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Adjustable nylon ties for abdominal wall closure.

A study in 64 patients with a high risk of wound dehiscence or eviscerated wounds or in whom repeat laparotomies for peritoneal lavages due to sepsis were planned was accomplished using adjustable nylon ties for the closure of the abdominal wall, either as retention sutures or as one-layer sutures. The adjustable nylon ties are described, as well as the technique for placing and adjusting them. It is concluded that the adjustable nylon ties can substitute advantageously for the conventional retention sutures since the former are wider, easy to place, and can be readjusted to the point that they can be opened completely if it is necessary and then closed again. This is especially useful when repeat laparotomies for peritoneal lavages are required in patients with intra-abdominal sepsis.

Abdominal Muscles↗

[Increased wound healing disorders in patients with inguinal hernia caused by administration of antithrombotic agents in the abdominal wall].

In a prospective, randomized study, including 108 patients, we investigated the effect of different locations for the subcutaneous injection of low dosed or low molecular heparin following standard herniotomia. In the group with injection into the contralateral abdominal wall the rate of local surgical complications was four times higher compared to those patients with injections into the thigh. Thus we conclude that after herniotomia low dosed or low molecular heparin should be applied into the subcutis of the thigh.

Adult↗

[Extraskeletal mesenchymal chondrosarcoma of lateral abdominal wall (case report)].

Mesenchymal chondrosarcomas are very rare in comparison to the conventional types. They can occur from any location containing mesenchymal cells, but most arise in the lower extremities, leptomeninges and in the orbits. Other sites are very uncommon. We present a case of mesenchymal chondrosarcoma of the lateral abdominal wall, and this is the first report of the tumor localized in this region.

Abdominal Muscles↗

[Can we define "histological tolerance" of the abdominal wall after the implantation of various prosthetic materials?].

This experimental work is a comparative trial in the rat of 6 inert prostheses (3 permeable and 3 non-permeable) that are regularly used in man for the repair of large abdominal wall defects. This is performed in both aseptic and septic conditions. Serial macroscopic and bacteriological observations were done. Quantitative histological criteria were defined to characterize the resistance and biological tolerance to the material. This shows that: 1. the width of the cellular reaction, the number of giant, inflammatory, fibroblastic cells confirms the superiority of meshes whatever the implantation conditions; 2. the proportion of fibroblasts to inflammatory cells is a histological expression of the solidity of the repair and of the biological tolerance to the material (Acta chir. belg., 1977, 76, 575-582).

Abdominal Muscles↗

Tissue regenerating capacity of carbodiimide-crosslinked dermal sheep collagen during repair of the abdominal wall.

In future, the function of collagen-based biomaterials as temporary scaffolds for the generation of new tissue may be emphasized. In this study the function of dermal sheep collagen (DSC) crosslinked with carbodiimide (ENDSC) as repair material for abdominal wall defects in rats was compared with that of commercial hexamethylenediisocyanate-crosslinked HDSC. The results indicate that early after implantation both ENDSC and HDSC functioned well as a matrix for cellular ingrowth. However during further implantation HDSC soon degraded resulting in herniations, while ENDSC showed a delay in the degradation time of at least 20 weeks. ENDSC thereby enabled collagen new-formation and functioned as a guidance for muscle overgrowth. These results are very promising concerning the problem of the ongoing foreign body reaction with continuing risk of implant rejection observed in clinical practice with non-degradable materials.

Abdominal Muscles↗

The occurrence of an abdominal wall abscess 11 years after appendectomy: report of a case.

Most complications after appendectomy occur within 10 days; however, we report herein the unusual case of a patient in whom a wound abscess was detected more than 10 years after an appendectomy. A 26-year-old woman presented to our hospital with nausea and vomiting, pain, and a mass in the right lower abdominal wall. She had undergone an appendectomy 11 years previously. Physical examination revealed a tender mass, 5 cm in diameter, under the appendectomy scar. An abdominal ultrasonography demonstrated a low-echoic mass lesion measuring 9.0 x 5.0 x 2.0 cm. Incision of the connective tissue revealed about 3 ml of cream-colored and odorless fluid in the abscess cavity. Fistulography revealed an abscess cavity not communicating with the bowel lumen. Floss was discovered in the connective tissue and removed. Debridement of the abscess wall was performed and a piece of the wall was sent for histologic examination. Pathological examination revealed panniculitis of the subcutaneous tissue, and panniculitis with granulation and granuloma of the abscess wall. This case report demonstrates that a preoperative diagnosis should be based not on one finding, but on all findings collected, inclusively.

Abdominal Abscess↗

Abdominal wall lift systems in laparoscopic surgery: gasless and low-pressure systems.

Positive pressure pneumoperitoneum (12 mm Hg) is associated with adverse physiologic effects that can prove detrimental to certain high-risk patients with diminished cardiorespiratory reserve. Mechanical abdominal wall lift (AWL) has been proposed as an alternative method of exposure in laparoscopic surgery to obviate or minimize these adverse physiologic effects, the risk of CO(2) embolism in trauma patients, and tumor dissemination in patients undergoing laparoscopic surgery for cancer. This article reviews the systems available for AWL, the clinical applications of the technique, and the findings of the randomized controlled trials that compare AWL with conventional pneumoperitoneum. AWL systems do appear to reduce the adverse cardiovascular and respiratory effects, but they do so at the expense of surgical exposure, which is less optimal than that provided by the positive-pressure pneumoperitoneum. This reduced exposure increases the execution difficulty of the operation and, hence, the operating times. This problem is overcome by combination of AWL with low-pressure (3 to 4 mm Hg) pneumoperitoneum. This combination provides good surgical exposure without adverse cardiovascular consequences.

Humans↗

Surgical treatment of congenital defects in the abdominal wall.

A series of 28 patients is presented with the two conditions of omphalocoele and gastroschisis treated over a five-year period . Improved survival can be obtained by the use of staged procedures with a silastic prosthesis plus intravenous alimentation with later definitive operation. If peripheral veins are used, serious complications are almost totally avoided. This combined form of therapy is the treatment of choice in infants with massive defects in the abdominal wall.

Abdominal Muscles↗

Treatment and outcome of right colon cancers adherent to adjacent organs or the abdominal wall.

Fifty-four (4%) of 1284 patients treated for adenocarcinoma of the colon and rectum during a 10-year period ending in 1989 underwent potentially curative resection of right colon lesions found during surgery to be adherent to adjacent organs, abdominal wall, or retroperitoneum. Final pathologic staging was as follows: modified Dukes' class B1 (n = 2), B2 (n = 24), C1 (n = 1), and C2 (n = 27). Thirteen (24%) patients had postoperative complications, including two (3.7%) with sepsis. One patient died after surgery (mortality, 1.9%). Survival rates at 1, 3, and 5 years were 74%, 52%, and 37%, respectively. Only one (11%) of nine patients with pancreatic or duodenal adherence treated with limited resection was free of disease during follow-up. Adjuvant radiation therapy and chemotherapy did not improve survival. Histologic depth of tumor penetration could not be predicted by intraoperative assessment, and therefore radical resection is recommended whenever possible.

Abdominal Muscles↗

Abdominal wall defects: neonatal surgical problems.

The advantages accruing from the prenatal diagnosis of gastroschisis and omphalocele are outlined. The surgical management of each defect is discussed, including details of the various surgical options available at the time of the repair. Seventy-five cases with abdominal wall defects born between 1970 and 1984 without an antenatal diagnosis having been made are compared with 8 recent cases in whom an antenatal diagnosis was made. The early results suggest that antenatal diagnosis improves survival.

Abdominal Muscles↗

Microsurgical reconstruction of chest- and abdominal-wall defects associated with intraperitoneal vessels.

Microsurgical reconstruction of abdominal or chest-wall defects requires extreme precision but may still raise serious problems. In previous publications many methods have been reported, including free fascia graft, synthetic mesh, pedicled flap, and free flap with microvascular anastomoses. Free-flap transfer has become a popular operative procedure for such reconstructions. The recipient vessels utilized have been mainly the external peritoneal system. In some cases, however, it is very difficult to find adequate recipient vessels in the external peritoneal region. Intraperitoneal vessels may be obviously exposed in the surgical field because there has been a full-thickness defect of the abdominal or chest wall. These vessels are rather easily found and dissected. Their diameter is about 1 to 2 mm, appropriate for microvascular anastomoses with flap vessels in the reconstruction. Using intraperitoneal vessels for the recipient vessels has rarely been reported. The authors report three cases of reconstruction of full-thickness defects of the abdominal or chest wall, using these vessels as recipients for free flaps.

Abdomen↗

Cutaneous ciliated cyst of the abdominal wall: a case report with a review of the literature and discussion of pathogenesis.

A cutaneous ciliated cyst is a rare lesion typically found on the lower extremity of young girls shortly after puberty. Here, we report a case involving a previously unreported site (i.e., abdominal wall) in a 14-year-old girl. We also describe immunohistochemical and ultrastructural findings, review and analyze the world literature, and offer insights as to the pathogenesis of this lesion.

Abdominal Muscles↗