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PubMed2004

Morphological changes in the anterior abdominal wall of rats with peritonitis and implanted synthetic film.

Histological study and electron microscopy of the anterior abdominal wall and laparotomy wound closed using a polytetrafluoroethylene film was performed on rats with experimental peritonitis. We studied 4 types of polytetrafluoroethylene films differing in the size of micropores and technology of treatment. The tissue response differed after implantation of various films. A multilayer film with minimum size of pores was optimal to repair the laparotomy wound.

Abdominal Wall↗
PubMed2003

Pathophysiology of giant incisional hernias with loss of abdominal wall substance.

Incisional hernia represents the most common wound complication after abdominal surgery. The repair of large incisional hernias requires an accurate knowledge of the interactions between the tissues of the abdominal wall, the prosthetic materials and the bowel. At the same time a careful attention must be placed on the physiopathology of abdominal hypertension. Repair of giant incisional hernias with heavy loss of substance may take to a sudden increase of intra-abdominal pressure and, sometimes, to Abdominal Compartment Syndrome (ACS). The aim of preventing recurrences very often requires the use of a prosthesis, which must be placed on a low-tension environment to avoid early failures and excessive increase of intra-abdominal pressure. It is also necessary to employ as much parietal tissues as possible to prevent visceral adhesions and lesions and to pay attention to an appropriate employment of prosthesis. Utilization of composite materials, absorbable prosthesis or of combinations of mesh and flaps looks promising in preventing endoabdominal hypertension without increasing the rate of recurrences, infections and adhesive complications.

Compartment Syndromes↗
PubMed1990

[Possibilities of using ultrasonography for intravital study of topographic anatomy of the anterior abdominal wall in humans].

The ultrasound investigation has been performed by means of the echodevices "Aloka-280" and "Aloka-650" (Japan), transducers of 3.5 and 5 MHz. Eighty-two persons of both sex at the age 16-72 years have been examined. The white line, m. rectus abdominis and m. vastus abdominis have been measured at three levels, as well as lateral amuscular spaces. The width of the abdominal white line is individually very variable; the area of the lateral amuscular spaces is greater to the right than to the left. In 20 persons examined they are absent. The thickness of the m. m. rectus abdominis increases from their superior parts to the inferior ones, and their width just the reverse, decreases in this direction. The state of the anterior abdominal wall muscles has been studied both at rest and under functional load. When the prelum abdominale is at the state of exertion, the muscles react differently: dimensions of the m. m. rectus abdominis at rest and under exertion significantly differ at all levels investigated; the m. m. vastus abdominis become thicker to a less degree. When the prelum abdominale is at the state of exertion, no correlation has been revealed between thickness of the m. m. rectus abdominis and degree of their thickening, as well as between width and manifestation of narrowing. A conclusion is made that the ultrasound method opens great possibilities for vital investigation of the anterior abdominal wall topography.

Abdominal Muscles↗
PubMed1990

Amniotic fluid acetylcholinesterase in the prenatal diagnosis of open neural tube defects and abdominal wall defects: a comparison of gel electrophoresis and a monoclonal antibody immunoassay.

Stored amniotic fluid samples collected in Oxford and East Birmingham as part of the Collaborative Acetylcholinesterase Study were assayed for the presence of acetylcholinesterase (AChE) using a monoclonal antibody (4F19) enzyme antigen immunoassay. These results were compared with the results of a gel AChE which had been performed earlier. A total of 5689 samples from singleton pregnancies were analysed (including 36 with anencephaly, 77 with open spina bifida and 17 with anterior abdominal wall defects). The gel test yielded detection rates of 97% for anencephaly, 99% for open spina bifida and 94% for abdominal wall defects; the false positive rate (excluding pregnancies associated with serious abnormalities, miscarriages and intrauterine deaths) was 0.24%. The monoclonal test yielded similar results; using appropriate cut-off values to allow for differences in acetylcholinesterase levels in blood stained and clear samples, a similar false-positive rate of 0.22% was associated with detection rates of 97%, 95% and 71% respectively for the three types of defect. Although the detection rates and the false positive rate were slightly higher for the gel test, a result that might be explained by a decrease in AChE activity caused by storage of the samples, the monoclonal test has the advantages of requiring less interpretative expertise, it can be performed on a larger number of samples a day and it is not affected by contamination with fetal calf serum.

Abdominal Muscles↗
PubMedDate not supplied

[The morphometric indices and echo structure of the muscles of the human abdominal wall under the action of physical loading].

An ultrasonic examination of muscles was carried out with the help of echo chamber "Aloka-280" and "Aloka-630" (Japan), transducers of 3.5 and 5 MHz. Under examination there were 15 sportsmen and a group of people not going in for sports, aged from 17 to 21 years. Morphometry of the white line, wide abdominal muscles on seven levels and of musculus rectus abdominis on five levels was performed. It was found that systematic physical exercises resulted in hypertrophy of muscles of the abdominal wall and enlargement of the white line width. The arrangement of wide muscles of the abdomen corresponding to the lateral margin of musculus rectus abdominis is symmetrical on the right and left in each group. At all the levels of scanning the internal oblique muscle of the abdomen was localized medial to the musculus rectus margin. In sportsmen such an arrangement relative to one another is better pronounced than in a control group from the 2nd to 5th levels. An analysis of histograms has shown that abdominal musculus rectus of sportsmen possesses less echogeneity and is more echo-homogeneous than the muscles of people not going in for sports. Thus, constant physical exercises cause not only enlargement of sizes of the abdominal wall muscles, but also leads to changes in topographic-anatomic interrelations of its structures.

Abdominal Muscles↗
PubMed1997

Abdominal wall endometriosis after amniocentesis. A case report.

BACKGROUND: Amniocentesis is a procedure performed commonly in the evaluation and early diagnosis of fetal chromosomal abnormalities. The procedure is safe, with a major complication rate of 0.5% and the most common minor complication, spotting. CASE: A 27-year-old woman underwent amniocenteses to document pulmonary maturity prior to cesarean section. She presented 18 months later with a 6-month history of left abdominal wall pain and a mass that enlarged 2 days prior to menses and shrank 1 week after. The mass was located at the prior amniocentesis site. Excisional biopsy revealed endometriosis on final pathology. CONCLUSION: To our knowledge, this is the first well-documented case of abdominal wall endometriosis following third-trimester amniocentesis. The procedure should be considered a possible complication of amniocentesis.

Abdominal Muscles↗
PubMed1994

[Function of the abdominal wall and development and therapy of hernias (among others: the para-colostomy hernia)].

The peritoneal cavity has a fascial skeleton with musculature that is nearly always active, i.e. it has resting tone activity. During pneumoperitoneum this resting activity increases very markedly. The pelvic floor and its integrated sphincters also have a similar type of spontaneous activity depending on Onuf's nucleus in the spinal cord together with the somatic and autonomic nerves. Hernias such as umbilical hernias develop with disruption of a scar. While in a child the common inguinal hernia develops in an open vaginal processus, in an adult it develops as the result of a congenital muscular defect in the abdominal wall. A femoral hernia develops in a gap through the pressure of the resting activity of the abdominal wall. A paracolostomy hernia develops after an incision in the fascial skeleton and after pull-through of a very adipose sigma-mesosigma. It can often be treated it by pulling a slim colon segment through the innervated rectus muscle incision and closing the gap in the fascial skeleton with a running suture. Incisional or umbilical hernias can be successfully treated by suturing with a continuous nonabsorbable thread. The best therapy for inguinal hernias is suturing of the hyperplastic fascia transversalis and the reconstruction of the muscle sphincter mechanism. Bassini operated on very large hernias with hyperplastic fascia, thereby achieving excellent results. Fascial hyperplasia has been shown to follow the use of tissue expanders.

Abdominal Muscles↗
PubMed1983

Treatment of defects of the anterior abdominal wall in newborns.

Primary closure of an omphalocele or gastroschisis may cause respiratory compromise in the neonate. Some authors recommend primary closure of the defect with prolonged respiratory support because of dissatisfaction with staged visceral reduction and use of a Silastic pouch. Our experience with use of a Silastic pouch from 1975 to 1982 was reviewed. Twenty-three newborns with major defects of the abdominal wall (14 omphaloceles and 9 gastroschisis anomalies) were surgically treated, and only one death occurred. The mean birth weight of the infants was 2,927 g; nine of them were premature. Seven infants had major associated anomalies. The goal of the surgical procedure was closure of the abdominal wall without compromise of the cardiorespiratory status. During the operation, muscle relaxants were avoided and the infants breathed spontaneously. If progressive visceral reduction caused tachypnea (rate of more than 70/min) or hemodynamic instability, a Silastic pouch was constructed. Ten patients were treated with primary fascial closure, and 13 were treated with a Silastic prosthesis. The neonates with the prostheses required three to eight reductions, and the prostheses were in place for 4 to 22 days. No patient had wound dehiscence, wound infection, or an intestinal fistula. The one death occurred in an infant with trisomy 18 syndrome and multiple anomalies. Thus, the Silastic pouch was effective when the defect could not be closed primarily without respiratory compromise.

Critical Care↗
PubMed1999

Foreign body reaction to meshes used for the repair of abdominal wall hernias.

OBJECTIVE: To investigate the local tissue reactions to meshes that had been removed from humans. DESIGN: Open study SETTING: Surgical department of the technical University, Aachen, Germany. MATERIAL: Samples of 17 non-absorbable meshes (1 polyester, 10 polypropylene, 2 reduced polypropylene, and 4 polytetrafluorethylene, PTFE) and 1 absorbable mesh (polyglactin 910) that had been implanted for repair of abdominal wall defects. INTERVENTIONS: Light and transmission electron microscopy, immunohistochemistry, and histological examination. MAIN OUTCOME MEASURES: Signs of inflammatory response. RESULTS: Light microscopy showed chronic inflammatory tissue reaction, even after years, with pronounced differences among materials. Partial volume of inflammatory cells (%) varied from 32 in polypropylene, to 12 in expanded PTFE, 8 in polyester, and 7 in reduced polypropylene. Formation of connective tissue correlated significantly with the extent of the inflammatory reaction (p<0.01). In meshes implanted for long periods there were still numerous macrophages at the interface between tissue and polypropylene (45%), polyester (45%), expanded PTFE (25%), and reduced polypropylene (22%). There was no difference in time dependent tissue reactions (p = 0.19). CONCLUSION: Inflammation around alloplastic materials used to repair defects in the abdominal wall persists for many years. There was evidence of long term wound complications as a result of persistent foreign body reactions. Further studies are required to evaluate the long term tissue response to these materials.

Abdominal Muscles↗
PubMed1992

[Treatment of incisional hernia of the abdominal wall by the skin lacing technique. Apropos of 30 cases].

The treatment of large incisional hernias is often difficult, as reflected by the many surgical techniques proposed and the high recurrence rate. Since 1983, the authors have used a skin lacing procedure in these large hernias which frequently tend to recur. This report was based on the study of 30 consecutively patients operated by this method between 1983 and 1989. The objective results evaluated clinically in terms of the quality of the abdominal wall after more than two years of follow-up appear to argue in favour of this little known technique which combines simplicity, rapidity and reliability. Based on their experience, the authors believe that this method has a place in the therapeutic arsenal for abdominal wall repair as, in some cases, it can resolve the difficult problem of treatment of large, recurrent incisional hernias regardless of the patient's age.

Abdominal Muscles↗
PubMed1992

Long-term evaluation of the abdominal wall competence after total and selective harvesting of the rectus abdominis muscle.

Fifty patients who underwent unilateral breast reconstruction by transverse rectus abdominis musculocutaneous flap transposition between January 1987 and December 1989 are the object of this study. Every patient underwent selective harvesting of the medial portion of the muscle, whereas the lateral strip was left in place and studied intraoperatively by selective stimulation of the ninth intercostal motor nerve before closure of the fascial defect. Two separate ecographic scans of the abdominal wall were performed respectively 7 days and 6 months postoperatively, to evaluate the diameters of the residual portion of the rectus muscle and its long-term evolution. Our results show that in a considerable number of patients, the lateral strip of rectus was denervated at surgery. Long-term ecographic scans demonstrate, however, that in spite of this finding, the residual muscle usually maintains its diameters, thus significantly contributing to the competence of the abdominal wall, at least from the static point of view.

Abdominal Muscles↗
PubMed1994

[Desmoid tumor of the abdominal wall].

Four cases of muscle-aponeurotic fibroadenomatosis (desmoid) of the abdominal wall are reported. The etiological factors, the recurrence rate, the treatment and the pre- and postoperative examinations are discussed.

Adult↗
PubMedDate not supplied

Laparoscopic treatment of ventral abdominal wall hernias: preliminary results in 100 patients.

OBJECTIVE: The laparoscopic treatment of eventrations and ventral hernias has been little used, although these hernias are well suited to a laparoscopic approach. The objective of this study was to investigate the usefulness of a laparoscopic approach in the surgical treatment of ventral hernias. METHODS: Between January 1994 and July 1998, a series of 100 patients suffering from major abdominal wall defects were operated on by means of laparoscopic techniques, with a mean postoperative follow-up of 30 months. The mean number of defects was 2.7 per patient, the wall defect was 93 cm2 on average. There were 10 minor hernias (<5 cm), 52 medium-size hernias (5-10 cm), and 38 large hernia (>10 cm). The origin of the wall defect was primary in 21 cases and postsurgical in 79. Three access ports were used, and the defects were covered with PTFE Dual Mesh measuring 19 x 15 cm in 54 cases, 10 x 15 cm in 36 cases, and 12 x 8 cm in 10 cases. An additional mesh had to be added in 21 cases. In the last 30 cases, PTFE Dual Mesh Plus with holes was employed. RESULTS: Average surgery time was 62 minutes. One procedure was converted to open surgery, and only one patient required a second operation in the early postoperative period. Minor complications included 2 patients with abdominal wall edema, 10 seromas, and 3 subcutaneous hematomas. There were no trocar site infections. Two patients developed hernia relapse (2%) in the first month after surgery and were reoperated with a similar laparoscopic technique. Oral intake and mobilization began a few hours after surgery. The mean stay in hospital was 28 hours. CONCLUSIONS: Laparoscopic technique makes it possible to avoid large incisions, the placement of drains, and produces a lower number of seromas, infections and relapses. Laparoscopic access considerably shortens the time spent in the hospital.

Adult↗
PubMed1992

CT evaluation of the abdominal wall.

Computed tomography (CT) is a useful method for evaluating the abdominal wall. Pathology includes hernia, hematoma, infection and inflammation, tumor, and post-traumatic, post-operative, and miscellaneous conditions. The CT findings of these various abnormalities are presented.

Abdominal Muscles↗
PubMed2000

[Experiences with reconstruction of large abdominal wall cicatricial hernias using Stoppa-Rives pre-peritoneal mesh-plasty].

BACKGROUND: The observed recurrence-rate up to 20-50% of conventional incisional-hernia repair might be improved by alloplastic hernia repair in "sublay-technique" described by Stoppa and Rives. METHODS: From 12/94 to 12/97 122 pt. underwent surgery of incisional hernia of whom 50 had a very large abdominal wall defect so that hernia repair by alloplastic technique was necessary. All 50 pt. had mesh-implantation in subfascial plane, 28 pt. by ePTFE-patch (Gore-Tex) and 22 pt. by polypropylen-mesh (Prolene). RESULTS: The implantation-procedure required a mean time of 165 min. (range 55-345 min.). There were pulmonary complications in 2 patients (4%) of whom one had to be ventilated over 34 days, prosthesis-infection occurred in 3 pt. (6%). Follow-up on average 19 months (range 5-44 months) postoperatively revealed 5 hernia-recurrences (10.4%) in 48 patients. CONCLUSION: Mesh-implantation for hernia repair in sublay-technique requires intensive preparation of preperitoneal plane. Thus it took approximately 3 hours for mesh-implantation in this study. From our data Stoppa-Rives-procedure seems to be effective for 4-repair of large incisional hernias and allows immediate abdominal wall stress.

Adult↗
PubMed2005

A case of a traumatic abdominal wall hernia that could not be identified until exploratory laparoscopy was performed.

Traumatic abdominal wall hernia (TAWH) is a rare condition secondary to blunt abdominal trauma in children. We herein report an 8-year-old boy who developed TAWH after falling onto a bicycle handlebar. Neither physical examination nor radiological findings suggested a diagnosis of TAWH at first presentation. TAWH in the right lower quadrant could not be identified until exploratory laparoscopy was performed. An open surgical repair was done, and the postoperative course was uneventful. The literature on pediatric TAWH is briefly reviewed and the findings discussed.

Abdominal Injuries↗