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PubMedDate not supplied

Ultrasonic detection of viscera slide as an indicator of abdominal wall adhesions.

Real-time ultrasonography can detect the movement of viscera immediately deep to the abdominal wall. This motion of abdominal contents is called viscera slide, and is produced by the force of respiratory motion (spontaneous viscera slide) or by manual ballottement of the abdomen (induced viscera slide). Viscera slide was observed in 18 "normal" subjects (no history of previous abdominal surgery or peritonitis) and in 24 subjects at "risk" for abdominal wall adhesions because of previous abdominal operations or past history of peritonitis. In 14 of the 24 "risk" group subjects, spontaneous and induced viscera slide was restricted to excursions of less than 1 cm (58.3%). Operations were performed on 18 patients, which confirmed the fact that restriction of ultrasonically detected viscera slide identified abdominal wall adhesions in all cases, but no adhesions were found in patients with normal viscera slide. This ultrasonic finding of restricted viscera slide may be useful in the preoperative discovery and localization of abdominal wall adhesions prior to laparoscopy or laparotomy.

Abdomen↗

PubMed1980

Ultrasonic diagnosis of surgical diseases of the anterior abdominal wall.

The use of ultrasound in surgical diseases of the abdominal wall has received scant attention. The criteria for the ulrasonic diagnosis of abdominal wall disease and the usefulness of ultrasound in patients with incisional pain, occult hernias and abdominal wall masses are illustrated by the records of these patients. Ultrasound of the abdominal wall is a safe, rapid and noninvasive test that can be performed in any patient population, including the postoperative patient, without risk of contrast reaction of radiation exposure.

Abdominal Muscles↗

PubMed2006

The use of acellular dermal matrix for contaminated abdominal wall defects: wound status predicts success.

BACKGROUND: Contaminated abdominal wall fascial defects present a challenging problem. The use of human acellular dermal matrix (AlloDerm; LifeCell Corp., Branchburg, NJ) provides a novel method of primary closure of abdominal wall defects in this setting. The aim of the current study was to determine what factors predicted fascial wall failure as determined by the presence of hernia on follow-up exam after AlloDerm placement. METHODS: All patients who underwent surgery for contaminated abdominal wall fascial defects with placement of AlloDerm from June 2003 to September 2005 at a tertiary care Veterans Affairs hospital were included in the analysis. Patients were followed until hernia recurrence or last clinic visit. RESULTS: Eighteen patients had AlloDerm placed for contaminated fascial defects and all were included in the analysis. Primary wound closure was performed on 12/18 (67%) patients, with 6/18 (33%) patients initially left with open wounds. Patients with open wounds were treated with wound vacuum-assisted closure (VAC) devices (4/6) or saline dressings (2/6). Overall ventral hernia recurrence rate was 50% (9/18) with an average follow up of 9.1 months. Patients who had primary wound closure at the completion of the operation had a 33% (4/12) recurrence rate. Patients who did not have primary wound closure had an 83.3% (5/6) recurrence rate. The significant difference shows (P = .03) that open wound status predicts recurrence. The average size of AlloDerm sheets used was 164.0 cm2 in the closed group and 146.2 cm2 in the primary open wound group (P = .64). Average cost per patient was 4680 dollars for AlloDerm. CONCLUSION: These data suggest that an open wound in the postoperative period after AlloDerm placement for treatment of contaminated fascial defects is associated with a high probability of hernia recurrence. Our data do not support the use of this expensive material unless there is a good chance of having a closed wound.

Abdominal Wall↗

PubMed1983

Comparative evaluation of synthetic meshes used for abdominal wall replacement.

The lack of adequate fascia for closure of large hernias and traumatic abdominal wall defects has led to a search for suitable fascial substitutes. In this study closure of rabbit abdominal wall defects with knitted polypropylene, knitted polytetrafluoroethylene (PTFE), and molded polyglactin mesh was evaluated for bursting strength, fibrous tissue incorporation, and inflammatory reaction. Full-thickness, inch-square defects in the abdominal walls of rabbits were closed with use of the synthetic meshes, and similar defects in the contralateral abdominal walls were closed with a vascularized flap of external oblique fascia (control flaps). The animals were sacrificed at 3 and 12 weeks, the abdominal walls were removed, and the bursting strength of the grafts and control flaps was determined with a tissue tensometer. Polypropylene and PTFE meshes were similar in bursting strength and not greatly different from controls at 3 and 12 weeks. At 3 weeks polyglactin mesh had a bursting strength comparable to that of control flaps but at 12 weeks was significantly weaker. Fibrous tissue incorporation within the mesh fibers was better with PTFE mesh than with polypropylene mesh. Adequate fibrous tissue incorporation into polyglactin mesh before hydrolysis did not occur, making it an unsatisfactory material for use for permanent abdominal wall replacement.

Abdominal Muscles↗

PubMed1990

Abdominal wall pain: an alternative diagnosis.

The cause of abdominal pain need not necessarily reside in the viscera; the abdominal wall is another source of symptoms. Some causes of abdominal wall pain are obvious, e.g. hernias, but not so others such as nerve entrapment syndromes. This review is concerned with causes of abdominal wall pain which, although common, may be easily overlooked.

Abdominal Muscles↗

PubMed1986

Excision of abdominal wall tumours and reconstruction with Marlex mesh.

Because metastatic abdominal wall tumours are rare and their biologic activity is unpredictable, they must be managed aggressively (a) for potential cure of isolated recurrences and (b) to obtain good palliation, as fetid exophytic lesions alter the patient's self-image and life-style. An aggressive surgical approach often leaves a large abdominal wall defect. The authors describe 19 patients (10 men, 9 women) with these tumours who had their abdominal wall reconstructed with Marlex mesh. All patients received antibiotics preoperatively, but 16 had either mechanically unprepared bowel due to obstruction or abdominal contamination from the intestine intraoperatively. The commonest complication was wound abscess in 10 patients; it was controlled without removing the Marlex mesh. The majority of patients had prolonged palliation with greatly reduced symptoms, a reasonable quality of life and acceptable cosmesis. Potentially life-threatening intra-abdominal complications were reduced. One patient was considered cured. The authors believe that there is a definite role for aggressive surgical management of abdominal wall metastases and that Marlex mesh may be used for reconstruction even when there has been peritoneal contamination.

Abdominal Muscles↗

PubMed1995

Conventional pneumoperitoneum compared with abdominal wall lift for laparoscopic cholecystectomy.

We have compared, in a randomized study, conventional carbon dioxide pneumoperitoneum with abdominal wall lift in 25 patients undergoing laparoscopic cholecystectomy. Intra-abdominal pressure (IAP) (11 (SD 2) mm Hg vs 2.7 (9) mm Hg) (P < 0.01) and total amount of carbon dioxide used (40 (23) litre vs 9 (7) litre) (P < 0.001) were significantly less with abdominal wall lift. Pulmonary compliance was significantly greater (P < 0.01) in the abdominal wall lift group throughout operation. During the first 15 min of insufflation, arterial pressures were lower with abdominal wall lift (P < 0.05). In the conventional pneumoperitoneum group, femoral vein pressure increased (P < 0.01) and remained elevated for 3 h in the recovery room. Postoperative drowsiness was of significantly longer duration in the conventional pneumoperitoneum group than in the abdominal wall lift group (98 (46) min vs 13 (34) min) (P < 0.01). Postoperative nausea and vomiting and right shoulder pain occurred more often in patients with conventional pneumoperitoneum (P < 0.05). We conclude that the benefits of abdominal wall lift may be attributed to avoiding excessive carbon dioxide and high IAP.

Abdominal Muscles↗

PubMed1998

Influence of different trocar tips on abdominal wall penetration during laparoscopy.

Most trocars currently used to place a cannula through the abdominal wall have a conical or pyramidal tip. Because the risk of inadvertent injury along with removal of the cannula is probably related to (a) the force needed to traverse the abdominal wall, (b) the force needed to remove the trocar, and (c) the defect in the abdominal wall, the optimum configuration of the penetrating tip should be determined. The entry force needed to perforate the abdominal wall, the removal force necessary to remove the trocar, and the defect in the abdominal wall were measured in a porcine model under standardized conditions (general anesthesia, 12 mmHg pneumoperitoneum). Nineteen trocars (six disposable, seven reusable, six custom-made) have been tested. They were divided into six groups according to the shape of the tip (conical, pyramidal, or a combination). The entry force (F = 25.6, p < 0.0001) and the removal force (F = 5.1, p < 0.01) were related to the shape of the tip. Conical tips needed a higher force than purely pyramidal tips. The abdominal defect was also different between groups (F = 6.5, p < 0. 001). The trocar with a pyramidal shape caused a greater defect than conical tips. The defect in the abdominal wall was inversely related to the entry force (r = -0.55, p < 0.001) and to the removal force (r = -0.57, p < 0.001). There is not an optimum configuration of a simple push-through trocar with a low entry force and a high removal force. Some kind of a conical tip is recommended for insertion of trocars under direct view.

Abdominal Muscles↗

PubMed1991

Abdominal wall function after rectus abdominis transfer.

The abdominal wall function of 57 patients who have undergone TRAM flap breast reconstructions using the whole rectus muscle, on one side (33 patients) or both (24 patients), was evaluated 6 months to 2 years after surgery. The defect was repaired with a Teflon mesh buried in the rectus sheath. There was a perfect tolerance to the mesh, and no hernia or bulging of the abdominal wall developed. Patients had less back pain after (10 patients) than before (18 patients) the operation and found their sit-up and sport possibilities about the same as before. Detailed assessment of the abdominal muscles by the physiotherapist showed, however, a decreased function, more evident in bilateral cases. CT scans demonstrated a medialization of the lateral muscles, leaving only a small medial portion of the abdominal wall devoid of muscles. On the whole, no problem of clinical significance was encountered, and patients showed a high degree of satisfaction with the operation.

Abdominal Muscles↗

PubMed2006

An MRI investigation into the function of the transversus abdominis muscle during "drawing-in" of the abdominal wall.

STUDY DESIGN: An operator blinded dual modality trial of measurement of the abdominal muscles during "drawing-in" of the abdominal wall. OBJECTIVES: 1) To investigate, using magnetic resonance imaging (MRI), the function of the transversus abdominis muscle bilaterally during a drawing-in of the abdominal wall. 2) To validate the use of real-time ultrasound imaging as a measure of the deep abdominal muscle during a drawing-in of the abdominal wall. SUMMARY OF BACKGROUND DATA: Previous research has implicated the deep abdominal muscle, transversus abdominis, in the support and protection of the spine and provided evidence that training this muscle is important in the rehabilitation of low back pain. One of the most important actions of the transversus abdominis is to "draw-in" the abdominal wall, and this action has been shown to stiffen the sacroiliac joints. It is hypothesized that in response to a draw in, the transversus abdominis muscle forms a deep musculofascial "corset" and that MRI could be used to view this corset and verify its mechanism of action on the lumbopelvic region. METHODS: Thirteen healthy asymptomatic male elite cricket players aged 21.3 +/- 2.1 years were imaged using MRI and ultrasound imaging as they drew in their abdominal walls. Measurements of the thickness of the transversus abdominis and internal oblique muscles and the slide of the anterior abdominal fascia were measured using both MRI and ultrasound. Measurement of the whole abdominal cross-sectional area (CSA) was conducted using MRI. RESULTS: Results of the MRI demonstrated that, as a result of draw-in, there was a significant increase in thickness of the transversus abdominis (P < 0.001) and the internal oblique muscles (P < 0.001). There was a significant decrease in the CSA of the trunk (P < 0.001). The mean slide (+/-SD) of the anterior abdominal fascia was 1.54 +/- 0.38 cm for the left side and 1.48 +/- 0.35 cm for the right side. Ultrasound measurements of muscle thickness of both transversus abdominis and the internal oblique, as well as fascial slide, correlated with measures obtained using MRI (interclass correlations from 0.78 to 0.95). CONCLUSIONS: The MRI results demonstrated that during a drawing-in action, the transversus abdominis contracts bilaterally to form a musculofascial band that appears to tighten (like a corset) and most likely improves the stabilization of the lumbopelvic region. Real-time ultrasound imaging can also be used to measure changes in the transversus abdominis during the draw-in maneuver.

Abdominal Muscles↗

PubMed2001

Abdominal wall muscle activity in irritable bowel syndrome with bloating.

OBJECTIVE: Recurrent episodes of bloating and visible abdominal distension are common and distressing in irritable bowel syndrome, but the mechanisms are unknown. Patients often note that the distension is most pronounced in the upright posture, suggesting that the bloating may be the result of a decrease or absence of the normal rise in electromyograph activity in the abdominal wall muscles when standing. There are no reports of noninvasive electromyograph recordings of abdominal wall muscles in irritable bowel syndrome. We examined the hypothesis that abdominal distension is the result of relaxation of anterior abdominal wall musculature. METHODS: Studies were performed on patients with irritable bowel syndrome and a history of visible distension (n = 11, mean age 48.6 yr, body mass index 24.8) and normal volunteers (n = 13, mean age 39.9 yr, body mass index 24.6). Surface recordings of muscle activity were made while subjects were lying, performing voluntary contraction of the abdominal wall, and standing. The examiners were blind as to the clinical status of the subjects. RESULTS: There were no differences in abdominal wall muscle activity (by electromyograph voltage) when comparing patients with irritable bowel syndrome to normal volunteers (e.g., relaxed lower abdomen supine mean electromyograph voltage in irritable bowel syndrome was 14.0 vs 14.6 in controls, p = 0.7, and relaxed lower abdomen standing in irritable bowel syndrome was 29.6 vs 25.2 in controls, p = 0.4). There was increased activity in both groups when contracting the muscles and when standing. CONCLUSIONS: Patterns of abdominal wall muscle activity do not differ between normal subjects and patients with irritable bowel syndrome. However, there is a clear increase in muscle activity in the standing position. Episodic distension is unlikely to be due to permanent anterior abdominal muscle weakness or a persistent inability of the muscles to activate with standing in irritable bowel syndrome.

Abdominal Muscles↗

PubMed2005

Surgical treatment of large contaminated abdominal wall defects.

BACKGROUND: Repair of a large, severely contaminated abdominal wall defect is a challenging problem. Most patients are currently treated with a multistaged procedure, which is time consuming, carries a high complication rate, and is often not finalized. STUDY DESIGN: In this study, our experience with a one-stage repair of contaminated abdominal wall defects using the Components Separation Method was evaluated with respect to morbidity and recurrence. Medical records of patients with contaminated abdominal wall defects, treated with the Components Separation Method from 1996 to 2000, were studied. Patients were invited to visit the outpatient clinic for a physical examination. RESULTS: Twenty-six patients with a median age of 49 years and a mean defect size of 267 cm2 were treated. Intraoperative contamination, graded according to the National Research Council (NRC), showed 22 National Research Council III patients and 4 National Research Council IV patients. Postoperatively, five superficial wound infections, three cases of pneumonia, three instances of recurrent enterocutaneous fistulation, and two cases of sepsis were observed. One of the patients with sepsis died after anastomotic disruption led to peritonitis and multiple organ failure. Two asymptomatic recurrences were diagnosed (8%) after a median followup of 27 months. CONCLUSIONS: Large contaminated abdominal wall hernias can be closed by the Components Separation Method, with a low recurrence rate but considerable morbidity.

Adult↗

PubMed2006

Creep behavior of commonly used suture materials in abdominal wall surgery.

BACKGROUND: The incidence of incisional hernia after abdominal wall closure is high. Furthermore, recurrence is a significant complication after correction of all abdominal wall hernias. Besides surgeon- and patient-related factors, in this experimental study a third factor, i.e., creep behavior of suture materials, is introduced and evaluated. MATERIALS AND METHODS: Creep measurements were performed on 0 and 2-0 Prolene (Ethicon, Johnson & Johnson Intl., Somerville, NJ) and 1 and 2-0 PDSII (Ethicon, Johnson & Johnson Intl.) sutures. Two different loads were used representing normal intra-abdominal pressure (IAP) and pathological IAP. A mean percentage of elongation was calculated for each type of suture material. Statistical analysis was performed using analysis of variance. RESULTS: All suture materials showed significant (3-51%) creep behavior. Prolene sutures showed more creep than PDSII sutures in both loading conditions. CONCLUSIONS: As significant creep was demonstrated for commonly used suture materials, creep might be a significant influential factor with regard to the etiology of incisional hernias and recurrence after abdominal wall hernia repair.

Abdominal Wall↗

PubMed1999

Closure of chronic abdominal wall defects: a long-term evaluation of the components separation method.

Incisional hernias and abdominal wall defects are frequently iatrogenic problems that have been found to complicate as many as 11% of all abdominal operations. Current techniques for closure of large, chronic abdominal wall defects have limitations. The use of local musculofascial flaps rather than fascial patches (i.e., the tensor fascia lata) or synthetic material for the repair of chronic abdominal wall defects is preferable. The superiority of innervated muscle flaps that provide dynamic abdominal support has been demonstrated. This report focuses on patients with chronic abdominal wall defects in whom previous techniques have failed. An algorithmic approach to planned reconstruction is presented utilizing the "components separation" technique as its foundation. Thirty-seven patients who underwent abdominal reconstruction following this algorithm are reviewed and their clinical course is outlined. The components separation technique provides a compound innervated and vascularized muscle flap for dynamic support of the reconstructed abdominal wall. The experience documented here and by others suggests that this technique is a safe and effective method for reconstructing the abdominal wall in patients with recurrent herniation. Enterocutaneous fistulas, however, continue to present a challenge to the surgeon.

Abdominal Muscles↗

PubMed1998

Functional and morphological evaluation of different polypropylene-mesh modifications for abdominal wall repair.

Modern surgical hernia repair depends increasingly on synthetic meshes for the reconstruction of the abdominal wall. Despite the undisputed advantages of the polypropylene (PP) meshes currently available (Marlex, Prolene), reports of complications after implantation are increasing. Although, serious complications such as perforation and fistula formation are rare, minor and local complaints such as seromas, misfeelings and a decreased abdominal wall mobility are observed in about one-half of the patients. In regard to the exaggerated strength of the currently available mesh modifications a reduction of the material should improve the integration of the meshes into the artificial abdominal wall. In the present study, the commercially available basic mesh Prolene has been compared to two newly constructed PP-mesh modifications with reduced amounts of PP. The modifications have gradually been adopted to the physiological requirements of abdominal wall stability and mobility by reducing the amount of PP to 64% (E-BLUE) and 24% (variant A) of the Prolene mesh (developed by ETHICON, Norderstedt, Germany). All PP-mesh variants have been implanted in a rat model and studied by 3D-photogrammetry, tensiometry, light- and electron microscopy, as well as morphometry over implantation intervals of 3, 7, 14, 21 and 90 days. The data show that current constructions of PP-meshes are oversized and definitely restrict abdominal wall mobility in the present model. Sufficient stability of the artificial abdominal wall is even guaranteed by PP-mesh modifications with a reduction of PP-quantity to about 25% of the Prolene mesh. The degree of fibrosis directly correlated with abdominal wall restriction, whereas the formation of connective tissue in the interface PP-fibre/host-issue depends on the amount and activity of the inflammatory reaction. The quantity and quality of inflammation, again, directly relies to the amount of PP and to the surface area in contact with the recipient tissues. Altogether, the present study suggests that a modification of the PP-meshes could be helpful to prevent major and minor complications of surgical PP-meshes.

Abdominal Muscles↗

PubMed1989

Pulmonary hypoplasia in infants with giant abdominal wall defects.

The medical records of 114 infants with abdominal wall defects, including 35 infants examined at autopsy, were reviewed to determine if giant (liver-containing) defects are associated with a narrow thoracic cage deformity and pulmonary hypoplasia. The study included 48 infants with gastroschisis, 60 with omphalocele, two with a lower midline syndrome (cloacal exstrophy) and four with an upper midline syndrome (Cantrell's pentalogy). A giant abdominal wall defect was present in 33 infants, including one with gastroschisis, 27 with omphalocele, two with a lower midline syndrome, and three with an upper midline syndrome. A thoracic cage deformity, characterized by a narrow chest and down-slanting ribs, was identified radiographically in 42% (14 of 33) of infants with giant abdominal wall defects. Among the 35 infants examined at autopsy, 14 infants with giant omphaloceles had mean chest circumference to occipital frontal circumference ratio and lung weight to body weight ratios that were significantly below the means for infants with gastroschisis or small omphalocele. Lung weight to body weight ratios indicated marked pulmonary hypoplasia in three of 12 (25%) of infants who had a narrow thoracic cage deformity, and radial alveolar counts indicated mild pulmonary hypoplasia in four additional infants. Prematurity (four infants), diaphragmatic abnormalities (seven infants), and congenital heart disease (four infants) potentially contributed to the respiratory distress experienced by these 12 infants. Infants with giant abdominal wall defects and narrow thoracic cages are at increased risk for pulmonary hypoplasia and respiratory distress.

Abnormalities, Multiple↗

PubMed1988

[Abdominal wall desmoid tumor--analysis of 42 patients].

Forty two patients with abdominal wall desmoid tumor, including one Gardner's syndrome, are reported. All patients were female except one. The tumor occurred in various sites in the abdominal wall, 66% in the lower abdominal wall. The fascia, sheath and muscle layer were chiefly involved and a very large tumor could invade peritoneum and viscera. This tumor shows aggressive growth and is prone to recurrence. Surgery is the treatment of choice. Local recurrence rate was 5.5%. Abdominal wall desmoid tumor associated colonic polyposis is named Gardner's syndrome. The authors emphasize that a local extended resection should be performed with a safety margin at least 2-3 cm beyond the tumor. Peritoneum, if involved, should be resected together with the primary focus.

Abdominal Muscles↗

PubMed1986

Primary actinomycosis of the abdominal wall.

Two cases of primary actinomycosis of the abdominal wall masquerading as abdominal wall tumours are presented. The interesting clinical presentation and the difficulty in diagnosis are discussed.

Abdominal Muscles↗