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[Biologic material for closure of abdominal wall defects].

A new preparation process was studied which should allow the implantation of collagen type I in its native structure in reconstructive surgery, in this special case for closure of incisional hernias. As experimental animals we used 30 female Lewis rats. A defect of the anterior abdominal wall - measuring 3 X 4 cm - was closed with our collagen substitute. Biopsies were taken after 4, 6 and 8 weeks and examined morphologically. As criteria for revitalization and revascularisation we used type of immigrated cells, depth and density of immigration and formation of new blood vessels. After 4 weeks the implants were immigrated by fibroblasts, density diminishing towards the centre. On the muscle-implant-interface good revascularisation could be seen. After 6 weeks density of immigrated cells has distinctly increased even in the centre of the collagen implant. Sporadically small vessels could be seen. Eight weeks after implantation density of immigrated cells was at the same high level, and capillary bundles could be seen within the whole implant. We think that the studied collagen implant is suitable for the closure of hernias as shown by its physical and morphological properties. Especially it seems to guarantee an earlier and tighter closure of hernias in comparison to other materials.

Abdominal Muscles↗

Bilateral photon deficient area along lateral abdominal wall in a Tc-99m DTPA renogram. A sign of massive ascites.

A patient with congestive heart failure and hepatic and renal dysfunction underwent Tc-99m DTPA renal scintigraphic studies in which persistent cardiac blood pool activity, hepatic arterialization, and a longitudinal photon deficient area in each side of the abdominal wall were observed. The increase in hepatic artery inflow was believed to be due to a decrease in portal inflow of the liver. The elevation of portal pressure secondary to heart failure is attributable to the decrease in portal inflow of the liver; this phenomenon could account for the hepatic arterialization. Progressive renal dysfunction with high body background resulted in demonstrable ascites as photon deficient areas. Scintigraphic findings of hepatic arterialization plus an abdominal photon deficient area reflect severe heart failure and renal dysfunction.

Abdominal Muscles↗

Clostridial gas gangrene of the abdominal wall after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is associated with a considerable rate of infectious complications of up to 2.8%. Such infections are usually of minor clinical importance. However, we observed a case of life-threatening Clostridial gas gangrene centering around the right lateral port site and developing across all of the right-sided abdominal wall, causing septic shock and severe multi-organ failure. Considering the overall infection rate and the possibility of even severe morbidity, we advocate perioperative antibiotics in laparoscopic cholecystectomy.

Abdominal Muscles↗

[Retrospective and comparative study of the medicoeconomical impact of a new mesh in the treatment of anterior abdominal wall incisinal hernia].

STUDY AIM: Determine the gain of hospitalization cost using a new intraperitoneal mesh compared to the retro-muscular pre-fascial implantation of a polyester mesh. PATIENTS AND METHODS: From January 1998 to June 2000, 52 patients with incisional hernia of the anterior abdominal wall were operated using intraperitoneal Parietex composite Mesh. The cost of surgery, anesthesia and hospitalization in this group were compared to similar data from a group of 21 patient where a Mesrsuture mesh in a prefascial retromuscular position was used. RESULTS: Parietex Composite Mesh in intraperitoneal position allows a significative reduction in surgery time, anesthesia time and hospitalization. The clinical results were confirmed by cost savings. CONCLUSION: Using new innovative medical device changing surgery technique insures significant cost saving despite its initial additional cost and increases patient's comfort during hospitalization.

Cost Savings↗

[Full-thickness abdominal wall closure of laparoscopic trocar incision sites: a new, simplified technique].

Description of a safe, quick, easy and cheap technique of suture closure of laparoscopic trocar sites utilizing a reusable instrument ("hook-needle") developed for the purpose. The procedure is done under laparoscopic vision without the need for laparoscopic suture handling and results in a one stage closure of all relevant layers of the abdominal wall. Other techniques recently published for the same purpose are critically reviewed.

Abdominal Muscles↗

Laparoscopic cholecystectomy using the abdominal wall lift in a cardiac patient.

We present a case report of a patient with impaired cardiac function after aortic valve replacement and open mitral commissurotomy who underwent a laparoscopic cholecystectomy for cholecystolithiasis. In preventing reduced cardiac output due to pneumoperitoneum, the laparoscopic operative procedure was performed using the abdominal wall lift. Cardiac function was continuously evaluated by transesophageal echocardiographic examination and remained stable during the surgery. Because of the patient's co-existing chronic atrial fibrillation and prosthetic aortic valve, perioperative anticoagulation management was carried out. The patient's post-operative course was uneventful, and he was discharged on the 7th post-operative day.

Cholecystectomy, Laparoscopic↗

Use of vascularized abdominal wall pedicle flaps to grow small bowel neomucosa.

Growing new mucosa from remnants of small bowel remaining in patients with short-bowel syndrome might offer a strategy for solving this clinical problem. We have performed a series of experiments investigating the possibility of growing rabbit ileal mucosa on vascularized pedicle flaps of abdominal wall musculature based on the inferior epigastric artery. By patching a defect of distal ileum with a skeletal muscle flap, we were able to demonstrate bowel augmentation by neomucosal ingrowth. Light and scanning electron microscopy confirmed the presence of essentially normal mucosa with well-developed villi atop the skeletal muscle pedicle flap. The mucosa was stripped from the skeletal muscle and compared with stripped mucosa from adjacent ileum in the Ussing chamber in 11 rabbits. The electrophysiologic studies showed no significant difference between normal mucosa and neomucosa in short-circuit current (Isc), potential difference or tissue conductance. The addition of 10 mM glucose resulted in similar unidirectional glucose flux and increase in Isc in both tissues. Bile salt absorption was also similar in both tissues. We conclude that neomucosa can be grown on flaps of skeletal muscle and is similar to normal mucosa by microscopic and electrophysiologic evaluation.

Abdominal Muscles↗

Abdominal wall penetration by a police "bean bag".

Police departments across the country now have at their disposal a "nonlethal" weapon known as a "bean bag" shotgun. The bean bags, which come loaded in standard shotgun shells, are missiles intended to disable dangerous suspects without having to resort to lethal force. They were specifically designed not to create penetrating injuries. Here we present a case of abdominal wall penetration by a police bean bag. To our knowledge this is the first such reported case of this type of injury.

Abdominal Muscles↗