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At least 217 records · Page 12Linked to original sources
PubMed2003

Abdominal wall closure with ePTFE--Goretex Dual Mesh after detensive laparotomy for abdominal compartment syndrome.

INTRODUCTION: Detensive laparotomy is the first choice treatment for abdominal compartment syndrome (ACS). Tension free closure of the abdominal wall with the use of prosthesis is a broadly diffused technique; the polypropylene and the ePTFE (expanded polytetrafluoroethylene--Goretex Dual Mesh) are the most commonly used materials. MATERIALS AND METHODS: We report our experience on five patients affected by ACS submitted to detensive laparotomy and positioning of a wide Goretex Dual Mesh prosthesis. RESULTS: In our initial experience ACS has been treated with success through detensive laparotomy and there were no complications related to the use of Goretex. DISCUSSION: Even though limited, our initial clinical experience is favorable to the use of Goretex Dual Mesh as first choice material for reconstruction of the abdominal wall after detensive laparotomy for ACS.

Abdominal Cavity↗
PubMed2003

Incision and abdominal wall hernias in patients with aneurysm or occlusive aortic disease.

INTRODUCTION: Patients undergoing midline incision for abdominal aortic reconstruction appear to be at greater risk for postoperative incision hernia compared with patients undergoing celiotomy for general surgical procedures. Controversy exists as to whether incidence of abdominal wall hernia and increased risk for incision hernia is higher in patients with abdominal aortic aneurysm (AAA) than in patients operated on because of aortoiliac occlusive disease (AOD). We conducted a prospective multi-institutional study to assess frequency of incision hernia after aortic surgery through a midline laparotomy and of previous abdominal wall hernia. METHODS: Patients with AAA (n = 177) or AOD (n = 82) from three major institutions were prospectively enrolled in the study and examined. Data collected included demographic data, cardiopulmonary risk factors, smoking status, history of previous or current abdominal wall hernia (incision, inguinal, umbilical, femoral), previous midline incision, suture type, and postoperative complications. At a minimum of 6 months after laparotomy, patients were evaluated clinically for a new incision hernia. Differences were tested with the unpaired t test, X(2) test, or Fisher exact test, and multiple logistic regression was used to control for confounding variables. RESULTS: Mean follow-up of the cohort was 32.8 +/- 2.3 months. Rate of abdominal wall hernia and inguinal hernia in patients with AAA versus AOD was 38.4% versus 11% (P =.001) and 23.7% versus 6.1% (P =.003), respectively. Rate of postoperative incision hernia in patients with AAA was 28.2%, and in patients with AOD was 11.0% (P =.002). Adjusting for age, smoking, chronic obstructive pulmonary disease, body mass index, diabetes, bowel obstruction, and suture type, patients with AAA had almost a ninefold risk for postoperative incision hernia formation (odds ratio [OR], 8.8; P =.0049). CONCLUSION: Compared with patients with AOD, patients with AAA have a higher frequency of abdominal wall hernia and inguinal hernia, and are at significant increased risk for development of incision hernia postoperatively. The higher frequency of hernia formation in patients with AAA suggests the presence of a structural defect within the fascia. Further studies are needed to delineate the molecular changes of the aorta and its relation to the abdominal wall fascia.

Aged↗
PubMed1996

Autopenetrating hernia: a novel form of traumatic abdominal wall hernia--case report and review of the literature.

Traumatic abdominal wall hernias remain relatively rare entities despite the increased incidence of blunt trauma. Mechanisms reported in the literature include a combination of a sudden increase in intra-abdominal pressure and powerful shear forces applied to the abdominal wall. These hernias are noteworthy in that they may be associated with significant intra-abdominal injuries. We describe a novel form of traumatic hernia with a unique mechanism. A blunt force leads to the fracture of a rib and penetration of the abdominal wall by the jagged costal remnant, creating a hernia defect. This autopenetrating hernia is presented in the context of a classification scheme for traumatic abdominal wall hernias.

Accidents, Occupational↗
PubMed2007

Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis.

OBJECTIVE: The purpose of this study is to measure abdominal wall myopathic histologic and mechanical changes during incisional herniation and its effect on incisional hernia repairs. SUMMARY BACKGROUND DATA: Unloaded skeletal muscles undergo characteristic atrophic changes, including change in fiber type composition, decreased cross-sectional area, and pathologic fibrosis. We hypothesize that these atrophic changes decrease muscle elastic properties and may contribute to the high laparotomy wound failure rate observed following incisional hernia repair. METHODS: A rat model of chronic incisional hernia formation was used. Failing midline laparotomy incisions developed into incisional hernias. Controls were uninjured and sham laparotomy (healed) groups. Internal oblique muscles were harvested for fiber typing, measurement of cross-sectional area, collagen deposition, and mechanical analysis. Mesh hernia repairs were performed on a second group of rats with chronic incisional hernias or acute anterior abdominal wall myofascial defects. RESULTS: The hernia group developed lateral abdominal wall shortening and oblique muscle atrophy. This was associated with a change in the distribution of oblique muscle fiber types, decreased cross-sectional area, and pathologic fibrosis consistent with myopathic disuse atrophy. These muscles exhibited significant decreased extensibility and increased stiffness. The healed (sham) laparotomy group expressed an intermediate phenotype between the uninjured and hernia groups. Recurrent hernia formation was most frequent in the chronic hernia model, and hernia repairs mechanically disrupted at a lower force compared with nonherniated abdominal walls. CONCLUSIONS: The internal oblique muscles of the abdominal wall express a pattern of changes consistent with those seen in chronically unloaded skeletal muscles. The internal oblique muscles become fibrotic during herniation, reducing abdominal wall compliance and increasing the transfer of load forces to the midline wound at the time of hernia repair.

Abdominal Muscles↗
PubMed1997

[Abdominal wall metastasis following surgical removal of colorectal carcinomas].

Abdominal wall metastases after laparoscopic resection of colorectal cancer have been reported by various authors. It appeared that abdominal wall metastases occur more frequently after laparoscopic than after conventional, open resection of colorectal cancer. However, the frequency of abdominal wall metastases after laparoscopic surgery varies from only 0 to 1.9% in centres with sufficient relevant experience, whereas after conventional resections the frequency is 0.8-3.3%. A randomized clinical study comparing laparoscopic with conventional resection of colon cancer is necessary to assess the optimal surgical approach to colon cancer. Such a trial has been set up.

Abdominal Muscles↗
PubMed1997

Massive abdominal-wall hernia reconstruction with expanded external/internal oblique and transversalis musculofascia.

We describe a technique for expansion and primary closure of massive and large recalcitrant abdominal-wall hernias in the middle and lower abdomen utilizing expanders placed in the lateral abdominal wall between the external oblique and the deeper complex of the internal oblique and transversalis fasciae. Since this technique describes expansion of the lateral abdominal wall, insertion incisions are made in the lateral abdominal wall away from the primary zone of injury surrounding the abdominal hernia and without interrupting the blood supply or innervation to the abdominal-wall muscle, fascia, or skin. This technique, described in four patients with massive abdominal-wall hernias, has been used successfully for primary closure with vascularized autogenous abdominal-wall fascia, obviating the need for interposition of prosthetic material or extraabdominal flaps.

Abdominal Muscles↗
PubMed2002

Day surgery for laparoscopic repair of abdominal wall hernias. Our experience in 300 patients.

Laparoscopic repair of abdominal wall hernias is still a controversial and nongeneralized therapeutic option. The aim of this paper is to evaluate the results of laparoscopic surgery on abdominal wall hernias at a day-surgery unit and to describe our procedure protocol. Prospective analysis of 300 patients undergoing laparoscopic surgery for abdominal wall hernias was conducted: 260 preperitoneal and 40 intraperitoneal. The patients' clinical features, hernia type, intraoperative and postoperative complications, and follow-up are studied for both types of surgery. All the patients receiving surgery with extraperitoneal laparoscopy were completed as a day-surgical procedure with a rate of conversion to open surgery of 2.3%. Twelve (30%) of the 40 patients operated on for ventral hernias using intraperitoneal laparoscopy required hospitalization: five for perioperative complications and seven for pain (16%). There was no case of infection or mesh rejection. The recurrence rates were 0.78% (two cases) for the inguinal hernias and 2.5% (one case) for the ventral hernias. In conclusion, laparoscopic repair of abdominal wall hernias in a day-surgery setting is an efficient alternative to open surgery.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Prenatal diagnosis of complicated abdominal wall defects.

The accurate prenatal diagnosis of anterior abdominal wall defects is important because it affects patient management and prognosis. The pathophysiology of each defect leads to key characteristics that make it possible to differentiate one entity from another. Among these features are the location of the defect in relation to cord insertion, the size and contents of the defect, and the associated anomalies. This article reviews the underlying defects, the characteristic ultrasound findings, the associated anomalies, and the prognosis of simple and complicated abdominal wall defects. The basic features of simple abdominal wall defects (i.e., omphalocele and gastroschisis) were used as the initial points of assessment. A comparison of the different features of these abnormalities and how they differ from one another resulted in the development of criteria that facilitated the understanding of the different ultrasound manifestations of these anomalies.

Abdominal Muscles↗
PubMed1991

Technique of ultrasonic detection and mapping of abdominal wall adhesions.

A technique for noninvasive ultrasound examination to detect and map abdominal wall adhesions is described. The examination is based on the demonstration of movement of abdominal viscera during real-time imaging. This movement is called viscera slide and either occurs spontaneously as a result of respiratory movement or may be induced by manual compression. Abdominal wall adhesions produce a restriction of viscera slide. Ultrasonic demonstration of restricted viscera slide has been used for the precise localization and mapping of abdominal wall adhesions prior to abdominal surgery. The technique may be particularly useful in providing safe initial access in patients undergoing laparoscopy who are at increased risk for trocar injury of viscera due to abdominal wall adhesions resulting from previous surgery or peritonitis.

Abdominal Muscles↗
PubMed1996

[Changes of respiratory system compliance by closure of congenital abdominal wall defects and postoperative complications].

We treated four neonates with congenital abdominal wall defects and performed pulmonary function testing before and after closure of abdominal wall defects. Pulmonary mechanics were measured by passive occlusion technique. Static respiratory system compliance (Crs) was 0.61 +/- 0.16 ml.cmH2O-1 .kg-1 (mean +/- SD) preoperatively and decreased to 0.31 +/- 0.03 ml.cmH2O-1.kg-1 postoperatively. Two cases with a marked decrease in Crs after the abdominal wall closure seemed to have longer intubation time and N.P.O period and to have more complications than with the other two cases. Our experience provides an evidence that Crs measurement could be a useful index in decision-making of the treatment of neonates with congenital abdominal wall defects.

Abdominal Muscles↗
PubMed2003

[Experience for reconstruction of defects of abdominal wall with Gore-tex].

OBJECTIVE: To evaluate the outcome of prevention of abdominal hernia in reconstruction of defect of abdominal wall with Gore-tex clinically. METHODS: Six cases of the large defects of abdominal wall were repaired with Gore-tex after surgical removal of abdominal wall tumor. RESULTS: The reconstructed cases were followed up six months to three years and there was no postoperative complication. CONCLUSION: Gore-tex is a reliable and effective biomaterial for reconstruction of the large defect of abdominal wall.

Abdominal Neoplasms↗
PubMedDate not supplied

Abdominal wall metastasis of ovarian carcinoma after low transverse abdominal incision: report of two cases and review of literature.

Occurrence of parietal metastases after surgery for a suspect adnexal mass may worsen the prognosis of the disease. However, it is not clear whether abdominal wall metastases is related to specific biologic features or simply to surgical mismanagement involving small incisions and traumatic extraction of the specimen, resulting in direct seeding of cancer cells. We report two cases with development of parietal dissemination of ovarian carcinomas after Pfannenstiel incision. The two patients needed parietal resection to obtain optimal surgical cytoreduction. Pfannenstiel incisions for exploration of suspicious adnexal masses increase the risk of extensive parietal metastasis in case of malignancy because they require reflection of several sheaths of tissue. The parietal extension of the disease may need major parietal resection that can worsen the functional and general outcome of the patients.

Abdominal Wall↗
PubMed2004

Closure of abdominal wall defects using acellular dermal matrix.

BACKGROUND: After some abdominal surgical procedures, the abdominal wall defect may be too large for closure by tension-free approximation of the wound margins because of tissue loss or swelling of the abdominal viscera. A variety of absorbable and nonabsorbable prosthetic materials have been used for emergency abdominal wall reconstruction. Of these materials, polytetrafluoroethylene (PTFE) sheets have proved to be the most efficacious. METHODS: This study compared the efficacy of allogenic acellular dermal matrix (ADM) and PTFE as prosthetic materials for wound closure in rats with surgical, full-thickness, 2 x 3-cm abdominal wounds. Healing was studied among animals with and those without experimentally induced peritonitis for 21 days after surgery. RESULTS: Acellular dermal matrix became vascularized and incorporated into the wound bed and was partially or fully epithelialized without the need for skin grafting. As a result, little superficial bleeding was seen, and ADM effectively closed the wounds even in the presence of peritonitis. Wounds treated with ADM also showed a significant reduction in wound area (sterile:p < 0.001; contaminated:p < 0.05). In contrast, PTFE temporarily closed the wounds, but was not incorporated into them. It consequently evoked the formation of extensive underlying granulation tissue that showed significant superficial bleeding when the PTFE was removed. Very limited wound contraction occurred in PTFE-treated wounds, and some instances of evisceration and fistula formation were observed. Wounds treated with both types of material showed significant amounts of adhesion to visceral organs underlying the wound site. CONCLUSIONS: Acellular dermal matrix exhibits a number of favorable features relative to PTFE for closing sterile or contaminated full-thickness abdominal wall defects.

Abdominal Wall↗
PubMed1985

[Ventral abdominal wall defects--antenatal diagnosis, course of pregnancy and post partum therapy].

The article reports on antepartal sonographic diagnosis and the course and completion of 27 cases with ventral abdominal wall defects. There were 17 cases of omphalocele, 4 cases of gastroschisis and 6 cases of complex ventral abdominal wall defects with associated malformations. In 23 of the 26 women examined prenatally via sonography (89%), the diagnosis was ventral abdominal wall defect. In the 3 cases not diagnosed via sonography, there was one case of intrauterine foetal death. In another case, Potter's syndrome with anhydramnion was found besides a foetal abdominal wall defect, whereas the last unrecognised case had been subjected to sonographic examination outside the hospital only. In 13 out of 17 cases (77%) with omphalocele there were additional malformations. On the other hand, no further associated malformations were seen in the 4 patients with gastroschisis. Complex abdominal wall defects (in the sense of total abdominal wall aplasias or thoracoabdominal gastroschisis, etc.) with multiple associated malformations occurred in the remaining 6 cases. The most frequently seen associated malformations in children with omphalocele were neural tube defects and skeletal malformations (35% each), followed by cardiac and vascular malformations and malformations of the digestive tract. In those women examined in our clinic via sonography who had foetal abdominal wall defects, amniotic anomalies were seen (hydramnion 44%, oligohydramnion 13%). Chromosomal anomalies occurred in omphalocele with 35% incidence. The results obtained point to the necessity of conducting detailed and accurate sonographic examination if a foetal abdominal wall defect is discovered, in order to exclude or confirm further associated malformations.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed1999

Optimal prosthetic for acute replacement of the abdominal wall.

OBJECTIVE: To compare two prostheses for use in acute abdominal wall replacement in the presence and absence of peritonitis. MATERIALS AND METHODS: Forty male Sprague-Dawley rats underwent full-thickness removal of a 2 x 3 cm portion of their anterior abdominal wall. Twenty rats had intraperitoneal contamination with stool slurry. Ten rats in each group (contaminated and noncontaminated) had a 2 x 3 cm piece of Gore-Tex dual-mesh expanded polytetrafluoroethylene (PTFE) sewn full-thickness to cover the abdominal wall defect. The remaining 10 rats in each group had replacement with a 2 x 3 cm piece of Dexon polyglycolic acid mesh (PGA). The rats were then awakened and returned to their cages. Rats were humanely killed at the end of a 3-week observation period or at the time of fistula formation or evisceration. At necropsy, the density of intraabdominal adhesions was graded on a scale of 0 to 3, and the extent of reepithelialization was noted. Results were analyzed with the Student's t test or Fisher's exact method of chi2 test as indicated. RESULTS: Nineteen PTFE rats and 10 PGA rats survived the observation period, The PTFE rats had significantly fewer adhesions (0.10+/-0.30 vs. 1.27+/-1.49,p < 0.005) and significantly more reepithelialization of their wounds (78.2+/-23.4% vs. 43.6+/-50.4%,p < 0.05) than the PGA rats. Evisceration and fistula formation occurred more frequently in the PGA group. The mortality in the PTFE rats was significantly less than the PGA rats (5% vs. 50%,p < 0.001.) Notably, the contaminated PGA rats had a significantly higher mortality (90%,p < 0.001) than any of the other subgroups. CONCLUSION: PTFE is superior to PGA as a replacement prosthesis for acute abdominal wall defects. There are significantly fewer adhesions, improved epithelialization of the wound, and less morbidity and mortality when PTFE is used. This finding is especially true in the presence of intraperitoneal fecal soilage.

Abdominal Muscles↗