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PubMed2003

Comparison of bursting pressure of abdominal wall defects repaired by three conventional techniques.

Still debated are the appropriate techniques for the repair of abdominal wall defects and the methods used to measure their strength. Although tension has been used in many studies to test wound strength, bursting pressure reflects more accurately the pathophysiology of wound dehiscence. The aim of the current study was to evaluate three different techniques for closure of abdominal wall defects using a new and more accurate device for bursting pressure measurements. Full thickness abdominal wall defects measuring 2 cm2 were created in 43 anesthetized rats randomly assigned to three groups: simple primary closure (n = 15), Mayo repair (n = 14), and primary closure reinforced with a mesh (n = 14). Thirty days after surgery, the rats were sacrificed. The abdominal wall was fully excised and placed over a bursting chamber made of a metal cylinder connected to a carbon dioxide source with a control valve and a manometer. Gas was gradually released while the pressure was recorded until bursting occurred. Disruption of all closures occurred at the point where the suture itself penetrated the tissue. The average bursting pressure was 1383 +/- 299 mm Hg for the primary closure group, 1200 +/- 409 mm Hg for the mesh reinforcement group, and 1607 +/- 337 mm Hg for the imbrication repair (Mayo) group (P < 0.03). The data suggests an advantage for the Mayo repair over the other two repairs. The bursting chamber tested is a new and more reliable method to study techniques and conditions influencing the strength of abdominal wall closure.

Abdominal Wall↗

PubMed2002

Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery.

PURPOSE: The purpose of the present study was to evaluate prospectively the abdominal wall recurrence rate after laparoscopic resection for colorectal cancer, to analyze the impact of the learning curve on abdominal wall recurrence, and to assess the outcome of those patients. METHODS: The Italian Registry of Laparoscopic Colorectal Surgery database was analyzed to obtain data on cancer patients with abdominal wall recurrence, concomitant local or distant metastases, and interval between initial surgery and diagnosis of trocar site or minilaparotomy recurrences. The records of the initial procedures and the technique of specimen removal were reviewed. RESULTS: From January 1992 to July 2000, 2,583 patients (1,753 cases of carcinomas and 830 cases of benign diseases) were recorded. The malignant lesions were located on the right colon in 19 percent, the left colon in 48.8 percent, and rectum in 32.2 percent. Sixteen patients with histologic evidence of colorectal adenocarcinoma recurrences at the abdominal wall were observed (0.9 percent). Ten patients presented an advanced stage (III for 7 patients and IV for 3 patients). Eleven cases occurred during the learning curve period (the first 50 consecutive cases). The median survival time after abdominal wall recurrence diagnosis was 16 (range, 12-60) months. By July 2000 only two patients were alive. CONCLUSIONS: The results of the Italian prospective Registry of Laparoscopic Colorectal Surgery confirm that the incidence of abdominal wall recurrences is similar to that reported in open studies (<1 percent). Most abdominal wall recurrences occurred in the learning curve period, suggesting that surgical experience may play a role in the development of this outcome. The prognosis of these patients is very poor.

Abdominal Muscles↗

PubMed2003

Abdominoplasty repair for abdominal wall hernias.

The objectives of abdominal hernial repair are to reconstruct the structural integrity of the abdominal wall while minimizing morbidity. Current techniques include primary closure, staged repair, and the use of prosthetic materials. Techniques for abdominoplasty include the use of the transverse lower abdominal incision and the resection of excess skin. By incorporating these aspects into hernial repairs, the procedures are made safer and the results are improved. The medical records were reviewed of 123 consecutive patients who underwent hernial repair. Seventy-six of these patients underwent a total of 82 herniorrhaphies using an abdominoplasty approach. This included using a transverse lower abdominal incision with or without extending it into an inverted-T incision. The hernial defect was then identified and isolated. Repair was obtained with primary fascial closure and plication, primary fascial approximation and reinforcement with absorbable Vicryl mesh, or placement of permanent mesh with or without fascial approximation. Overall, 8 of 82 hernias recurred. Most complications were minor and could be managed with local wound care only. Major complications included one enterocutaneous fistula, one occurrence of skin flap necrosis requiring operative debridement and skin grafting, and one delayed permanent mesh extrusion 2 years after repair. The abdominoplasty approach isolates the incision from the hernial defect and repair. This technique is safe with a low risk of complications and a low rate of recurrence. It is particularly helpful in obese patients, in patients with multiple hernias, and in those patients with recurrent hernias.

Abdominal Wall↗

PubMed2003

Emphysema of the abdominal wall obscuring postcesarean volvulus. A case report.

BACKGROUND: Emphysema of the abdominal wall occurs after infection with gas-forming organisms or when intraabdominal gas has a mechanical pathway to the retroperitoneum. CASE: Emphysema of the abdominal wall associated with volvulus developed after cesarean delivery. CONCLUSION: Postcesarean abdominal pathology may be associated with emphysema of the abdominal wall.

Abdominal Wall↗

PubMed1986

Measurement of abdominal wall compliance in normal subjects and tetraplegic patients.

On inspiration descent of the diaphragm is opposed by the passive properties of the abdominal wall, the tone of its muscles, and the inertia of the abdominal contents. As a result, intra-abdominal pressure rises and promotes rib cage expansion. In patients with high spinal injury the diaphragm is the most important muscle of inspiration and abdominal wall displacement is more evident than in normal subjects. Abdominal wall compliance has been measured by relating gastric pressure to abdominal wall displacement, which was determined by means of an optical contour mapping system. Six normal subjects and six tetraplegic patients were studied in the supine posture, during passive expiration from total lung capacity to functional residual capacity. Over this lung volume range the normal subjects partitioned an average of 31% of expired volume to the abdominal compartment, while the corresponding average figure in the patients was 77% of expired volume. Since the range of gastric pressure was similar in the two groups, it is concluded that abdominal wall compliance is greater in tetraplegic patients. This high compliance could have a detrimental effect on lower rib cage expansion.

Abdominal Muscles↗

PubMed1988

Abdominal wall defects and cryptorchidism: an animal model.

Intra-abdominal pressure has been implicated in the mechanism of testicular descent. Boys born with abdominal wall defects reportedly have an increased incidence of cryptorchidism. To examine this relationship further a rat model was developed. The rat testis normally descends postnatally on or about day 21. In this study newborn male rats underwent surgical excision of all anterior abdominal musculature from the umbilicus to the xiphoid, while a control group had a sham procedure. In both groups steel wire was inserted into both testes as radiological markers to monitor descent. Animals were explored on day 28 to confirm the position of the testes. A total of 36 animals survived all sections of the protocol. Eight animals had adhesions and were dropped from the study. The results of 17 rats in the experimental group and 11 in the control group revealed that the surgically created abdominal wall defect did not result in cryptorchidism. This finding suggests that an intact anterior abdominal wall is not a prerequisite for testicular descent in the rat.

Abdominal Muscles↗

PubMed1997

Laparoscopic cholecystectomy in patients with cardiac disease: hemodynamic advantage of the abdominal wall retraction method.

We examined the use of an abdominal wall retraction method instead of pneumoperitoneum in laparoscopic cholecystectomy for patients with cardiac disease to prevent the hemodynamic deterioration associated with pneumoperitoneum. Eight patients with cardiac diseases, mainly valvular or coronary artery diseases, underwent laparoscopic cholecystectomy under hemodynamic monitoring. Five patients without cardiac disease served as controls. As hemodynamic parameters, heart rate, mean systemic arterial pressure (mAP), mean pulmonary arterial pressure (mPAP), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and cardiac index (CI) were measured. The patients with cardiac disease showed significantly elevated mPAP and PCWP compared with the control group under pneumoperitoneum, and one patient showed critically decreased CI due to increased tricuspid regurgitation under pneumoperitoneum. These changes, however, were resolved on the abdominal wall retraction. There was no major perioperative complication. This abdominal wall retraction method is, therefore, favorable for patients with underlying cardiac disease to minimize the hemodynamic deterioration during laparoscopic cholecystectomy.

Abdominal Muscles↗

PubMed2005

The use of tensor fascia lata pedicled flap in reconstructing full thickness abdominal wall defects and groin defects following tumor ablation.

BACKGROUND: The tensor fascia lata is a versatile flap with many uses in reconstructive plastic surgery. As a pedicled flap its reach to the lower abdomen and groin made it an attractive option for reconstructing soft tissue defects after tumor ablation. However, debate exists on the safe dimension of the flap, as distal tip necrosis is common. Also, the adequacy of the fascia lata as a sole substitute for abdominal wall muscles has been disputable. The aim of the current study is to report our experience and clinical observations with this flap in reconstructing those challenging defects and to discuss the possible options to minimize the latter disputable issues. PATIENTS AND METHODS: From April 2001 to April 2004, 12 pedicled TFL flaps were used to reconstruct 5 central abdominal wall full thickness defects and 6 groin soft tissue defects following tumor resection. In one case, bilateral flaps were used to reconstruct a large central abdominal wall defect. There were 4 males and 7 females. Their age ranged from 19 to 60. From the abdominal wall defects group, all repairs were enforced primarily with a prolene mesh except for one patient who was the first in this study. Patients presenting with groin defects required coverage of exposed vessels following tumor resection. All patients in the current study underwent immediate reconstruction. RESULTS: The resulting soft tissue defects in this study were due to resection of 4 abdominal wall desmoid tumors, a colonic carcinoma infiltrating the abdominal wall, 4 primary groin soft tissue sarcomas, a metastatic SCC of the leg to groin nodes, and a primary SCC of the groin. The size of the flaps used ranged from 20 x 10 cm to 31 x 18 cm. All flaps survived. However, distal flap necrosis occurred in 4 cases. Three of those cases developed in flaps reconstructing abdominal wall defects, and one case developed in a flap used to cover a groin defect. In the former 3 cases, the flap was simply transposed without complete islanding of the flap. In the latter case, a very large flap was harvested beyond the safe limits with its distal edge just above the knee. In addition, wound dehiscence of the flap occurred in 2 other cases from the groin 132 group. Nevertheless, all the wounds healed spontaneously with repeated dressings. Out of the 5 cases that underwent abdominal wall reconstruction, one case developed ventral hernia, in which bilateral TFL flaps were used without mesh enforcement. There was minimal donor site morbidity in the form of partial skin graft loss in 2 cases. The average follow up period in this study ranged from 6 months to 2 years. Only one patient died of distant metastasis of a SCC of the groin skin, 8 months postoperatively and another 2 patients with abdominal desmoid tumors developed local recurrence. CONCLUSION: The tensor fascia lata flap is a reliable and a versatile flap, with minimal donor site morbidity. Problems with the flap's vascularity of its distal part should not be encountered, if the flap is harvested within the safe limits and properly designed and the edges comfortably insetted to the defect. A pedicled flap would be appropriate for lower abdominal wall defects, and is better islanded to achieve extra mobilization and allow a tension free closure, while for groin defects, simple flap transposition should be enough. Nevertheless, reconstruction for full thickness abdominal wall defects by this flap is a static reconstruction. We therefore strongly recommend enforcing the repair with a synthetic mesh primarily to minimize the incidence of ventral hernia. However, further studies with larger number of cases are needed to confirm this observation.

Abdominal Neoplasms↗

PubMed1999

Epidemiology of abdominal wall defects, Hawaii, 1986-1997.

The various types of abdominal wall defects are considered to differ in their etiologies, a hypothesis suggested by differences in their epidemiologies. This study examined the impact of selected demographic factors on abdominal wall defects (omphalocele, gastroschisis, and body stalk anomaly) included in a birth defects registry in Hawaii from 1986-1997. The total prevalence for the various defects were: omphalocele (2.76 per 10,000 births, 95% confidence interval (CI), 2.14-3.50), gastroschisis (3.01, 95% CI, 2. 36-3.77), and body stalk anomalies (0.32, 95% CI, 0.14-0.64). The prevalence increased over the 12-year period for both omphalocele (P = 0.052) and gastroschisis (P = 0.008). Women less than age 20 were at increased risk for a gastroschisis-affected pregnancy, while those age 40 and over were disproportionately more likely to have an omphalocele-affected pregnancy. Pacific Islanders had the lowest risk for omphalocele, whereas Far East Asians were least likely to have gastroschisis. Omphalocele rates were lower outside metropolitan Honolulu, while place of residence did not significantly impact gastroschisis risk. The 1-year survival rate was higher for gastroschisis than for omphalocele (88.5% and 70.7%, respectively), while none of the infants with body stalk anomalies was live-born. The results of this study tend to support the hypothesis of differing etiologies for the studied abdominal wall defects.

Abdominal Muscles↗

PubMed2005

[Repair of large abdominal wall defect with pedicle graft of greater omentum and polypropylene mesh].

OBJECTIVE: To evaluate the outcome of pedicle graft of greater omentum and polypropylene mesh in reconstruction of large defect of abdominal wall caused by surgical incision. METHODS: From 1994 to 2004, 12 cases of large abdominal wall defects were repaired with pedicle graft of greater omentum and polypropylene mesh after removal of abdominal wall tumor; the defect sizes of abdominal wall ranged from 10 cm x 7 cm to 25 cm x 17 cm. RESULTS: The abdominal wall wound in 12 cases were healed by first intention. After a follow-up of 1 to 5 years, no complications of abdominal hernia, infection and intestine obstruction occurred in all patients. CONCLUSION: It is reliable to repair abdominal wall defect caused by surgical incision with pedicle graft of greater omentum and polypropylene mesh instead of peritoneum.

Abdominal Injuries↗

PubMed1988

Is abdominal wall tenderness a useful sign in the diagnosis of non-specific abdominal pain?

Pain arising from the abdominal wall has been implicated as a cause of non-specific abdominal pain (NSAP), and the presence of abdominal wall tenderness (AWT) has been proposed as an accurate diagnostic test for NSAP. One hundred and fifty eight patients admitted to hospital with abdominal pain were tested for the presence of positive AWT. In 53 patients the final diagnosis was appendicitis and positive AWT was found in five. Thirty eight patients were found to have a variety of other recognised pathological diagnoses, none of whom had a positive AWT. In 67 patients a diagnosis of NSAP was made in the absence of other pathological diagnosis, 19 of whom had positive AWT, which was significantly different from the other diagnostic groups. This study confirms the presence of AWT in up to 28% of patients with NSAP, and suggests that testing for AWT is of value in patients with abdominal pain, although a positive AWT is not as accurate a predictor of NSAP as previously reported.

Abdomen↗

PubMed2004

Inguinal hernia: measurement of the biomechanics of the lower abdominal wall and the inguinal canal.

BACKGROUND: The stability of the lower abdominal wall may play a considerable role in the development of inguinal hernia. Therefore, the strength of the individual wall layers needs to be quantified. Despite numerous advances in hernia repair, comparatively few systematic biomechanic and morphometric analyses have been performed. Our aim was to establish and apply a standardised procedure for testing the abdominal wall layers' stability. METHODS: After dissecting the abdominal walls of 16 cadavers into separate layers, we used a spherical punch and a force transducer to investigate the forces necessary to foraminate the layer. In addition, maximum tensile-strength and suction tests and histologic morphometry were performed. RESULTS: The transversalis fascia was torn up on an average of 10.5 N, the peritoneum including pre- and subperitoneal tissue on 46.6 N, the aponeurosis of obliquus internus abdominis muscle on 51.7 N, and the aponeurosis of obliquus externus abdominis muscle on 92.6 N. Tensile tests of tissue strips obtained from defined areas showed comparable results. In contrast, surgical mesh revealed values between 60 and 150 N in punching tests. Left-right comparisons, as well as comparisons of the individual areas, revealed considerable intra- and inter-individual differences. CONCLUSIONS: Biological hernia repair should focus on a reinforcement of the tissue layers with the highest biomechanic stability. Reinforcement of the transversal fascia must be questioned according to our results of poor mechanical resistance.

Abdominal Wall↗

PubMed1999

Anterolateral thigh flap for abdominal wall reconstruction.

The free or pedicled anterolateral thigh flap was introduced for the reconstruction of large abdominal wall defects. This flap is superior to the tensor fasciae latae musculocutaneous flap in several respects. These include the wide, reliable skin territory (which can reach the level of the knee) and the long pedicle. Therefore, a pedicled anterolateral thigh flap with reliable blood circulation can easily be positioned above the umbilicus. In addition, the free anterolateral thigh flap has greater freedom of orientation and can be used to repair larger abdominal wall defects than can the tensor fasciae latae flap. Seven patients in whom abdominal wall defects had been reconstructed with pedicled or free anterolateral thigh flaps were reviewed. Their average age was 47.1 years (range, 21 to 74 years), and the average follow-up period was 10.7 months (range, 2 to 21 months). The size of the abdominal wall defects ranged from 12 x 12 cm to 18 x 24 cm, and the size of the transferred flap ranged from 10 x 20 cm to 20 x 20 cm. Three flaps were pedicled and four were free, of which three incorporated the tensor fasciae latae flap. All flaps survived completely, and no postoperative abdominal hernias developed. Despite some variations in vascular anatomy and technical difficulties in elevating the anterolateral thigh flap, the authors conclude that the pedicled or free anterolateral thigh flap is superior to the tensor fasciae latae flap for reconstruction of large abdominal wall defects.

Abdominal Muscles↗

PubMed2004

[Laparoscopic ovarian cystectomy with abdominal wall lift during pregnancy under combined spinal-epidural anesthesia].

Abdominal wall lift laparoscopic surgery is often used for patients during pregnancy because it is physiologically superior to CO2 pneumoperitoneum laparoscopic surgery. Operation for adnexal cysts is performed in the 1st trimester. We report seven cases of ovarian cysts during pregnancy, resected using gassless laparoscopic method with a whole abdominal wall lift under combined spinal-epidural anesthesia (CSEA). Combined spinal-epidural anesthesia had several advantages in these cases; 1. In the 1 st trimester, general anesthesia should be avoided. We could manage these cases without general anesthesia nor sedative medications. 2. During pregnancy, it is difficult to estimate the level of sensory blockade by spinal anesthesia. Epidural top-up helped us to easily control the level of sensory blockade. 3. Differential diagnosis of pain related to uterine contraction and postoperative pain is difficult. Post-operative analgesia was established by epidural PCA, thus anti uterine contraction medicines were prophylactically administered in only one of seven cases. There was no particular trouble during the anesthesia and all the operative procedures were performed uneventfully. Based on our limited experiences, CSEA may be a safe and appropriate anesthetic technique for laparoscopic ovarian cystectomy with abdominal wall lift during pregnancy.

Abdominal Wall↗

PubMed2004

[Imaging of the abdominal wall: combination of tissue-harmonic-imaging and extended field-of-view sonography].

PURPOSE: To evaluate the combined use of extended field-of-view sonography and tissue harmonic imaging (THI) for assessment of the abdominal wall. MATERIALS AND METHODS: In 32 patients (25 patients without and 7 patients with abdominal wall pathologies) extended field-of-view sonography of the abdominal wall was performed with and without THI using a 7.5 MHz ultrasound transducer. Images with a scan length of 60 cm were acquired above and below the arcuate line. The images were independently assessed by two observers regarding visibility of the anatomic structures and delineation of pathological changes using a 4-point grading scale. Furthermore, the influence of the extent of the subcutaneous fat on the image quality was assessed. For statistical analysis, kappa coefficients, Fisher"s exact test and a repeated measurement analysis of variance (ANOVA) were applied. RESULTS: In all patients, delineation of the abdominal wall was possible with diagnostic image quality. Abdominal wall pathologies were concurrently diagnosed for extended field-of-view sonography with and without utilization of THI. Image quality was rated better with THI when compared to extended field-of-view B-Mode sonography. In comparison to extended field-of-view B-Mode sonography, the agreement between both readers regarding image quality was markedly improved using extended field-of-view sonography in combination with THI. With increasing thickness of the subcutaneous fat layer, image quality was rated significantly better using THI than B-Mode ultrasound. CONCLUSION: Combined use of extended field-of-view sonography and THI improves image quality and documentation of ultrasound examinations. Especially in obese patients, the use of THI is advantageous. Therefore, abdominal wall ultrasound gains additional value in the preoperative planning.

Abdominal Wall↗

PubMed1999

Desmoid tumours of the anterior abdominal wall.

AIMS: To review the surgical management and outcomes for large desmoid tumours of the abdominal wall. METHODS: Seven patients with large desmoid tumours of the anterior abdominal wall were treated by wide local excision and reconstruction with two layers of Marlex V mesh (Bard, Galway, Ireland). RESULTS: No patient having initial surgery at this hospital has either a significant residual functional deficit or developed a recurrence. CONCLUSIONS: Large desmoid tumours of the abdominal wall are safely and adequately managed with abdominal wall resection followed by mesh reconstruction.

Abdominal Muscles↗

PubMed1994

Abdominal wall hernias. The value of computed tomography diagnosis in the obese patient.

The abdominal wall is a common and often overlooked source of pain. Three obese patients with pain that proved to come from an abdominal wall hernia are described. The hernias were not found on physical examination, and extensive workup of the digestive tract did not disclose the diagnosis. Computed tomography directed at the abdominal wall demonstrated the hernias. We review the literature on the use of computed tomography in the diagnosis of abdominal wall lesions.

Abdominal Muscles↗

PubMed2003

Surgical complications of inguinal and abdominal wall hernias.

Inguinal and other abdominal wall hernias are some of the most commonly encountered problems in the pediatric population that require surgical intervention. Surgical repair is straightforward in most cases and can be performed on an outpatient basis. Complications are unusual, but potentially devastating. This article focuses specifically on incidence and risk factors of these complications, reviews the currently accepted treatment options, and points out strategies to avoid them.

Abdominal Wall↗