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PubMedDate not supplied

[Abdominal wall metastasis of pancreatic adenocarcinoma following laparoscopy].

Wound recurrence after oncologic surgery is known since 1885, but nowadays we deal with a new problem after the rapid diffusion of laparoscopically assisted surgery and the 22 cases of trocar site metastases already reported in literature. Aim of this paper is to present a case of cutaneous seeding of adenocarcinoma of the pancreas, in two trocar sites, after laparoscopy for lithiasis of the gallbladder. Diagnosis of neoplasia was made intraoperatively for the presence of peritoneal and omental carcinomatosis; no cholecystectomy was performed and after biopsy and postoperative TC-scan a chemotherapeutic treatment was started. Five months after the operation parietal seeding was evident and treated with local radiotherapy; the patient died one month later for further dissemination of the disease. The etiopathogenesis of tumor recurrence in the abdominal scar tissue is still unknown, local (trauma) and general (decreased immunologic defences) factors could be responsible. The apparent higher incidence after laparoscopic surgery could presuppose the presence of further specific risks: more tissue manipulation (increased cellular exfoliation), contact between trocar and abdominal wall for the whole operative period (malignant cell carrier), pneumoperitoneum. In conclusion, as 50% of the patients with cutaneous metastases die within 6 months after the operation and almost nobody is still alive after 4 years, it is necessary to establish if a real additional risk, due to the laparoscopic procedure, exists to contrast eventual benefits of the mini-invasive procedure.

Abdominal Muscles↗
PubMed2002

Laparoscopic tension-free repair of anterior abdominal wall incisional and ventral hernias with an intraperitoneal Gore-Tex mesh: prospective study and review of the literature.

BACKGROUND: Recurrence rates after repair of incisional and ventral hernias range from 18% to 52%. Prosthetic open repair has decreased this rate, but the wide fascial dissection it requires increases the complication rate. Laparoscopic repair is a safe and effective alternative. PATIENTS AND METHODS: A prospective study was performed including 86 patients (63 women and 23 men) with a mean age of 54 years (range 29-79 years) having incisional or ventral hernias who underwent laparoscopic repair in our institution between July 1994 and October 2001. The majority of the patients were obese with a mean body mass index of 31.7 kg/m2. The abdominal wall defect size ranged from 2 X 1 cm to 20 X 13 cm. In all cases, a Gore-Tex mesh (Dual Mesh, W.L. Gore & Associates, Flagstaff, AZ, USA) was used in sizes ranging from 10 X 15 cm to 20 X 30 cm. RESULTS: Nineteen repairs were performed for recurrent hernias (12 incisional and 7 ventral). The mean operative time was 110.3 minutes (range 50-240 minutes). There was one open conversion (1.2%), one intraoperative complication (1.2%), and no deaths. There were no wound or mesh infections. Immediate postoperative complications occurred in 9 patients (10.6%) and late complications occurred in 16 patients (18.8%). The average hospital stay was 4.8 days (range 2-19 days). During a mean follow-up of 37 months (range 6-73 months), there were 6 hernia recurrences (7%). CONCLUSION: Laparoscopic repair of incisional hernia and ventral hernia appears to be safe, especially with the use of Gore-Tex mesh, and is proving to be effective as it decreases pain, complications, hospital stay, and recurrences.

Adult↗
PubMedDate not supplied

Laparoscopic hepatic resection: a new and safe procedure by abdominal wall lifting method.

HCC is well known for its high incidence of intrahepatic tumor recurrence and many patients suffering from them, usually undergo further treatments, such as PEI, TAE, MCNT or hepatic resection. However, conventional hepatic resection by large skin incision causes severe intraabdominal adhesions, which disturb US examination and further treatments. The aim of the laparoscopic procedure is to prevent intraabdominal adhesions. This is a study of the feasibility of laparoscopic hepatic resection without CO2 pneumoperitoneum, which is not yet popular, as a safe and effective procedure. The patient in this study had a solitary HCC in the lateral segment. Mobilization of the lateral segment, dissections of the left hepatic artery and portal venous branches, i.e. P2 and P3, were performed under CO2 gas insufflation. However, to avoid CO2 gas embolism, further procedures, including parenchymal compression and hepatic venous dissection, were performed using the abdominal wall lifting method without pneumoperitoneum. The patient could eat on the second postoperative day and had an uneventful postoperative recovery and was discharged from the hospital 13 days after surgery. Hospital stay was shorter than conventional hepatic resections with large skin incisions. The importance of this procedure lies in that it is not only a minimally invasive procedure, but also provides us with the possibilities of further treatments, including PEI and re-hepatic resection.

Abdominal Muscles↗
PubMed2002

Association between abdominal wall fat index and carotid atherosclerosis in women.

We tried to investigate whether accumulation of visceral fat assessed by a simple but widely used ultrasonography was associated with common carotid atherosclerosis in women. The subjects were consecutively admitted in-patients whose body mass index was more than 22 kg/m2. Those with cardiorenal or nutritional disorders that would affect blood pressure, and lipid and glucose metabolism were excluded. An ultrasonographic evaluation with a 7.5 MHz linear type B-mode probe was performed by a specialist to determine the intima-media thickness (IMT) of the common carotid artery and maximum thickness of preperitoneal fat (Pmax) at the anterior surface of the liver and the minimum thickness of subcutaneous fat (Smin) of the abdomen. The Pmax/Smin ratio which was termed the abdominal wall fat index (AFI), was then calculated. The subjects were 241 women aged 69 +/- 12 (range, 26-104) years. Multiple regression analysis using the IMT as an object variable, adjusted by various risk factors as explanatory variables showed that AFI [odds ratio, 2.995; 95% confidence interval, 1.106-8.109] was a significant independent contributing factor along with known risk factors such as age, systolic blood pressure, total-cholesterol, and HDL-cholesterol.AFI was useful in evaluating disorders of metabolism, circulation and atherosclerosis.

Abdomen↗
PubMed2001

Transport of protein in the abdominal wall during intraperitoneal therapy. I. Theoretical approach.

Intraperitoneal therapies such as peritoneal dialysis or regional chemotherapy use large volumes of solution within the peritoneal cavity. These volumes increase intraperitoneal hydrostatic pressure (P(ip)), which causes flow of the solution into tissues that surround the cavity. The goal of this paper is to integrate new experimental findings in a rigorous mathematical model to predict protein transport from the cavity into tissue. The model describes non-steady-state diffusion and convection of protein through a deformable porous medium with simultaneous exchange with the microcirculation and local tissue binding. Model parameters are dependent on local tissue pressure, which varies with P(ip). Solute interactions with the tissue in terms of local distribution volume (solute void space), local binding, and retardation relative to solvent flow are demonstrated to be major determinants of tissue concentration profiles and protein penetration from the peritoneal cavity. The model predicts the rate of fluid loss from the cavity to the abdominal wall in dialysis patients to be 94 ml/h, within the observed range of 60-100 ml/h. The model is fitted to published transport data of IgG, and the retardation coefficient f is estimated to be 0.3, which markedly reduces the rate of protein penetration and is far lower than previously published estimates. With the value of f = 0.3, model calculations predict that P(ip) of 4.4 mmHg and dialysis duration of 24 h result in several millimeters of protein penetration into the tissue.

Abdominal Muscles↗
PubMed2005

Association between abdominal wall fat index on ultrasonography and carotid atherosclerosis in non-obese men.

We tried to investigate whether accumulation of visceral fat, assessed by a simple but widely used ultrasonographic method, was associated with common carotid atherosclerosis in non-obese men ranging from 16 to 79 years old. The subjects were consecutive 297 male in-patients whose body mass index ranged from 18.5 kg/m(2) to 25 kg/m(2). An ultrasonographic evaluation using a 7.5 MHz linear type B-mode probe was performed by a specialist to determine the intima-media thickness (IMT) of the common carotid artery and the maximal thickness of peritoneal fat (Pmax) at the anterior surface of the liver and the minimal thickness of subcutaneous fat (Smin) of the abdomen. The Pmax/Smin ratio, which was termed the abdominal wall fat index (AFI), was then calculated. The mean age +/- standard deviation in this series was 65 +/- 13 (range, 15-79) years. Multiple regression analysis using IMT as an objective variable, adjusted by various risk factors as explanatory variables, showed that AFI [beta, 0.0538; 95% confidence interval (CI), 0.0116-0.0960] was a significant independent contributing factor along with known risk factors such as age, smoking status, systolic blood pressure, HDL-cholesterol and LDL-cholesterol. We found that AFI was useful in evaluating disorders of metabolism and atherosclerosis in non-obese men.

Abdomen↗