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Abdominal wall hernia repair: use of the Gianturco-Helfrich-Eberbach hernia mesh.

A new polyester hernia mesh (Gianturco-Helfrich-Eberbach) is introduced for laparoscopic repair of the abdominal wall and groin hernias. The device incorporates the optional use of an internal wire to form a circular shape. A detachable carrier is used, permitting easy, accurate preperitoneal placement. Thirty-four patients with groin hernias and five with ventral hernias were repaired without significant complication. This innovative device greatly facilitates mesh placement during transabdominal or extraperitoneal laparoscopic repair, reducing technical difficulty and operative time. It further broadens the use of laparoscopy to repair ventral hernias.

Adult↗

Abdominal wall defect with liver appendage.

We present an unusual case in which an appendage of the liver was the only herniated organ through a small defect on the left lower quadrant of the abdominal wall. To our knowledge this is the first case reported with this malformation.

Abdominal Muscles↗

The vascular anatomy of the inner anterior abdominal wall with special reference to the transversus and rectus abdominis musculoperitoneal (TRAMP) composite flap for vaginal reconstruction.

This study was designed to clarify the vascularization of the inner anterior abdominal wall with respect to the novel transversus and rectus abdominis musculoperitoneal (TRAMP) flap, which was introduced recently for vaginal reconstruction. A series of human cadavers was injected with a lead oxide-gelatine mixture by means of the deep inferior epigastric artery and subsequently dissected and examined by radiography. In all cases we found that the blood supply of the entire rectus abdominis muscle from the symphysis to the costal arch and that of the medial 10 to 15 cm of the transversus abdominis muscle, as well as the underlying peritoneum, was provided by several branches of the deep inferior epigastric artery. "Choke" arteries to the superior epigastric artery and also to the intercostal arteries (X, XI, and XII) have been shown to be common features. From the anatomic point of view, these observations offer the possibility of mobilizing large parts of the transversus abdominis muscle together with the rectus abdominis muscle for reconstructive surgery.

Abdominal Muscles↗

Early effects of exogenous arginine after the implantation of prosthetic material into the rat abdominal wall.

We have investigated the effects of high arginine (Arg) levels (7.5 mg/100 g body weight per hour) on the early integration of biocompatible mesh grafts into the rat abdominal wall. Studies were performed over implantation intervals of 6, 12, 24 or 48 hours (n=12, each). Arginine and related compounds were quantified in plasma, wound fluids and multiple tissues. Plasma nitric oxide (NO) production was studied. Strips were taken from the polypropylene fiber-host tissue interfaces (PTIs) for optical microscopic analysis and for immunohistochemical analysis using rat-specific antibodies against type I and type III collagens. Exogenous Arg was metabolized at the peripheral tissues but reliably reached the wound space. High amounts of Arg and ornithine (Orn) were detected in the specimens considered. No changes on citrulline (Ctr) or NO concentrations were observed, overall suggesting that, during the period studied, the arginase pathway predominated. The acute scarring response differed significantly in the two placements considered. The P-SS interface evidenced more extensive new tissue growth than the P-DS interface. Forty-eight hours after mesh implantation cellular infiltration, fibroblast proliferation, and mesh-surrounding angiogenesis were higher in the arginine-treated rats. Type III collagen staining was related to arginine treatment, being higher (++) in the study group. In conclusion, and independently of the site of mesh placement, supplemental Arg seemed to favorably affect early local collagen deposition. This could be potentially helpful to ameliorate the integration of biomaterials into the tissues and, consequently, to allow for the design of more selective therapeutic strategies to prevent hernia recurrence rates.

Abdominal Muscles↗

Implants in the abdominal wall of the rat.

An experimental model is presented that allows qualitative as well as quantitative studies of the soft tissue response to implant materials used in reconstructive surgery. Plugs of non-alloyed titanium and polymers (Teflon, Delrin) were inserted into the abdominal wall of rats, with a portion of the plug penetrating through the peritoneum into the abdominal cavity. The tissue reaction was evaluated by means of light and electron microscopy for up to 9 weeks after insertion. Titanium implants were in direct contact with the connective tissue without intervening inflammatory cells. The defect in the peritoneum was sealed by a close apposition of the mesothelial membrane to the titanium surface and no connective tissue surrounded the intra-peritoneal portion of the plug. In contrast, a fibrous capsule surrounded the intra-peritoneal portion of Teflon and Delrin implants. A reactive zone consisting of active macrophages and giant cells was present at the surface of these implants separating the implant from the surrounding fibrous capsule. This study shows that the tissue response at the interface to foreign materials can be studied using light and electron microscopic techniques and that profound differences in tissue response exist between different materials.

Abdominal Muscles↗

Risk factors in congenital abdominal wall defects (omphalocele and gastroschisi): a study in a series of 265,858 consecutive births.

The aim of this study was to describe the prevalence at birth of two abdominal wall defects (AWD), omphalocela and gastroschisis and to identify possible etiologic factors. The AWD came from 265,858 consecutive births of known ouome registered in the registry of congenital malformations of Strasbourg for the period 1979 to 1998. Request information on the child, the pregnancy, the parents and the family was obtained for cases and for controls. Hundred five cases with AWD were analysed, 55.2 % were omphalocele and 44.8 % were gastroschisis. The mean prevalence rate for omphalocele was 2.18 per 10,000 and for gastroschisis 1.76 per 10,000. Associated malformations were found in 74.1 % of omphalocele compared with 53.2 % of gastroschisis; 29.3 % of fetuses with omphalocele had an abnormal karyotype, 44,8 % had a recognizable syndrome, association or an unspecified malformation pattern; 51.0 % of fetuses with gastroschisis had additional malformations that were not of chromosomal origin, but 1 case. Antenatal ultrasound examination was able to detect 39 (67.2 %) cases of omphaloceles and 27 (57.4 %) cases of gastroschisis. In 30 (51.7 %) cases of omphalocele and in 7 (14.9 %) cases of gastroschisis parents opted for termination of pregnancy. The overall survival rate was 14 (24.1 %) for omphalocele and 30 (63.8 %) for gastroschisis. Weight, length and head circumference at birth of infants with AWD were less than those of controls. The weight of placenta of infants with AWD was not different from the weight of placenta of controls. Gastroschisis was associated with significantly younger maternal age than omphalocele. Pregnancies with AWD were more often complicated by threatened abortion, oligohydramnios and polyhydramnios. Mothers of children with AWD took more often medication during pregnancy than mothers of controls.

Abdominal Muscles↗

A population-based study of abdominal wall defects in South Australia and Western Australia.

The purpose of this study was to determine the prevalence, clinical characteristics, prenatal diagnosis and occurrence of other birth defects with abdominal wall defects in births and terminations of pregnancy in South Australia (SA) and Western Australia (WA) over the period 1980-90. Cases of gastroschisis, exomphalos, bladder exstrophy, cloacal exstrophy and body stalk anomaly were ascertained from the WA Birth Defects Registry (1980-90) and the SA Birth Defects Register (1986-90). The registers are comparable population-based data collections with information on livebirths and stillbirths of at least 400 g birthweight or 20 weeks' gestation, and terminations of pregnancy for fetal abnormality. The prevalence of gastroschisis was 1.65/10,000 births (59 cases) and of exomphalos 2.90/10,000 births (104 cases). There was no significant difference in prevalence of exomphalos or gastroschisis between SA and WA for the years 1986-90. However, if data from WA for the years 1980-85 were included, SA had a significantly higher prevalence of exomphalos (prevalence ratio 1.71, confidence interval [CI] 1.16-2.55), although not of gastroschisis (prevalence ratio 1.35, CI 0.79-2.32). Exomphalos was significantly more common in mothers < 20 years (odds ratio [OR] 2.45, CI 1.22-4.86) and in mothers of 40 years or older (OR 5.65, CI 1.69-16.77). Gastroschisis was more common in younger mothers (OR 8.76, CI 4.02-19.32). Both exomphalos and gastroschisis were associated with low birthweight, prematurity, intrauterine growth retardation and caesarean section. The reason for the higher prevalence of exomphalos in SA than WA was not clear, but may be related to differences in prenatal diagnosis. The association between maternal age < 20 years and exomphalos raises the possibility of common factors in the aetiology of gastroschisis and exomphalos.

Abdominal Muscles↗

Scanning electron microscopy of the structural reconstruction of the abdominal wall after experimental paramedian incision.

The various healing stages of experimental paramedian incisions in the right rectus sheath of 36 albino rats were examined by utilizing the scanning electron and the light microscope. The successive reconstruction processes were visualized stereoscopically at a cellular level. During the inflammatory stage (7 days) various inflammatory cells accumulated around a wide network of trabeculae which traversed the gap of the wound. The fibrillogenetic stage increased in the period between the 2nd and 12th weeks postoperatively. Various stages of fiber maturation were visualized. Mechanisms of fiber formation, maturation, and junction between the newly formed fibers and the old healthy ones at the wound margin were also seen three dimensionally and described. The newly formed fibers were always arranged parallel to each other in a definite direction. This direction had a constant angular relationship to the long axis of the wound, i.e., the line of incision, regardless of the direction of the incision itself. This constant relationship might prove to be useful to the surgeon while choosing his incision in the anterior abdominal wall.

Abdominal Muscles↗

Pelvic abscess with fistula to the abdominal wall due to verrucous carcinoma.

The case report of a 38-year-old woman with a pelvic abscess resulting from verrucous carcinoma of the uterine cervix is presented. This case is remarkable because the abscess formed a fistula through the anterior abdominal wall and because there was no visible lesion on the cervix. The patient underwent a total abdominal hysterectomy, left salpingectomy, fistulectomy, and removal of the abscess. Diagnosis was made on pathologic examination of the extirpated specimen. Genital tract verrucous carcinoma and genitocutaneous fistulae are reviewed.

Abdominal Abscess↗

An isolated abdominal wall metastasis of ovarian carcinoma ten years after primary surgery.

This report describes the case of a woman with early stage ovarian carcinoma who developed an isolated metastasis in the anterior abdominal wall following an apparent disease-free interval of ten years. The management of the case is discussed and important factors are highlighted. Comparison is also made to the phenomenon of port-site recurrence following laparoscopy in cases of ovarian carcinoma.

Abdominal Muscles↗

In vivo exploration of the tensile strength of the abdominal wall after repair with different prosthetic materials. Experimental study in the rat.

The problem of parietal herniation seems to be a simple mechanical one for which there should be a safe method of repair. In the present study, the bursting strength of abdominal wounds was explored by mechanical investigation and the repair process evaluated at a cellular level by quantitative microscopy. Both methods of investigation show that mesh materials have advantages over nonporous cloth materials in the repair of large defects of the abdominal wall.

Abdominal Muscles↗

Changing trend in congenital abdominal wall defects in eastern region of Ireland.

In the past six years, there have been reports from abroad of an unexplained rise in the birth prevalence rate of the congenital abdominal wall defect gastroschisis, while rates for the macroscopically similar anomaly omphalocoele have remained stable. The Dublin EUROCAT Registry of congenital anomalies monitors trends in the birth prevalence of birth defects in the eastern region of Ireland. We analysed births of children with omphalocoele and gastroschisis born in the period 1981-2000, with comparisons of a number of demographic and obstetric variables. During the 20 year period the birth prevalence rate for omphalocoele remained stable at 2.5/10,000 births, whereas the rate for gastroschisis increased significantly during the 1990s from 1.0/10,000 in 1991 to 4.9/10,000 in 2000. Most of the increase occurred among mothers under 25 years of age. Omphalocoele was associated with a relatively high proportion of other major congenital anomalies. This study showed that there has been an unexpected rise in the birth prevalence of gastroschisis in the region, similar to that experienced in other countries in the same time period and likely to have common aetiological features.

Adult↗

[Influence of pre- and postnatal exercises on the abdominal wall].

The authors took a number of biometric measurements from two groups of young women who had had babies. A statistical study of the facts that were obtained shows that muscular strength and tone in the abdominal wall comes back quicker in women who have followed specialised courses of gymnastics before and after delivery.

Abdominal Muscles↗

Translocation of the umbilical artery to the lower abdomen: an adjunct to the postoperative monitoring of arterial blood gases in major abdominal wall defects.

A technique is presented for preserving the umbilical arteries for postoperative monitoring of arterial blood gases after repair of giant omphaloceles and gastroschisis. Translocation of the arteries to the lower abdominal wall removes them from the operative field and allows cannulation and long-term blood sampling. Complications have been minimal and the improved application of modern pulmonary support mechanisms has materially contributed to better patient management. The technique is a simple one and may prove applicable to other major newborn medical and surgical diseases involving respiratory insufficiency.

Abdomen↗

Cellular variant of extraskeletal myxoid chondrosarcoma of abdominal wall--a case report with comparative immunohistochemical study on cartilaginous collagenous proteins in various myxoid mesenchymal tumors.

A rare cellular variant of recurrent extraskeletal myxoid chondrosarcoma occurring in the right lower abdominal wall of a 70-year-old man, is presented with emphasis on a characteristic distribution pattern of cartilaginous collagen proteins in the stroma. While the primary and the first recurrent tumors showed the typical histology of extraskeletal myxoid chondrosarcoma, the later tumor, which recurred 14 years after the first resection, comprised mostly compact nodules of proliferating anaplastic cells with little mucoid stroma. Some areas presented a hemangiopericytomatous pattern. A few nodules possessed abundant myxoid stroma. Immunohistochemically, type II collagen was demonstrated in the stroma of some cellular areas, and type VI collagen was intensely stained around individual tumor cells both in cellular and myxoid areas. In a comparative immunohistochemical study, the same distribution pattern of cartilaginous collagen proteins was observed only in skeletal myxoid chondrosarcomas, but not in other mesenchymal tumors with abundant myxoid stroma. These findings seem to support the cartilaginous nature of extraskeletal myxoid chondrosarcoma, and will facilitate the differential diagnosis of soft-tissue tumors with myxoid stroma.

Abdominal Muscles↗

Giant spigelian hernia due to abdominal wall injury: a case report.

Spigelian hernia is a rare clinical entity. It is difficult to diagnose due to its location. In this article we report the case of a giant spigelian hernia consequent to abdominal wall injury. The neck of the hernia was 10 cm in diameter. We repaired this hernia with a polypropylene mesh.

Abdominal Injuries↗