A new technique for repairing large abdominal wall defects.
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Abdominal Wall↗
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[Actinomycosis of the anterior abdominal wall; case report].
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Abdominal Wall↗
[Surgical management of congenital defects of the abdominal wall musculature].
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Abdominal Wall↗
[A case of metastatic liver cell carcinoma in the abdominal wall due to direct skin invasion from protruding liver tumor].
A case of a hepatocellular carcinoma with a metastasis to abdominal wall is reported. The patient was a 52-year-old man who, in December, 1982, had been found to have a 16 x 13 cm of tumor in the right lobe of the liver. He received transcatheter arterial embolization (TAE) several times and a hepatic segmentectomy twice. He survived more than six years until his death on January, 17, 1989. A subcutaneous tumor that had appeared in May, 1988 had gradually increased in size and was found to have reached 6 x 5.5 x 2.5 cm on autopsy. The tumor had connected directly with the liver tumor.
Abdominal Muscles↗
Cervical carcinoma recurring in an abdominal wall incision.
Incisional recurrence of carcinoma of the uterine cervix is very rare. We report two patients who developed recurrence in the abdominal wall incision after hysterectomy. The first patient was aged 60 years and had a FIGO Stage IB1 cervical carcinoma treated initially by Wertheim's hysterectomy and postoperative radiotherapy. Nine months after surgery she developed recurrence on the abdominal scar, which was outside the radiation portal. She was treated with electron beam radiation therapy. The second patient developed an incisional recurrence 23 months after surgery and was treated by wide excision of the mass followed by radiotherapy. A survey of the literature identified 12 reported cases to date (eight squamous cell carcinoma and four adenocarcinoma).
Abdominal Muscles↗
Hematoma of bowel and cellulitis of the abdominal wall complicating herniography.
Two complications of herniography are presented: a hematoma of bowel causing intestinal obstruction, and a cellulitis of the abdominal wall causing septicemia. A technical error probably caused the hematoma and gastroenteritis played a role in the cellulitis. We have now narrowed our indications for herniography. We think it should be reserved for more difficult diagnostic problems such as recurrent inguinal hernia, recurrent hydrocele or eventration of the diaphragm.
Abdominal Muscles↗
Aesthetic aspects of abdominal wall and external genital reconstructive surgery in bladder exstrophy-epispadias complex.
Long-term follow-up of patients born with classical bladder exstrophy-epispadias complex (EEC) reveals that many of them suffer from poor self-image, and the aesthetic aspects of the genitalia and lower abdomen acquire greater significance with age. In this article, we review the aesthetic outcomes in performing puboplasty, umbilicoplasty, and genitoplasty in patients born with EEC. Retrospective review of the cosmetic and functional outcomes in 116 patients born with EEC treated by puboplasty, umbilicoplasty, or genitoplasty was performed. Satisfaction with the cosmetic and functional outcomes of these three reconstructive surgeries was high following initial reconstructive efforts (> 90%). Attention to cosmesis during abdominal wall and genital reconstruction for EEC helps to improve a patient's perception of body image and self-esteem. Our experience with these procedures over the past 25 years demonstrated that the efforts directed toward aesthetics have been well worthwhile.
Abdominal Wall↗
[Operations in inguinal hernia from the preperitoneal approach with explant prosthesis of the abdominal wall].
The authors describe the method of operative treatment of inguinal hernias from the pre-peritoneal access with plasty of the abdominal wall with a lavsan flap. Recidivation of hernias was noted in 4 of 127 patients.
Abdominal Muscles↗
[Treatment of strangulated postoperative hernias of the anterior abdominal wall in old persons].
Based on the experience with treatment of 16 patients with large strangulated postoperative hernias of the anterior abdominal wall, the authors describe some peculiarities of the clinic, diagnosis and surgical tactics in the given pathology in persons aged over 74 years. A planned surgical therapy for postoperative hernias in senile persons is strongly advocated. The question of the planned operation should be settled only under stationary conditions after a careful detailed examination of such patients.
Abdominal Muscles↗
Acute hemodilution in an anemic Jehovah's Witness during extensive abdominal wall resection and reconstruction.
A 47-year-old anemic Jehovah's Witness with Gardner's syndrome presented with a large abdominal wall desmoid tumor requiring extensive resection with a musculocutaneous flap reconstruction. At surgery a technique of acute limited normovolemic hemodilution (ALNH) was used to minimize blood loss and avoid blood transfusions. Complications that follow transfusions of homologous blood are reviewed, and a recommendation is made to use ALNH because of its advantages in those patients in whom significant blood loss is expected.
Abdominal Neoplasms↗
Improved surgical outcome by modification of porcine dermal collagen implant in abdominal wall reconstruction in rats.
AIM: We earlier showed in rats that fascial repair with Pelvicol, a porcine dermal collagen implant, was associated with a lesser inflammatory response but lower tensile strength in the early postoperative period as compared to Prolene. Herein we wanted to evaluate whether creation of pores in Pelvicol, facilitating ingrowth of fibrous tissue and vessels, would result in a higher tensile strength at d30 without compromising longer term results. METHODS: First tensile strength of Pelvicol modified with different pore sizes was evaluated ex vivo. In a second step, Pelvicol implants with pores were used to cover full-thickness abdominal wall defects in 36 rats. Implants were either Pelvicol (non-porous) or with pores of Phi : 0.7, 1.2, or 2.0 mm (n=6 each). Animals were sacrificed on d30 and 90 to evaluate the presence of herniation, infection, adhesions, change in thickness and tensile strength. Histopathology was performed to assess inflammatory response and collagen deposition. Data were compared to available data on Prolene implanted animals at same time points. RESULTS: Pelvicol with pore diameter of 2.5 mm was significantly weaker ex vivo. Animals repaired with non-porous material did develop seroma (2/6) or clinical infection (1/6) whereas none in the other groups did. There was a trend for increasing tensile strength at 30 d with increasing pore diameter, being significant in the 2.0-mm pore size group. This difference disappeared by 90 d, where all materials were equally strong as Prolene. The foreign body reaction was less intense in a pore-size dependent manner, with more abundant neo-vascularization and collagen deposition passing through the pores. CONCLUSION: Creation of pores in Pelvicol promotes neo-vascularization, collagen deposition, and fibrous tissue ingrowth, and at pore size 2.0 mm tensile strength was increased at d30 whereafter all materials had comparable strength.
Abdominal Wall↗
A case of self-inflicted wounding by the introduction of needles through the abdominal wall to induce abortion.
The self-inflicted wounding of a 23-year-old woman who introduced needles through the abdominal wall to induce abortion is reported. The woman first came to hospital with metrorrhagia and pain in the right iliac fossa. Initially she refused treatment and went home. Twenty-two hours later she was admitted to hospital after giving birth at home to a male fetus of 610 g. The placenta was expelled in the hospital and a sewing needle was found. Lateral and anteroposterior radiographs revealed 15 such needles in the hypogastric region, most of them at subcutaneous level. The newborn was admitted to the intensive care unit in a generally poor condition, with hypothermia, cyanosis and bradycardia. An X-ray showed a metallic object in the abdominal region which, again, corresponded to a sewing needle. The newborn did not respond to treatment and died 2h after admission.
Abdominal Muscles↗
Mature bone metaplasia in abdominal wall scar.
A 58-year-old man who had had three laparotomies for gastric surgery, developed a painful mass in the abdominal wall scar. Radiology confirmed bone formation in the scar. The bone was excised and the wound repaired. Histology confirmed metaplastic mature bone formation. This case draws the attention to the clinical condition of bone formation in midline scars. Clinically, it should be differentiated from scar recurrence following surgery for abdominal malignancy.
Cicatrix↗
Trocar-related abdominal wall bleeding in 200 patients after laparoscopic cholecistectomy: Personal experience.
AIM: To determine the complications and incidence of the first and second access-related vascular injuries induced by videolaparoscopic cholecistectomy. METHODS: We retrospectively reviewed vascular injuries in 200 consecutive patients who underwent videolaparoscopic cholecistectomy from 2003 to 2005. One hundred and one patients with placement of radial expanding trocars were assigned into group A and 99 patients with placement of pyramidal tipped trocars into group B. All the patients were submitted to open access according to Hasson for the first trocar. RESULTS: Bleeding did not occur at the intraoperative cannula-site in group A. However, it occurred at the intraoperative cannula-site of 7 patients (7.1%) in group B, with a statistically significant difference (P < 0.01). No mortality was registered. More vascular lesions were found in group B. CONCLUSION: The advantage of Hasson technique is that peritoneal cavity access is gained under direct vision, preventing most severe injuries. The open technique with radial expanding trocars is recommended for secure access to the abdominal cavity in videolaparoscopy. Great care should be taken to avoid major complications and understanding the abdominal wall anatomy is important for reducing bleeding during or after s placement of trocars.
Abdominal Wall↗
Composite prostheses used to repair abdominal wall defects: physical or chemical adhesion barriers?
In a composite prosthesis, the component placed at the peritoneal interface takes the form of a physical or chemical barrier. In this experimental study performed on the white New Zealand rabbit, several composites were examined to establish the effectiveness of these barriers at impeding adhesion formation. The biomaterials tested were two polypropylene prostheses (PP) with the physical barriers of expanded polytetrafluoroethylene or polyurethane (PP + ePTFE and PP + PU) and two prostheses (one polyester and the other PP) with the absorbable chemical barriers of polyethylene glycol/glycerol and hyaluronate, respectively (PO + gl and PP + hy). The composites were used to repair 7 x 5 cm defects created in the abdominal wall of the animals by placing the implant in contact with the visceral peritoneum and the subcutaneous tissue and fixing it to recipient tissue by 4/0 polypropylene running suture. Fourteen days after surgery the animals were sacrificed and specimens were taken for light microscopy and scanning electron microscopy. Adhesions developing at the prosthesis/visceral peritoneal interface were quantified. All the prostheses induced optimal mesothelialization. Composites with physical barriers behaved similarly in terms of provoking adhesions. However, the prostheses with chemical barriers differed in their effectiveness at preventing adhesions. Overall, the best results were obtained with the PP + PU composite.
Abdominal Wall↗
A comparative study of adhesion formation and abdominal wall ingrowth after laparoscopic ventral hernia repair in a porcine model using multiple types of mesh.
BACKGROUND: The ideal mesh for laparoscopic ventral hernia repair is not yet identified. METHODS: We laparoscopically placed polypropylene (PPM), expanded polytetrafluoroethylene (ePTFE), and polyester with antiadhesive collagen layer (PCO) in eight pigs using sutures and tacks for fixation. After 28-day survival, we compared adhesion formation, fibrous ingrowth, and shrinkage among the types of mesh. RESULTS: Mean area of adhesions to PCO (8.25%) was less than that to ePTFE (57.14%, p < 0.001) or PPM (79.38%, p < 0.001). Adhesions peel strength was less for PCO (2.3 N) than for PPM (16.1 N, p < 0.001) or ePTFE (8.8 N, p = 0.02). Peel strength of mesh from the abdominal wall was less for ePTFE (1.3 N/cm of mesh width) than for PCO (2.8 N/cm, p = 0.001) or PPM (2.1 N/cm, p = 0.05). ePTFE area (94.4 cm(2)) was less than that for PCO (118.6 cm(2), p < 0.001) or PPM (140.7 cm(2), p < 0.02). CONCLUSION: PCO had fewer and less severe adhesions than ePTFE or PPM while facilitating excellent ingrowth of the adjacent parietal tissue.
Abdominal Wall↗
Clinical outcome of abdominal wall after DIEP flap harvesting and immediate application of abdominoplasty techniques.
BACKGROUND: Although breast reconstruction with the deep inferior epigastric perforator (DIEP) flap is a well-known technique, few publications have reported the aesthetic outcome of the abdomen and the donor-site closure techniques utilized. The aim of this study was to analyze the feasibility of immediate clinical application of traditional abdominoplasty techniques after DIEP flap harvesting. METHODS: Forty-four patients underwent 48 DIEP flap breast reconstructions, with 32 immediate and four bilateral procedures. All patients underwent full abdominoplasties with some technique of musculoaponeurotic system plication. Information on age, weight, height, smoking status, comorbid medical conditions, complications, and revision surgery was collected. RESULTS: In all patients, the anterior rectus fascia was closed by a two-layer imbrication-type closure and the rectus diastasis was corrected by a median plicature. In 36 patients (81.8 percent), a contralateral rectus plicature was performed. In 21 patients (47.7 percent), plication of the external oblique aponeurosis was performed. All patients achieved an improved abdominal contour, and 41 (93.2 percent) were satisfied with their result. Ten patients (22.7 percent) had minor complications. CONCLUSIONS: Clinical application of abdominoplasty techniques is feasible immediately after DIEP harvesting and must address not only skin and subcutaneous tissue but also the muscular abdominal wall. All of the musculofascial plication techniques improved the definition of the waistline. Patient selection is crucial to achieve a satisfactory outcome. The main objective is that patients safely undergo dual procedures with no increased risk and with the added aesthetic benefits at the abdominal donor site.
Abdominal Wall↗
[Spontaneous hematoma of the abdominal wall: diagnostic error of abruptio placentae].
An emergency cesarean section was performed in the 38th week of pregnancy in a patient with acute abdominal pain in the left upper quadrant. The ultrasound picture was interpreted as a retroplacentar hematoma. Cardiotocography demonstrated fetal tachycardia which was interpreted as asphyxia. A diagnosis of abruptio placentae was made, but was finally ruled out when the cesarean section was performed. The intraabdominal exploration revealed a large hematoma of the rectus sheath with about 800 ml of blood. After evacuation and drainage the postoperative recovery was uneventful. Sudden rupture of a deep epigastric vessel with formation of an abdominal wall hematoma also mimics intraabdominal conditions such as appendicitis, diverticulitis, cholecystitis, tumours and visceral injuries.
Abdominal Muscles↗