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Large abdominal wall herniae may pose problems of management, particularly in the presence of obstructive airway and cardiovascular disease. Preoperative induction of pneumoperitoneum usually permits the anatomical repair of large herniae without complications and without the use of prosthetic materials to close the defect.
OBJECTIVE: To identify morbidity and mortality in newborns with congenital defects of the anterior abdominal wall. DESIGN: Descriptive, comparative, and retrospective study. PATIENTS: Thirty nine patients with gastroschisis and 26 patients with omphalocele. RESULTS: Median size of the defect in the gastroschisis group was 4 cm. Infants underwent primary closure en 41% of cases. Post-surgical morbidity occurred in 74% of patients with sepsis the main complication in 61.5%. A total of 16.2% died mainly due to acute renal failure and sepsis. In the omphalocele group, median size of defect was 5.5 cm. Primary closure was done in 65% of patients. Complications occurred in 65% of newborns, sepsis was the most frequent complication (46%). Mortality rate was 16.6% related to acute renal failure and cardiogenic shock. CONCLUSIONS: The main causes of morbidity in the two groups were infections and acute renal failure. Mortality rate was similar to that reported in the world literature for gastroschisis and slightly lower for omphalocele.
An experience with treatment of 42 patients with large and giant hernias of the anterior abdominal wall is described. The treatment used plasty with a polypropylene net by the method used in the clinic. Long-term results were followed up in 36 patients during the period from 6 months to 5 years. Recurrences of hernias were not noted.
The role of herniography in patients with unexplained pain in the groin or anterior abdominal wall is discussed and referred to that of other imaging modalities. The technique of herniography, its indications and contraindications, and anatomical aspects are dealt with. A series of 81 patients who underwent herniography is presented and the results are correlated with findings at surgery.
A persistent sinus tract of the abdominal wall caused by retained fragments of gallstones following laparoscopic cholecystectomy is reported. Review of the literature and suggested technique and methods to avoid this complication are described.
The authors describe a case of a desmoid tumor of the anterior abdominal wall. From a review of the world literature, the main characteristics of these tumors are detailed, and the various pathophysiological hypotheses, demonstrating the necessity of exclusively surgical treatment, are presented.
The experimental study concerning the particularities of the cicatrization process in cases of defects of the abdominal wall -- in rabbits -- for which substitution grafts were applied, demonstrated them to be well tolerated. No essential differences were noted between surgical nets imported from foreign manufacturers, and those manufactured in our country.
This article begins with a presentation of the embryology of the anterior abdominal wall and umbilical cord. Abnormal embryology and resulting anomalies are presented in tabular form and later reviewed in chronologic order of embryologic development. Techniques involved in the prenatal diagnosis of these abnormalities are also described.
BACKGROUND: Necrotising Fasciitis is a life threatening soft tissue infection which requires aggressive, early surgical management. CASE PRESENTATION: We present a rare case of a retroperitoneal perforation of a carcinoma of the caecum presenting as a necrotising fasciitis of the anterior abdominal wall. CONCLUSION: This case highlights the importance of early aggressive debridement to healthy tissue limits, the consideration of a rare underlying cause, and the scope for plastic surgical reconstruction in order that aggressive initial surgery can be adequately performed.
Over a two-year period (1982-1984) polypropylene (Marlex) mesh was used without closing the abdominal wound in 21 patients judged clinically likely to require further abdominal exploration. A total of 43 meshes were implanted. All 21 patients had more than one major laparotomy, median 3 laparotomies (range 2-7) for drainage of pus (76 per cent) and/or intestinal leakage (67 per cent). Definitive abdominal wound closure after removal of polypropylene mesh was either by delayed primary suturing (33 per cent) or consisted of split skin grafting on the granulating wound (24 per cent). Three wounds were left to granulate without skin grafting (14 per cent). Mortality in this group of patients was 29 per cent and no complications resulted directly from implantation of polypropylene mesh. Polypropylene mesh closure of the abdominal wall not only provides simple and rapid access to the abdomen but also allows free drainage and daily inspection for the development of fistulae or the seepage of pus which are indications for further exploration. In that the clinical outcome is relatively favourable in this group of critically ill surgical patients who required multiple laparotomies within a short interval, it is suggested that mesh closure of the abdominal wound is indicated whenever abdominal re-entry is judged probable or rational.
The authors report one case of abdominal wall endometriosis secondary to cesarean section. They emphasize the rarity of this localization and discuss about the incidence of extrapelvic endometriosis stressing the importance of this pathology in the differential diagnosis with other disease.
Presented is the successful management of a difficult abdominal wall closure after pediatric liver transplantation. A 5-week-old boy with biliary atresia underwent urgent cadaveric split liver transplantation. The left lateral segment of an adult donor was utilized. Postoperatively, abdominal skin and fascia could not be closed. A SILASTIC (Dow Corning, Midland, MI) silo was applied, and complete closure was possible 6 days later.
Incisional hernia is a common surgical problem, frequently requiring prosthetic mesh repair. The demands of the ideal mesh seem conflicting; ingrowth at the mesh-fascia interface, without development of adhesions at the visceral mesh surface. Various antiadhesives combined with macroporous mesh and composite meshes were studied for prevention of adhesions to mesh and ingrowth into the fascia. In 60 rats an abdominal wall defect was created and repaired with underlay mesh. Rats were divided into six groups and treated with polypropylene mesh (PPM, control), PPM with auto-cross-linked polymers (ACP) gel, PPM with fibrinogen glue (FG), polypropylene/expanded polytetrafluoroethylene (ePTFE) mesh, polypropylene/sodium hyaluronate/carboxymethylcellulose (HA/CMC) mesh, and polypropylene-collagen/polyethylene-glycol/glycerol (CPGG) mesh. Mesh infection was assessed in the postoperative period, adhesions and reherniations were scored at sacrifice 2 months after operation, and tensile strength of the mesh-tissue interface was measured. Six rats developed mesh infection, half of them were treated with PPM/ePTFE. The PPM/HA/CMC group showed a significant reduction in the amount and severity of adhesions. In animals treated with PPM/ACP and PPM/FG, severity of adhesions was reduced as well. Reherniation rate in the PPM/ACP group was 50% and significantly higher than that in other groups. Rats in the PPM/HA/CMC had the highest tensile strength. PPM/HA/CMC approaches the demands of the ideal mesh best, having superior antiadhesive properties, no reherniation and no infection in this rat model of incisional hernia.
The tensor fascia lata myocutaneous flap provides a reliable autogenous building block for anatomical lower abdominal wall reconstruction. Preservation of innervation allows maintenance of voluntary motor control and protective sensation. The excellent blood supply of this flap is particularly helpful in reconstructing previously irradiated areas. A one-stage repair is possible, leaving minimal secondary defect. We describe 4 patients illustrating the uses and versatilty of this flap. Anatomy, operative procedures, and indications for delay are also discussed.
Abdominoplasty procedures involve a high risk of early complications, including hematomas, seromas, necrosis, and wound-healing problems. Their rationale is evident from the vascular anatomy of the abdominal wall, as traditional abdominoplasty includes a division of the main perforating vessels. No studies exist to quantitatively assess the consequences of abdominoplasty on the perfusion of the random pattern abdominal flap. To address this issue and quantify the influence of classic abdominoplasty on the perfusion of the abdominal skin, the authors performed a prospective clinical trial including 15 low-risk patients undergoing abdominoplasty for aesthetic purposes. Perfusion of the abdominal flap was measured intraoperatively using the technique of dynamic laser-fluorescence-videoangiography. In the region between the umbilicus and the transverse scar (zone 1), the increment of fluorescence (the slope of the intensity curve during inflow of the indocyanine green) was recorded and compared with the intensity curve of normal tissue that was not involved in surgery (thoracic wall). The results of the intraoperative indocyanine green perfusography showed a significant impairment of the vascular supply of zone 1 in all patients. The mean perfusion index in this region was 17.2 percent (range, 5 to 32 percent) of the perfusion of the surrounding skin that was not involved in surgery. The complication rate was 33 percent (five patients) and included two cases of hematoma and three cases of scar dehiscence with skin and/or fat necrosis. These data indicate that conventional abdominoplasty including extended undermining and division of the superficial and the deep arterial systems causes profound devascularization of the abdominal flap. This might explain the high incidence of complications following this procedure.
Soft tissue lymphoma is a very rare clinical entity with varying presentation characteristics and atypical clinical and imaging features. The present report describes a patient who presented with a painless soft tissue mass on the posterolateral surface of the abdominal wall, simulating a neoplasm of mesenchymal origin. After complete surgical excision, the tumor was diagnosed as a diffuse large B-cell lymphoma. No B-symptoms were present and clinical staging did not reveal other sites of disease (stage I EA). The International Prognostic Index score was equal to 1 and classified the patient to the good risk group. Post-operatively the patient was treated with immuno-chemotherapy consisting of rituximab plus cyclophosphamide, epirubicin, vincristine and prednisolone and is currently free of disease for 10 months. The case is discussed with a brief review of the literature on the diagnosis, treatment and outcome of soft tissue lymphomas.
BACKGROUND: Patients treated with peritoneal dialysis (PD) have increased intra-abdominal pressure and a high prevalence of abdominal wall complications. OBJECTIVE: The purpose of this study was to determine the incidence of hernias and peritoneal leaks in our PD patients and to investigate their potential risk factors. PATIENTS: We studied 142 unselected patients treated with PD during the past 5 years, including those that were already on PD and those that started PD during this period. Mean age was 54 years and mean follow-up on PD was 39 months. 72 patients had been treated with only continuous ambulatory PD (CAPD), 8 with automated PD (APD), and 62 with both modalities. RESULTS: 53 patients (37%) developed hernia and/or leak. A total of 39 hernias and 63 leaks were registered. The overall rates were 0.08 hernias/patient/year and 0.13 leaks/patient/year. 17 patients had both abdominal complications. Hernia was most frequently located in the umbilical region, and the most frequent site of leakage was the pericatheter area. Both complications appeared more frequently during the CAPD period (87% of hernias, 81% of leaks). The rate of hernias was higher in patients treated only with CAPD than in those that used only cyclers [0.08 vs 0.01 hernias/patient/year, not significant (NS)]. No patient treated only with APD had peritoneal leak; 25% (18/72) of patients treated with CAPD developed this complication (p = 0.18, NS). Dialysate exchange volumes ranged from 2000 to 2800 mL. 25 (66%) patients required surgical repair of the hernia, with recurrence in 7 patients (28%). 27 (84%) patients with leaks were initially treated with transitory temporary transfer to hemodialysis, low volume APD, or intermittent PD for 4 weeks. The leak recurred in half of the cases and surgical repair was necessary in 12 cases. The development of hernia and/or leak did not correlate with gender, diabetes, duration of follow-up, type of PD, history of abdominal surgery, or with the largest peritoneal exchange volume used. Polycystic kidney disease was the only factor associated with higher rate of hernias (p = 0.005), whereas increased age (p = 0.04) and higher body mass index (p = 0.03) were significantly associated with the appearance of leaks. CONCLUSION: Abdominal hernias and peritoneal leaks are very frequent in the PD population. Advanced age, polycystic kidney disease, and high body mass index are independent risk factors for their development. Automated PD with low daytime fill volume should be considered in all patients at risk for hernias and/or leaks.
We describe a 52 year-old woman in whom lymphedema primarily of the abdominal wall was superimposed on lipedema resulting in an abdomen of enormous dimensions with marked impairment of ambulation. Treatment consisted of preoperative compression of the legs by an external pneumatic device (Lympha-Press) followed by excision of the lymphedematous abdominal fat pad in conjunction with "debulking" of the right leg. The patient illustrates the extremes of lipedema complicated by lymphedema and the technical difficulties associated with its management.