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At least 343 records · Page 19Linked to original sources
PubMed1999

Abdominal wall lift versus carbon dioxide insufflation for laparoscopic resection of ovarian tumors.

STUDY OBJECTIVE: To evaluate and compare changes in pulmonary mechanics and stress hormone responses between abdominal wall lift (gasless) and carbon dioxide (CO2) insufflation laparoscopic surgery during controlled general anesthesia. DESIGN: Prospective, randomized clinical study. SETTING: Operating rooms at a university medical center. PATIENTS: 12 ASA physical status I and II female patients undergoing laparoscopic resection of ovarian tumors. INTERVENTIONS: Patients were divided into two groups of six each: the abdominal wall lift group and the CO2 pneumoperitoneum laparoscopic group. Following induction of anesthesia, patients were paralyzed and the trachea was intubated. Anesthesia was maintained with isoflurane and nitrous oxide (N2O) in oxygen. Throughout the procedure, patients were mechanically ventilated with a tidal volume of 10 ml/kg and a respiratory rate of 10 breaths per minute. MEASUREMENTS AND MAIN RESULTS: During the laparoscopic procedure, arterial blood gases, acid-base balance, pulmonary mechanics, stress-related hormones, and urine output were measured and recorded. In the CO2 pneumoperitoneum group, arterial CO2 tension increased (p < 0.01), dynamic pulmonary compliance decreased (p < 0.01), peak inspiratory airway pressure increased (p < 0.01), and plasma epinephrine (p < 0.05), norepinephrine (p < 0.05), dopamine (p < 0.01), and antidiuretic hormones (p < 0.05) increased significantly during the laparoscopic procedure as compared to the abdominal lift group. Adrenocorticotropic hormone and cortisol increased as compared to baseline value in both groups (p < 0.05). Urine output was significantly less (p < 0.01) in the CO2 pneumoperitoneum group than in the abdominal wall lift group. CONCLUSIONS: Abdominal wall lift laparoscopic surgery is physiologically superior to CO2 pneumoperitoneum laparoscopic surgery as seen during the conditions of this study. Abdominal wall lift laparoscopic surgery provides normal acid-base balance and a lesser degree of hormonal stress responses, it maintains urine output, and it avoids derangement of pulmonary mechanics.

Abdominal Muscles↗
PubMed1975

Bladder carcinoma involving the lower abdominal wall.

Our experience in treating 13 patients with bladder tumors involving the abdominal wall is presented. A technique is described wherein part of the suprapubic abdominal wall is excised and the resultant defect is closed with ox fascia. Of the 9 patients treated surgically 8 have had no local recurrence but distant metastases have developed. Presently 2 patients are clinically free of disease, 18 and 22 months after abdominal wall excision. One of these 2 patients required a subsequent groin dissection and was then lost to followup.

Abdomen↗
PubMed2005

Use of the omentum flap as additional soft-tissue cover for abdominal wall defects reconstructed with Gore-Tex.

BACKGROUND: Use of alloplastic materials such as Gore-Tex and locoregional flaps for reconstruction of large abdominal wall defects has been well described. The purpose of this article is to present a novel technique of using the omentum as an interpositional flap to protect the Gore-Tex repair of the abdominal wall. METHODS: Four patients with large abdominal wall defects underwent reconstruction with Gore-Tex and omentum flap. These defects resulted from tumor resection and recurrent incisional hernia. Their dimensions ranged from 15 x 10 cm to 25 x 27 cm. The Gore-Tex patch was inset using an underlay technique. The omentum was tunneled through a separate opening in the abdominal wall into the subcutaneous plane and used to cover the Gore-Tex. Skin coverage was accomplished by direct closure or myocutaneous flaps. RESULTS: The mean follow-up was 17 months. All wounds healed, with no hernias. One patient developed a subcutaneous abscess 6 months postoperatively, and this was treated successfully by percutaneous drainage, as the omentum had walled-off the abscess. CONCLUSION: The omentum flap served as an additional soft-tissue cover over the Gore-Tex repair to prevent exposure in the event of infection or flap breakdown. This technique is useful in situations in which delayed wound healing is anticipated or when large quantities of prosthetic material are used.

Abdominal Wall↗
PubMed1987

Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE).

Most abdominal wall incisional hernias can be repaired by primary closure. However, where the defect is large or there is tension on the closure, the use of a prosthetic material is indicated. Expanded polytetrafluoroethylene (PTFE) patches were used to repair incisional hernias in 28 patients between November 1983 and December 1986. Twelve of these patients (43%) had a prior failure of a primary repair. Reherniation occurred in three patients (10.7%). Wound infections developed in two patients (7.1%), both of whom had existing intestinal stomas, one with an intercurrent pelvic abscess. The prosthetic patch was removed in the patient with the abscess, but the infection was resolved in the other without sequelae. Septic complications did not occur after any operations performed in uncontaminated fields. None of the patients exhibited any undue discomfort, wound pain, erythema, or induration. Complications related to adhesions, erosion of the patch material into the viscera, bowel obstruction, or fistula formation did not occur. Based on this clinical experience, the authors believe that the PTFE patch appears to represent an advance in synthetic abdominal wall substitutes.

Adult↗
PubMed1991

Abdominal wall reconstruction (the "mutton chop" flap).

Reconstruction of full-thickness abdominal wall defects can be a difficult surgical challenge. Reconstructing the epigastrium may be especially vexing. The use of prosthetic mesh has significant drawbacks, and the use of pedicled myofascial and myocutaneous flaps should be advantageous. We present 15 consecutive cases demonstrating highly successful reconstructions of massive abdominal wall defects using myofascial and myocutaneous flaps without prosthetic mesh. The extended rectus femoris flap, or "mutton chop" flap, which is capable of resurfacing the epigastrium, is described. Complications were minimal, and use of myofascial units, particularly the rectus femoris, should be considered as the technique of choice for reconstruction of major abdominal wall deficits.

Abdominal Muscles↗
PubMed1981

Synovial sarcoma of abdominal wall: a case report and study of tumor fine structure.

A case of synovial sarcoma in the abdominal wall of a 50-year-old Iraqi woman is reported. The ultrastructure of the tumor has been studied. Eight other cases of synovial sarcoma in the abdominal wall reported in the English literature up to 1978 have been reviewed. Synovial sarcomas in the abdominal wall tend to occur with a much greater frequency in women, whereas such tumors occurring in the extremities or the neck are more common in men than woman. No ultrastructural studies of abdominal wall synovial sarcomas could be found in the English literature. The ultrastructural characters of this tumor are similar to those of such tumors arising in the usual sites and the neck. However, the present study has indicated that the light and dark cells reported by earlier workers are not limited solely to the epitheloid areas but are also present in the spindle cell zones.

Abdominal Muscles↗
PubMed2004

Abdominal wall neurofibroma presenting as an inguinal hernia.

Inguinal hernias are a common cause of abdominal wall pain and are the most common abdominal wall abnormality. They can usually be differentiated from other abnormalities by history and physical examination. Occasionally, the diagnosis may be difficult with very small or very large lesions. The following case report describes an abdominal wall neurofibroma presenting as an inguinal hernia in a young, active duty, male soldier with previously undiagnosed neurofibromatosis.

Abdominal Neoplasms↗
PubMed1981

Synovial sarcoma of the abdominal wall: a case report and study of its fine structure.

A case of synovial sarcoma in the abdominal wall of a 50-year-old Iraq female is reported. The ultrastructure of the tumor has been studied. Eight other cases of synovial sarcoma in the abdominal wall which reported in the English literature up to 1978 have been reviewed. Synovial sarcomas in the abdominal wall tend to occur with a much greater frequency in females in contrast to such tumors in the extremities or the neck which tend to occur with a much greater frequency in males. No ultrastructure studies of abdominal wall synovial sarcomas could be found in the English literature. Ultrastructure characteristics of this tumor were similar to those arising in the usual sites and in the neck. However, the present study has indicated that the light and dark cells reported by earlier workers are not solely limited to the epitheloid areas but are also present in the spindle cell zones.

Abdominal Muscles↗
PubMed2005

[Advance in researches on materials for abdominal wall defect].

How to succeed in repairing an immense abdominal wall defect is often a perplexed question for surgeons. Finding perfect substitute material, therefore, is of great importance. The materials in this regard are often divided into two categories: biomaterial and non-boimaterial. The former has excellent mechanics properties while the latter possesses more favourable biocompatibility. The characteristics, clinical effects and advantages of biomaterials and non-biomaterials for abdominal wall repair are reviewed.

Abdominal Wall↗
PubMed2006

Efficacy of polypropylene mesh coated with bioresorbable membrane for abdominal wall defects in mice.

Incisional hernias due to trauma, infection, or tumor are a common abdominal wall defect. Repair of these defects when autogenous tissue is insufficient or inadequate often results in abdominal tissue adhesion. These adhesions often lead to complications such as intestinal obstruction and enterocutaneous fistula. Previous reports have shown that application of prosthetic materials, such as polypropylene mesh and anionic polysaccharides, has been effective in reducing the amount of tissue adhesion. However, some tissue adhesion still occurs with application of these materials when previously described methodologies are used. We evaluated the efficacy of a novel surgical approach that combines the application of Sepramesh, a coated polypropylene mesh, and Seprafilm, composed of anionic polysaccharides (both products from Genzyme, Cambridge, MA), in the repair of abdominal wall hernias. We report that combined application of these 2 materials in a "sandwich technique", by placing the peritoneum between the Seprafilm and Sepramesh, further reduces (and in some instances prevents) tissue adhesion after abdominal wall defects in mice. Moreover, our combined treatment markedly decreased tissue inflammation after hernia repair.

Abdominal Wall↗
PubMed1989

Familial abdominal wall defects.

We report 2 families, each having multiple sibs with abdominal wall defects. In family 1, normal parents gave birth to identical (monochorionic, diamniotic) twins. This is the first reported case of gastroschisis occurring in monozygotic twins. In family 2, a normal mother gave birth to a son with omphalocele. Two subsequent pregnancies with a different husband resulted in a stillborn girl with partial atresia of the colon and a liveborn girl with gastroschisis. In neither case were there any associated anomalies. In neither of the 2 families was there consanguinity or history of other abdominal wall defects. The familial occurrence of these defects suggests that 1) multifactorial determination should be considered in at least some cases of abdominal wall defects, 2) the bowel atresias that occasionally accompany gastroschisis may also have a genetic (multifactorial) cause, and 3) some cases of gastroschisis and omphalocele may have the same genetic cause.

Abdominal Muscles↗
PubMedDate not supplied

[New abdominal wall reconstruction technique with a plastic-rehabilitative intent (back pain improvement)].

Many abdominal wall reconstruction techniques have generally failed to pay attention to a number of anatomical considerations concerning the continuity of the thoraco-lumboabdominal fascia that envelops the dorsal and ventral muscles. We have introduced a new surgical technique (round mesh) developed to improve the abdominal wall weakness or pathology (hernia, laparocele) with the aim of restoring the muscular synergy between the anterior and posterior trunk compartments, thus improving sacroiliac stability, posture, and standing effort endurance. One hundred patients of both sexes were enrolled in this investigation. All were affected by abdominal wall impairment, frank hernia or laparocele, and had been complaining of lumbar and sciatic pain for long periods without any definite intervertebral disk pathology. They underwent pre- and postoperative subjective and objective evaluation and insertion of a prefascial polypropylene mesh with a posterior martingale that passes across the spine and paravertebral muscles, ending in two wider rectangles that are criss-crossed ventrally and finally sutured to the iliopubic brim. All the patients improved either subjectively or objectively with the round mesh procedure. This new technique is particularly useful in cases of reduction or impairment of the recti abdominis, transverse and oblique muscles, because simple suture and plication of these muscles is no guarantee of long-term functional restoration.

Abdominal Wall↗
PubMed2006

[Malignant transformation of abdominal wall endometriosis: a new case report].

Cancer arising in abdominal wall endometriosis is a rare event, hindering diagnosis and making management uncertain. A cesarean section scar is generally at the origin of the disease. We report the case of a 45-year-old woman, with a past medical history of cesarean deliveries, complaining of a repeat abdominal wall endometriosis which transformed into a clear-cell carcinoma. Outcome was rapidly fatal. Compared with endometriosis-associated ovarian carcinoma, the prognosis of this abdominal scar complication is poor. In the literature, survival rate reaches only 57% after a short follow-up of 20 months. Clear-cell carcinoma is the most common histological subtype, followed by endometrioid carcinoma. Radical surgery is the main treatment. Good technique and proper care during cesarean section may help in preventing this endometriosis complication.

Abdominal Neoplasms↗
PubMed2005

Progressive fascial wound failure impairs subsequent abdominal wall repairs: a new animal model of incisional hernia formation.

BACKGROUND: Fascial wound failure alters the phenotype of the abdominal wall. This study introduces a novel animal model of progressive failure of the ventral abdominal wall fascia, which generates large incisional hernias. MATERIAL AND METHODS: A mechanistic model of incisional hernia was compared with a model of acute myofascial defect hernia repair. Using biological tissue repair markers, tensiometric measurements and recurrent hernia rate, we measured the mechanism by which incisional hernias regenerate abdominal wall structure and function after mesh and suture herniorrhaphy. RESULTS: Recurrent incisional hernia formation was significantly increased after repairs of the hernia model, compared with the myofascial defect model (6/16 vs 0/16, P < .05). In the hernia model, there were significant decreases in the recovery of wound strength, energy, and extensibility before mechanical disruption, compared with the myofascial defect model. Unexpectedly, excision of fascial hernia wound edges did not significantly improve tissue repair outcomes in the hernia model group. CONCLUSIONS: Clinically accurate animal modeling can recreate the wound pathology expressed in mature incisional hernias. Progressive fascial wound failure decreases the fidelity of subsequent incisional hernia repair, compared with identically sized acute abdominal wall defect repairs. The mechanism appears to include decreased fascial wound strength and decreased tissue compliance after herniorrhaphy.

Abdominal Muscles↗
PubMed1995

Morphology of the abdominal wall in the bat, Pteronotus parnellii (Microchiroptera: Mormoopidae): implications for biosonar vocalization.

We investigated the structure of the abdominal wall of Pteronotus parnellii and made comparisons with eight other species of Microchiroptera and one megachiropteran. Similar to other mammals, the abdominal wall of bats consists of the three flank muscles laterally and the m. rectus abdominis ventrally. In Microchiroptera, flank muscles are mostly confined to dorsal portions of the wall. The mm. transversus abdominis and obliquus internus abdominis form the bulk of the wall; the m. obliquus externus is poorly developed. Ventrolaterally, a large portion of the wall is a dense, bilaminar aponeurosis, composed of collagen, elastin, and fibroblasts. The thicker, superficial lamina derives from the mm. obliquus internus and transversus abdominis. The deep lamina is a continuation of the transversalis fascia. Collagen fibers of the two fused laminae are oriented orthogonally, resulting in a resilient, composite fabric. Fascicles of the flank muscles are oriented along the margins of the aponeurosis so that their forces appear to be concentrated onto the aponeurosis. We suggest that this system is adapted for the regulation and generation of intra-abdominal pressure. The abdominal wall of Pteropus, the one megachiropteran examined, lacks the derived aponeurosis and is similar to other mammals. We consider the abdominal wall of Microchiroptera to be analogous to the diaphragma, in that it functions in the regulation of pressure within body cavities and facilitates biosonar vocalization.

Abdominal Muscles↗
PubMed1984

Traumatic hernia of the anterior abdominal wall.

Despite an increase in incidence of blunt abdominal trauma and despite the variations in compressive forces that occur, very few cases of traumatic hernia of the anterior abdominal wall have been recorded. Two recently treated cases of traumatic disruption of the musculature and fascia of the anterior abdominal wall with herniation of intestine into the subcutaneous space are herein reported. The occurrence of blunt abdominal trauma associated with an extra-abdominal mass believed to contain intestine signifies a severe compressive force and probable extensive associated injury. It represents an acute emergency and requires prompt resuscitative measures and surgical intervention.

Abdominal Muscles↗
PubMed2001

Elasticity of the anterior abdominal wall and impact for reparation of incisional hernias using mesh implants.

Mesh implantation to repair incisional hernia involves extensive disturbance of the integrity of the abdominal wall. To define the physiological requirements, we measured the elasticity of the abdominal wall of 14 anatomic samples. The complete abdominal wall was excised and stretched at a strain of 0-24 N in horizontal, vertical and oblique (upper and lower abdomen) directions. The resulting mean distension at 16 N was in the range between 11% and 32% for all directions. Furthermore, we found significant differences between tissue samples from male and female subjects, as well as considerable inter-individual differences in each group. Textile analysis of common mesh materials at 16 N showed elasticities in the range of 4%-16%. Comparing the textile characteristics with the physiological elasticity revealed inadequate properties in at least some of the mesh materials. Our findings indicate that the flexibility of the abdominal wall must be more or less restricted by extensive implantation of large meshes and recurrences may possibly be provoked at the margins of implanted materials.

Abdominal Muscles↗