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At least 235 records · Page 13Linked to original sources

PubMed1988

Full thickness abdominal wall resection for recurrent and metastatic neoplasms. A report of three cases.

Full thickness infiltration of the abdominal wall by intraabdominal cancer, especially after effective prior therapy, is frequently considered a sign of inoperability. Such patients are treated with irradiation, chemotherapy, or locally destructive means (laser, cryosurgery) with limited success. Full thickness resection of portions of the abdominal wall has not been widely used in such settings because of concerns regarding abdominal wall reconstruction and also because of the perceived noncurative nature of such "radical" procedures. While long-term prognosis in patients with abdominal wall infiltration by cancer depends upon various factors, technical considerations regarding reconstruction need not prevent effective local palliative therapy. Bridging large defects can be successfully accomplished by using available synthetic material of a durable, inert nature. Polyprophylene (Marlex) mesh, a readily available and inexpensive inert fabric, meets all desirable features for such use. This paper details the successful treatment of three patients in whom recurrent carcinoma infiltrated the full thickness of the abdominal wall and caused intractable pain. In all three, full thickness portions of the abdominal wall were resected, segments of intestine and of urinary bladder were also excised, and the defects were closed using a double layer of polypropylene mesh. Complete relief of pain was accomplished and the cosmetic and functional results were excellent. Illustration A depicts procedure in patients one and two. Illustration B depicts procedure in patient three.

Abdominal Muscles↗

PubMed1994

Abdominal-wall reconstruction with expanded musculofascial tissue in a posttraumatic defect.

An anatomic basis for expansion of the abdominal wall is presented and clinically demonstrated in an adult man with a posttraumatic defect. The patient demonstrates an intact, functional abdominal wall 4 years after the procedure. The procedure provides autogenous, innervated, well-vascularized, contractile tissue for repair of abdominal-wall hernias. Large tissue expanders are placed between the external oblique and internal oblique muscles. A small incision in the posterior rectus sheath is made in order to gain access to the potential space between these muscles. The incision in the posterior rectus sheath is kept small to minimize risk of denervation of the rectus abdominis muscle. Tissue expansion is carried out over several weeks. After removal of the expanders, abundant musculofascial tissue is available for reconstruction of the abdominal wall. The abdominal wall is then reconstructed with innervated, functioning tissue.

Abdominal Muscles↗

PubMed1997

End-results of experimental gastroschisis created by abdominal wall versus umbilical cord defect.

An experimental study was conducted to determine the end-results of two different defects on the anterior abdominal wall: an abdominal wall defect (AWD) versus an umbilical cord defect (UCD) using chick embryos. The AWD was created by leaving an intact skin bridge between the defect and the umbilical cord in group 1; the UCD was created on the umbilical cord near the junction of the skin in group 2. At the end of incubation, the intestines appeared hemorrhagic in the AWD group, but not in the UCD group. During microscopic examination, hemorrhagic areas were observed in the bowel wall and mucosal villi in the AWD group but not in the UCD group. The end-result of the defect causing the physiological umbilical hernia resulted in bowel damage resembling the classic picture of gastroschisis (GS). We conclude that the site of the defect in GS is not the abdominal wall itself, but the physiological umbilical hernia.

Abdominal Muscles↗

PubMed1992

Heterotopic gastric mucosa and pancreatic tissue in the skin of the abdominal wall.

A lesion in the upper abdominal wall of a 10-year-old boy had been excised twice at the age of 3 years at another hospital but the lesion recurred shortly thereafter. We completely excised this lesion and histological examination showed the presence of heterotopic gastric mucosa and pancreatic tissue in the skin of the abdominal wall.

Abdominal Muscles↗

PubMedDate not supplied

Abdominal wall hernias: imaging features, complications, and diagnostic pitfalls at multi-detector row CT.

Abdominal wall hernias are a common imaging finding in the abdomen and may be complicated by strangulation, incarceration, or trauma. Because of the risk of developing complications, most abdominal wall hernias are surgically repaired, even if asymptomatic. However, post-surgical complications are also common and include hernia recurrence, infected and noninfected fluid collections, and complications related to prosthetic material. Multi-detector row computed tomography (CT) with its multiplanar capabilities is particularly useful for the evaluation of unrepaired and surgically repaired abdominal wall hernias. Multi-detector row CT provides exquisite anatomic detail of the abdominal wall, thereby allowing accurate identification of wall hernias and their contents, differentiation of hernias from other abdominal masses (tumors, hematomas, abscesses), and detection of pre- or postoperative complications. These findings improve the communication of imaging results to clinicians and help optimize treatment planning. Knowledge of multi-detector row CT findings in unrepaired and surgically repaired abdominal wall hernias and their complications is essential for making the correct diagnosis and may help guide clinical management.

Adult↗

PubMed1991

Temporary closure of the abdominal wall by use of silicone rubber sheets after operative repair of ruptured abdominal aortic aneurysms.

Management of patients after operative repair of abdominal aortic aneurysms can be further complicated if primary closure of the abdominal wall cannot be technically accomplished or is associated with profound increases in intraabdominal and peak inspiratory pressures. We recently treated five patients with ruptured abdominal aortic aneurysms and one patient with a ruptured thoracoabdominal aneurysm whose abdominal incisions had to be closed with a Dacron reinforced, silicone sheet. All patients were hemodynamically unstable either at admission to the hospital or became so during operation. Four patients required the insertion of a silicone rubber sheet at the primary operation because of massive retroperitoneal hematoma or edema of the bowel wall or both. Incisions in two patients were closed primarily, but the patients required reexploration and secondary closure with silicone rubber sheets because of the development of marked increases in peak inspiratory pressures, intraabdominal pressures, and decreased urinary output. Four of the six patients subsequently underwent successful removal of the silicone rubber sheets with delayed primary closure of the abdominal wall, and two others died before removal. The patient with the ruptured thoracoabdominal aneurysm died on postoperative day 20 because of pulmonary sepsis but had a healed abdominal incision. The three surviving patients have been discharged. A silicone rubber sheet may be necessary for closure of the abdominal wall after repair of ruptured abdominal aortic aneurysm in patients where primary abdominal wall closure is impossible or where it results in compromise in respiratory or renal function.

Abdomen↗

PubMed2006

[A case of gastric cancer with abdominal wall invasion treated by weekly low-dose paclitaxel therapy].

Here we report a case of gastric cancer with diffuse abdominal wall invasion treated with weekly low-dose paclitaxel therapy. A 62-year-old male visited our hospital because of abdominal distention, prepubic tumor,and testicular hydrocele. Computed tomography revealed diffuse swelling of the abdominal wall and hydronephrosis of the right kidney. Upper gastrointestinal endoscopy demonstrated type 3' advanced gastric cancer. Pathological diagnosis of both gastric tumor and abdominal wall biopsy specimens was poorly-differentiated adenocarcinoma containing signet ring cell carcinoma. Low-dose paclitaxel (90 mg/body) was given once a week for 3 weeks. Abdominal wall swelling like cuirass disappeared after 2 courses of low-dose paclitaxel therapy. Nine repeated courses of this regimen have been given until now; the relapse of the abdominal wall invasion has not become apparent, and primary gastric lesion has been a stable disease. Diffuse abdominal wall invasion of gastric cancer like cuirass without ascites is a rare condition, and low-dose paclitaxel was very effective for this condition.

Abdominal Wall↗

PubMed2005

Repair of infected abdominal wall hernias in obese patients using autologous dermal grafts for reinforcement.

BACKGROUND: Reconstruction of large, infected abdominal wall hernias in obese patients can be extremely challenging. A novel approach to abdominal wall reconstruction in a contaminated setting without the use of prosthetic materials is introduced. METHODS: Two patients with massive abdominal wall hernias and infected mesh underwent removal of mesh and abdominal wall reconstruction with the component separation technique. Panniculectomy was performed and a dermal graft was obtained by defatting and deepithelializing the specimen. The dermal graft was then applied in an onlay fashion over the fascial closure or used to bridge a fascial gap. RESULTS: One morbidly obese woman underwent reconstruction with onlay dermal graft reinforcement. She is hernia-free at 16 months. A second obese woman, with two enterocutaneous fistulae, had reconstruction with a dermal graft placed to bridge the midline fascial gap. She is hernia-free at 20 months. CONCLUSIONS: Autologous reconstruction of abdominal wall hernias, in the setting of infected prosthetic material, provides an excellent opportunity for successful closure of the defect. Failure of component separation is most commonly due to fascial separations at the midline. Autologous dermal grafts provide an ideal reinforcement of these fascial edges in a contaminated environment.

Adipose Tissue↗

PubMed1989

[Repair of large abdominal wall defects with expanded polytetrafluoroethylene].

Most abdominal wall defects can be repaired by primary closure. However, when the defect is so large that there is tension on closure, use of prosthetic material is indicated. Expanded polytetrafluoroethylene has the advantages of low rates of infection, foreign body reaction and adhesion formation, making it the material of choice for repair of large abdominal wall defects.

Abdominal Muscles↗

PubMed2000

Evaluation of seprafilm and amniotic membrane as adhesion prophylaxis in mesh repair of abdominal wall hernia in rats.

INTRODUCTION: Adhesion formation following abdominal wall hernia repair with prosthetic mesh may lead to intestinal obstruction and enterocutaneous fistula. Physical barriers, namely, human amniotic membrane (HAM) or Seprafilm (Genzyme, Cambridge, Mass., USA), a bio-absorbable, translucent membrane composed of carboxymethylcellulose and hyaluronic acid, have been reported to prevent postsurgical intra-abdominal adhesions. OBJECTIVE: Evaluating the effect of HAM and Seprafilm in preventing adhesion formation in the rat model of ventral hernia repair with polypropylene mesh (PPM). MATERIAL AND METHODS: Sixty female Sprague-Dawley rats were divided into three groups. A full-thickness abdominal wall defect was created in each animal. Control animals had the PPM sutured into the defect, whereas in the other two groups, either HAM or Seprafilm were laid over the abdominal viscera before the repair with PPM. Half of the animals in each group were sacrificed on the 21st postoperative day. The remaining rats of the same group were re-operated on the 42nd day for investigation and measurement of the adhesion area in relation to the graft area. RESULTS: Direct mesh repair showed 52.8 and 56% area adhesion formation 3 and 6 weeks postoperatively, respectively. The HAM barrier covered with mesh repair demonstrated 0 and 0.96% area adhesion formation, and the Seprafilm-covered mesh repair showed 0 and 0% area adhesion formation 3 and 6 weeks postoperatively, respectively. Uncovered mesh showed a significantly larger adhesion area than both covered mesh (p = 0.001 and 0.001). Both HAM and Seprafilm were equally effective in preventing postoperative adhesions. CONCLUSIONS: HAM and Seprafilm proved to be an effective antiadhesive barrier in PPM repair of abdominal wall hernia.

Abdomen↗

PubMed2001

The surgical trauma of abdominal wall incision. A comparison of laparoscopic vs open surgery with three-dimensional stereography.

BACKGROUND: Laparoscopic operations seem to respect the integrity of the abdominal wall better than conventional laparotomy, but the effects of surgical trauma are not well understood. The new technique of three-dimensional stereography makes it possible to describe and calculate the mobility of the abdominal wall and the nature of the underlying disturbances. METHODS: Three-dimensional stereography is a noninvasive optical method of measuring surface areas. Abdominal wall mobility can be assessed by comparing changes to the abdominal surface in its minimum and maximum excursions. Different parameters, such as height difference and curvature, are calculated. We studied patients undergoing different types of surgical procedures (laparoscopy and open surgery) by measuring their abdominal wall mobility before and after the procedure. We also compared these patients to a control group. Each group consisted of 30 patients, who were evaluated prospectively. RESULTS: We found a significant difference in abdominal wall mobility between patients treated via a laparoscopic approach, and those who had conventional surgery. At 7 days after laparoscopy, abdominal movement was always the same in the laparoscopic group as in the controls. By contrast, the open surgery group still showed a significant lack of mobility 12 days after the procedure. CONCLUSION: The new method of three-dimensional stereography makes it possible to compare the trauma associated with different surgical approaches as it affects the integrity of the abdominal wall. As compared with open surgery, laparoscopy has a significant positive effect on abdominal wall integrity.

Abdominal Muscles↗

PubMed1994

Abdominal-Wall Tumor Implantation Following Laparoscopic for Malignant Conditions

To determine the incidence of abdominal-wall tumor implantation following laparoscopic procedures in patients with known malignancies, we reviewed 550 laparoscopic procedures performed on the Gynecologic Oncology Service between November 1990 and December 1993. In 100 procedures malignancy was documented cytologically or histologically, 84 with intraperitoneal and 16 with retroperitoneal disease. Ovarian cancer comprised 80% (67/84) of the procedures with intraperitoneal malignancy; the remainder consisted of fallopian tube (2), endometrial (11), cervical (1), breast (2), and gastric (1) carcinomas. Except for a recurrent squamous cell carcinoma of the cervix, all intraperitoneal carcinomas were adenocarcinomas. Four hundred twenty-three different abdominal-wall puncture sites were used, 37 Veress needle sites, and 386 laparoscopic ports. One of the 423 (0.2%) abdominal-wall puncture sites developed an implantation, for an incidence of 1.0% (1/100) per procedure. This developed after a second-look laparoscopic procedure for ovarian carcinoma in which only microscopic disease was present. If just intraperitoneal disease is considered, the incidence of implantation was 0.3% (1/351) per abdominal puncture and 1.2% (1/84) per procedure. No port site that was irrigated developed implantation. We concluded that abdominal-wall tumor implantation at the abdominal-wall puncture site is an infrequent occurrence after laparoscopy in patients with intraperitoneal and retroperitoneal carcinoma.

Journal Article↗

PubMedDate not supplied

Prevention of adhesion formations following repair of abdominal wall defects with prosthetic materials (an experimental study).

BACKGROUND/AIMS: Adhesion formation after abdominal surgery or incisional hernia repair with prosthetic materials may cause chronic pain, intestinal obstruction, enterocutaneous fistulae, difficulty in reoperative procedures and infertility in females. The aim of this study was to compare different modalities in terms of adhesion prevention in a rat model of abdominal wall defect repaired with prosthetic materials. METHODOLOGY: Forty-eight female Wistar-Albino rats were divided into four groups. In all rats, laparotomy was performed through a 3-cm midline incision and an abdominal wall defect (2 x 3 cm) was created in rats in groups II, III and IV. Following procedures were performed in all rats: seroza of the cecum was abraded and sutured with 4-0 silk and two ischemic buttons were created by ligating with 4-0 silk on the left and right sides of abdominal parietal peritoneum. In Group I, abdominal closure was obtained with a running 4-0 prolene suture. In Group II, abdominal wall defect was repaired with polypropylene mesh. In Group III, Seprafilm, an absorbable adhesion barrier, was laid over the abdominal viscera and defect was repaired with polypropylene mesh. In Group IV, defect was repaired with Composix mesh. Adhesion density score, adhered organ and strength of mesh incorporation were evaluated. Biochemical analysis and histopathological examination were performed. RESULTS: Groups II and III had more adhesion density scores than groups I and IV, (P < 0.001). Group II had more cecal and ischemic button adhesions than groups I, III and IV, (P < 0.001). Strength of mesh incorporation was higher in groups II and III than group IV, (P < 0.001). Abscess formation was more common in group IV than those in groups II and III, (P < 0.001). There were no differences between groups, regarding serum levels of C-reactive protein and fibrinogen. The most common adhered organ was omentum. CONCLUSIONS: There is no single treatment modality to prevent adhesion formation after abdominal wall defect repaired with prosthetic materials. While intraperitoneal adhesions were less common in Seprafilm group, adhesions to mesh were less common in the Composix mesh group.

Abdominal Wall↗

PubMedDate not supplied

Use of homologous acellular dermal matrix for abdominal wall reconstruction in rats.

Homologous acellular dermal matrix graft (HADMG) has been used for the reconstructions of bowel, bladder, or urethra, but its suitability in the reconstruction of abdominal wall has not been tested. Therefore an experimental study was performed to evaluate the use of HADMG for the reconstruction of abdominal wall defects in weanling rats. Thirty weanling Wistar rats were used. A patch of abdominal wall 20 x 20 mm in dimension was removed. The defects were reconstructed with HADMGs that were derived from rat skin and prepared through a detergent enzymatic method. The reconstructed abdominal walls were evaluated as hernia rate and graft take ratio, excised and prepared for histological examination at 21 (n = 10), 40 (n = 10), and 90 (n = 10) days postoperation. The healing of repaired abdominal walls was uneventful. Histological evaluation demonstrated the migration of fibroblasts and neovascularization within the HADMG. Hernia in four rats were developed at 90 days. Neither significant wound contraction nor inflammation was seen at 21, 40, and 90 days after surgery in wounds receiving HADMGs. Thus, the use of a HADMG for reconstructing the abdominal wall in weanling rats has not given rise to any complications. HADMG has progressively remodeled into fibrous tissue. It appears to represent an important alternative substitute for the reconstruction of abdominal wall.

Abdominal Wall↗

PubMed1989

Recognition and treatment of abdominal wall pain.

In some patients with abdominal pain, the source of the pain may be the abdominal wall. A simple test is described which allows these patients to be identified and treated with injections of local anaesthetic and steroid. Twenty-six patients were studied, 20 of whom were available for follow-up. Sixteen of these 20 were symptom free or improved at a median follow-up period of 29 months. Failure to recognize abdominal wall pain may lead to unnecessary investigation.

Abdominal Muscles↗

PubMed1993

Improved zipper closure of the abdominal wall in patients requiring multiple intra-abdominal operations.

Optimal management of pancreatic abscess and septic complications of acute pancreatitis remains controversial. With the "open packing" approach, repeated closure of the midline fascia is complicated by loss of tissue integrity and suture strength. An improved zipper closure of the abdominal wall in six patients with pancreatic abscess is presented. Improvements included: (1) using a separating jacket-type zipper to allow maximal intraoperative exposure; (2) employing a removable tuck for expansion of the patch covering the wound; (3) substituting a nonmeshed polytetrafluoroethylene material for the polypropylene mesh to prevent adherence to the underlying viscera; and (4) creating a flap underneath the zipper teeth to protect the underlying tissue from injury. Satisfactory results were achieved with the improved zipper technique.

Abdominal Muscles↗

PubMed2000

[Reconstruction of defects of the anterior abdominal wall].

Reconstruction of the abdominal wall is of importance in many clinical situations, but may require the entire spectrum of plastic and reconstructive surgery. Indications for particular procedures depend on the clinical situation and the patient's individual profile. One has to differentiate between life-saving primary measures and secondary corrections to improve form or function. The article outlines current actual concepts of plastic surgical defect reconstruction with which the general/visceral surgeon should be acquainted, in order to integrate these concepts into a multi-disciplinary approach in pertinent clinical situations.

Abdominal Muscles↗

PubMed1994

[Comparative study of the management of abscesses of the abdominal wall after cesarean section].

Abdominal wall wound dehiscences, more frequently those involving skin and subcutaneous tissue, are a common surgical complication in Obstetrics and Gynecology. A prospective, longitudinal study was done in 65 patients presenting with wound abscess. The evolution of the wound was compared using the following methods a) Bandage, b) Bandage with 30% iron subcarbonate pomade, c) Silk, d) Silk with 30% iron subcarbonate pomade. Eighty five percent of the patients, with silk used, were completely recovered in less than 10 days; comparing this option with the others used in this study, there were significant statistical differences.

Abdominal Muscles↗