tolerates up to 3.5 kilopounds (kp). Our results show that using this technique, complete reconstruction is possible in 65% of cases with a recurrence rate of 2.3%.

Cicatrix↗

Tissue reaction to polypropylene mesh: a study of oedema, blood flow, and inflammation in the abdominal wall.

The purpose of the present work was to study the tissue reaction to polypropylene mesh (Marlex) implanted in three different layers of the abdominal wall, comparable to common clinical practices. The reaction to mesh was compared in terms of tissue oedema, blood flow, and histological appearance in rats. When mesh was placed between muscle layers, blood flow in the abdominal wall was high during the first 4 days after implantation but similar to flow in nonoperated rats 14 and 140 days after implantation. When mesh was placed under skin or on the peritoneum, there was no hyperaemia early after implantation, and flow rate was clearly lower than in non-operated controls 140 days after implantation. The operative procedure produced increased tissue water content, declining from the 1st to the 14th day after operation. Mesh induced additional oedema in adjacent muscle tissue irrespective of localization of the implant (p less than 0.01, vs. sham). Except when separated by peritoneum, mesh caused hyperaemia in muscle tissue in direct contact with mesh the 1st and the 4th day after implantation. After 14 and 140 days no mesh-induced hyperaemia was present. The inflammatory response to mesh was similar in the peritoneum and between muscles, less pronounced in the subcutis. It was characterized by the accumulation of macrophages and the formation of inflammatory granulation tissue in the subacute phase, later followed by the formation of fibrous tissue around mesh fibres. This study suggests that mesh implants should be placed in apposition to muscles in order to obtain well-vascularized healing.

Abdominal Muscles↗

Effectiveness of laparoscopic gonadectomy using abdominal wall lift method on Turner's syndrome patients with 45, X/46, XY mosaicism.

We present a Turner's syndrome patient with a 45, X/46, XY mosaicism who underwent a prophylactic laparoscopic gonadectomy using the abdominal wall lift method. The patient was a 14-year-old phenotypic girl who was referred for an examination of primary amenorrhea. She had already been found to have Turner's syndrome with 45, X/46, XY mosaicism. After an extensive discussion with the patient and her family regarding her high risk for developing a gonadoblastoma, a laparoscopic bilateral salpingo-oophorectomy using the abdominal wall-life method was performed. Laparoscopy using the abdominal wall lift method has an advantage over CO2 pneumoperitoneum method for patients with Turner's syndrome when it is difficult to intubate because of a webbed neck or a shortened trachea.

Adolescent↗