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PubMed2002

Abdominal wall hernias: a cross-sectional pictorial review.

The classification of abdominal wall hernias is often made difficult by confusing eponymous and anatomic nomenclature. In this article, we review the anatomy that defines the various types of hernias. The specific cross-sectional radiologic features required to correctly identify each type are then emphasized. The appropriate clinical context and the merits of the various imaging techniques available for the investigation of abdominal wall hernias are also discussed.

Abdominal Wall↗

PubMed2002

Abdominal wall endometriomas.

Endometriosis is a condition in which uterine mucosal tissue is located outside the uterus. Endometriosis may be pelvic or extrapelvic. The term endometrioma is used when endometriosis appears as a circumscribed mass. Abdominal wall endometriomas are usually a secondary process in scars after surgical procedures. A retrospective study of abdominal wall endometrioma, from March 1992 through April 1999 at our institution was done. The mean age of the patients was 28.4 years. Twelve of these reported cases were secondary to previous surgery. One patient presented primarily with an abdominal wall mass without previous surgical history. The most common presentation was an abdominal wall mass associated with pain during the menstrual cycle. Endometrioma was considered as a differential diagnosis in seven patients. All patients underwent surgery. Along with the literature review on endometrioma, the importance of considering it in the differential diagnosis for patients of child-bearing age is discussed.

Abdominal Muscles↗

PubMedDate not supplied

[Necrotizing fasciitis of the abdominal wall secondary to a perforated sigmoid diverticulum in a Spiegel's hernia. A case report].

It is uncommon that a complicated diverticular disease presents as an extraperitoneal manifestation, and it is also rare for diverticulitis to be the cause of a necrotizing fasciitis. Necrotizing fasciitis (NF) of the abdominal wall is not common and has a high mortality rate. We present a patient with NF of the abdominal wall secondary to a perforated colon diverticulum in a Spiegel's hernia without peritonitis or intraabdominal abscess. The absence of peritoneal manifestations delayed early diagnosis, which was evident through crepitation of the abdominal wall. Computed tomography (CT) revealed a severe inflammatory process characterized by the presence of gas in the abdominal wall. The patient underwent emergency surgery with debridement of all necrotic tissue, exploratory laparotomy, sigmoidectomy and derivative colostomy, but due to her advanced age and multiple organ failure, the outcome was fatal.

Abdominal Wall↗

PubMedDate not supplied

[Plastic repair with Plastex-type synthetic mesh in abdominal wall defects].

This paper analyses a statistical series of 53 patients suffering from single or multiple abdominal wall defects and who were managed by plastic surgery with Plastex type synthetic mesh. Our results are pleading for the extension of the indications of Plastex mesh buttressing surgery beyond the usual recurrent "hernia" cases to the patients admitted with nonrecurrent either large abdominal wall defects or, and poor-quality musculoaponevrotic parietes of the abdominal wall. Our study recorded recurrence and postoperative morbidity rates have been minimal due to both a correct selection of cases for this type of surgical repair and an adequate patient preoperative management in which antibiotic and thromboembolic prophylaxis have been applied on a regular basis.

Abdominal Muscles↗

PubMed1999

[A technique for treatment of extensive defects of the abdominal wall with gastrointestinal fistulae].

Under certain extreme conditions in abdominal surgery, such as in septic complications of resections of the GIT with dehiscence of the anastomosis the only possible surgical approach is classical laparostomy. In the latter, contrary to the technique of temporary closure, the abdominal cavity is left open. After control of the sepsis usually the greatest problem is treatment of the defect in the abdominal wall with a fistula of the GIT. Unfortunately special devices for the treatment of such wounds cannot be used in all cases. At the Department of Surgery in Plzen such situations are resolved by suction drainage led beyond the defect in the abdominal wall which is then covered with an incision foil. In this way treatment of the patient is greatly simplified.

Abdominal Muscles↗

PubMed1990

Upper abdominal wall defects: immediate or staged reconstruction?

One-stage reconstruction of the central and lower abdominal wall with vascularized tissue has been well described. A few cases of one-stage reconstruction of the upper abdomen also are reported. We attempted this procedure in six of seven patients who had large abdominal wall defects that reached the xiphoid process. In three patients, the intraabdominal parts of the procedures went well and the reconstructive goals were accomplished. In three other patients, prolonged and difficult intraabdominal operations resulted in considerable intestinal dilatation that compromised the reconstruction. We therefore recommend being prepared to abort a planned immediate abdominal wall reconstruction following a difficult intraabdominal operation. The abdomen should be temporarily closed with skin flaps, skin grafts, or absorbable mesh, and definitive reconstruction of the fascia should be done at a later operation.

Abdominal Muscles↗

PubMed1990

[Surgical anatomy of the anterior abdominal wall in normal viscera, dolichoviscerosis and visceroptosis].

There are three types in position of the abdominal internal organs: visceronorm, dolichoviscerosis and visceroptosis. The anterior abdominal wall also has its own anatomical peculiarities at every type of the internal organs position. Anatomical differences of its structure at visceronorm and dolichoviscerosis in comparison with visceroptosis are characterized as following: the area of aponeurotic formations of the anterior abdominal wall at dolichoviscerosis and visceroptosis increases and that of the muscular-decreases. Umbilical and inguinal rings are essentially dilated in comparison with those at visceronorm. It means that at dolichoviscerosis and visceroptosis there are anatomical prerequisites for development of external hernias in the anterior abdominal wall. A considerable mobility of the intestinal tract loops at dolichoviscerosis and visceroptosis results in certain disturbances of its function and their outlet into hernial sacs.

Abdominal Muscles↗

PubMed2006

Collagen foil (TissuFoil E) reduces the formation of adhesions when using polypropylene mesh for the repair of experimental abdominal wall defects.

BACKGROUND AND AIMS: Polypropylene meshes (PPMs) are routinely used in the treatment of incisional hernias to achieve a tension-free closure of the abdominal wall. Severe adhesions are a common cause of intestinal obstruction, or even intestinal fistulas. Using a porcine model, we investigated whether applying a collagen foil (CF) to the undersurface of a PPM will reduce adhesion formation. METHODS: In ten domestic pigs (20-25 kg), a median laparotomy was performed. In each animal the abdominal wall was reconstructed using three types of closure: simple closure by a running suture (control), PPM only, and PPM covered with CF (PPM-CF). After 6 weeks, the abdominal wall with adherent tissue was resected en bloc for macroscopic (quality and quantity of adhesion formation) and histological work-up. RESULTS: The PPM-CF showed significantly less severe (1.9 vs 3.0 according to a scoring system), and also less extended (23.8 vs 55.9% total coverage of the mesh), adhesions to the resected abdominal wall. Histological examination revealed fewer and less severe inflammatory reactions, necrosis, and foreign body reactions for the mesh and CF (PPM-CF). CONCLUSION: To combine meshes with the anti-adhesion properties of a CF may be another option to achieve more physiological and more tolerable prosthetic materials.

Animals↗

PubMed2005

Giant pseudocyst of the anterior abdominal wall following mesh repair of incisional hernia: a rare complication managed laparoscopically.

UNLABELLED: Giant pseudocyst formation of the anterior abdominal wall, following on-lay polypropylene mesh repair for incisional hernia is an under reported complication. We report an unusual case of a 56-year-old female who underwent a polypropylene mesh repair of incisional hernia 2 years back. Subsequently she developed a giant pseudocyst of the anterior abdominal wall, which was occupying the whole of the abdomen from the xiphisternum to the pubic bone, and over both the flanks. Over a period of one year, the cyst had defied multiple attempts at aspiration. The patient underwent a laparoscopic drainage of the collection with piecemeal excision of the entire cyst wall. Histopathology of the cyst wall revealed necrotic material with intervening areas of hemorrhage. No epithelial lining was seen. There has been no recurrence in the two years of follow-up. CONCLUSION: giant pseudocyst of the anterior abdominal wall is a rare complication following mesh repair of an incisional hernia. Such pseudocysts can be managed successfully by laparoscopic procedures.

Abdominal Wall↗

PubMed2000

Sonographic diagnosis of recurrent ulcer penetrating the anterior abdominal wall.

Penetration of a recurrent ulcer into the anterior abdominal wall after surgical treatment of peptic ulcer disease is a rare surgical emergency. Early diagnosis is essential, but there are no specific radiographic or endoscopic features. We report 2 cases of recurrent ulcer penetration into the anterior abdominal wall diagnosed preoperatively with transabdominal sonography. The ulcers appeared as cavity lesions, with hyperechoic bases that had destroyed the continuity of the stomach wall. Associated findings were a minimal amount of fluid around the ulcer cavity and a hypoechoic area considered secondary to inflammation or edema. The diagnoses were confirmed at laparotomy.

Abdominal Muscles↗

PubMed2002

[Surgical treatment of postop abdominal wall hernia].

Two methods of combined plasty of postoperative abdominal wall hernia (PAWH), based on biochemical conception of pathogenesis of the disease, were proposed. Application of the methods had allowed to close the defect of any size of anterior abdominal wall. For the 1996-2001 period 221 patients with large, huge and giant PAWH were operated. Local and general complications in 29 (13.1%) patients had occurred, one patient died. Result of treatment in term up to 6 years was studied, recurrency of the disease was not revealed.

Adult↗

PubMed1997

Laparoscopic surgery by abdominal wall lifting using original lifting bars.

Laparoscopic surgery by abdominal wall lifting may be less invasive than by pneumoperitoneum, because the influence of the pneumoperitoneum can be avoided. We have performed laparoscopic surgery without pneumoperitoneum by lifting the full layer of the abdominal wall using two unique kinds of lifting bars that we developed. We have used this method on a total of 154 patients and obtained favorable results. Laparotomy was performed in three of the 104 patients undergoing cholecystectomy. All of them had previously undergone gastrectomy, and laparotomy was performed because of severe intraperitoneal adhesions. There were no severe complications, but insufficient suturing was experienced in one patient who underwent resection of the large intestine. In this article we describe the procedures and results of the lifting method.

Abdominal Muscles↗

PubMed2005

Abdominal wall cellulitis in the morbidly obese.

Currently, almost two-thirds of the US population is either overweight or obese. In addition to non-infectious complications, obesity predisposes to infections, including lower extremity cellulitis. Although cases of abdominal wall cellulitis in the morbidly obese occur, to date there has been no formal address of this syndrome in the literature. We therefore reviewed our clinical experience of abdominal wall cellulitis complicating morbid obesity. A retrospective database search was performed to identify patients with both cellulitis and morbid obesity who were seen at the Mayo Clinic between January 1998 and August 2003. Clinical and microbiologic data were collected for these patients. Of the 260 cases of cellulitis identified, 24 (9.2%) had morbid obesity and abdominal wall cellulitis. The mean age of the 24 patients was 47 (range 22-70) y and over two-thirds of them were females. Their mean body mass index (BMI) was 62.3 (range 39.6-108.6). 17 (70.8%) had a remote history of abdominal surgery. 16 patients required 23 hospitalizations. Five patients developed cellulitis complications and 7 (29.1%) patients had recurrent bouts of cellulitis during the study period. Abdominal wall cellulitis is a unique infectious complication in patients with morbid obesity. Further study is needed to better define the pathogenesis of this illness to develop strategies in treatment and prevention.

Abdominal Wall↗

PubMed1982

Abdominal wall resection and reconstruction with the aid of Marlex mesh.

Treatment of malignant tumours of the abdominal wall is primarily surgical and should consist of ample excision with margin of 4-6 cm into the adjacent healthy tissue. When primary closure of the defect in the abdominal wall is not feasible, it can be repaired with the aid of Marlex mesh, combined if necessary with a pedicled omentum flap and free skin grafts. Major resections of the abdominal wall are thus made possible.

Abdominal Muscles↗

PubMed1997

The behavior of different types of polytetrafluoroethylene (PTFE) prostheses in the reparative scarring process of abdominal wall defects.

Currently one of the most widely used prosthetic materials in the repair of abdominal wall defects, is expanded polytetrafluoroethylene (ePTFE). It has been suggested that its behavior with respect to the reparative process may depend on its structure. The aim of the present study was to evaluate the effect of the structure of 3 ePTFE prostheses on the scarring process in an abdominal-wall-defect experimental model. The prostheses employed were the Soft Tissue Patch (STP) which is laminar in structure, Mycro Mesh (MM) which is multilaminar with perforations, and the Dual Mesh (DM) prosthesis which has one non-porous surface. Abdominal wall defects (7 x 5 cm) were created in 36 New Zealand rabbits and repaired using fragments of STP, MM and DM. Follow-up periods were 14, 30, 60 and 90 days post-implant. At these times prostheses were macroscopically examined for the presence of infection and/or rejection and the formation of adhesions to abdominal viscera. Specimens were also taken for microscopic analysis (optical and scanning electron) and for immunohistochemical analysis using the rabbit macrophage-specific monoclonal antibody RAM-11. Labelled macrophage counts were performed at each follow-up session. No cases of infection or rejection were found. Loose adhesions between prosthesis and underlying viscera were observed in 2 of the STP, 4 of the MM and 2 of the DM implants. STP and DM implants were progressively encapsulated by organized connective tissue on both peritoneal and subcutaneous surfaces. Cellular colonization was observed on both STP surfaces and on the porous surface of the DM although no more than a third of the biomaterial was penetrated by cells in either case. Colonization was very slight at prosthesis anchorage points. MM implants differed only in the formation of connective tissue bridges in perforated areas, and cellular infiltration in interlaminar spaces. Macrophage response was similar in the 3 prostheses with a reduction in RAM-11 labelled cells (p < 0.05) between 14 and 90 days post-implant. We conclude: a) the 3 types of PTFE prosthesis induced low incidence of adhesion formation between biomaterial and viscera; b) integration mechanism of the 3 prostheses were similar and culminated with the encapsulation of the PTFE by the neoformed tissue; c) the macrophage response induced by the 3 prostheses was similar to that of any reparative process in the absence of biomaterial.

Abdominal Muscles↗

PubMedDate not supplied

Abdominal wall endometrioma after cesarean section: a preventable complication.

The occurrence of abdominal wall scar endometrioma after cesarean section has been reported previously in the literature. However, steps to prevent this complication have not been delineated. A study was undertaken of six patients seen at our general surgical clinic, each of whom had presented with a painful mass at a previous cesarean section site. Ages ranged from 20 to 34 years. The duration of their symptoms ranged from 6 to 84 months. All patients underwent surgical exploration and excision of the mass, which was revealed by histology to be endometrioma. It is strongly recommended that, at the conclusion of the procedure of cesarean section, the abdominal wall wound be cleaned thoroughly and irrigated vigorously with high-jet saline solution before closure.

Abdominal Wall↗

PubMed2003

Recalcitrant abdominal wall hernias: long-term superiority of autologous tissue repair.

Secondary repair of recurrent ventral hernia is difficult, and success depends on re-establishing the functional integrity of the abdominal wall. Current techniques used for closure of these defects have documented recurrence rates as high as 54 percent. The authors' 8-year experience utilizing variations of the components separation technique for autologous tissue repair of recalcitrant hernias emphasizes that recurrent or recalcitrant hernias benefit from the creation of a dynamic abdominal wall. A total of 389 patients were retrospectively identified as having abdominal wall defects, and 284 of these patients met the selection criteria. Study patients were grouped according to the type of surgical repair used. The recurrence rate was 20.7 percent over all study groups and was directly related to the extent of repair required. Group 1 patients (wide tissue undermining) had a recurrence rate of only 15 percent, while in group 2 (complete components separation), the recurrence rate was 22 percent. Group 3 patients (interpositional fascia lata graft) had a 29 percent recurrence rate. Time to recurrence was also significantly different across treatment groups, with study group 3 experiencing earlier hernia recurrence. The most frequent postoperative complication was wound infection, which was directly related to the repair performed. The relative odds of recurrence versus the risk factors of age, sex, perioperative steroid use, wound infection, defect size, and the presence of enterocutaneous fistula were studied with a logistic regression analysis. These factors did not possess statistical significance for predicting hernia recurrence. The preoperative presence of mesh was independently significant for hernia recurrence, increasing the relative odds 2.2 times (p = 0.01). Similarly, when other risk factors were controlled for, increasing the complexity of the treatment group, from study group 1 (wide tissue undermining) to study group 3 (interpositional fascia lata graft), also increased the odds of hernia recurrence 1.5-fold per group (p = 0.04). Average inpatient cost was $24,488. The length of inpatient stay ranged from 2 to 172 days (average, 12.8 days). The length of inpatient stay and costs were directly related to the extent of repair required. Using the analysis of variance test for multiple factors, the presence of an enterocutaneous fistula (p = 0.0014) or a postoperative wound infection (p = 0.008) independently increased the length of inpatient stay and hospital costs. A total of 108 successfully repaired patients were contacted by telephone and agreed to participate in a self-reported satisfaction survey. The patients noticed improvements in the appearance of their abdomen, in their postoperative emotional state, and in their ability to lift objects, arise from a chair or a bed, and exercise. These results suggest that recalcitrant hernia defects should be solved, when possible, by reconstructing a dynamic abdominal wall.

Abdominal Muscles↗

PubMedDate not supplied

Metastatic nodules of the abdominal wall: US and CT evaluation..

PURPOSE: Metastatic recurrence in the abdominal wall surgical scar is not uncommon. Our aim was to evaluate the role of ultrasonography (US), computed tomography (CT) and percutaneous fine needle aspiration biopsy in the diagnosis of metastatic recurrence along the surgical scar. MATERIALS AND METHODS: We evaluated 17 nodules in the surgical scar, either single (n=9 patients) or multiple (n=2 patients), in 11 patients operated on for known abdominal neoplasm confirmed by histology. The most common primary tumour was colonic carcinoma. All patients had undergone open surgery, and the lesions were detected at routine follow-up or at diagnostic examinations performed for clinical suspicion of recurrence. Ultrasonography (7.5-10/10-13 MHz) and fine needle biopsy were performed in all cases; contrast-enhanced CT was carried out in 10 patients. All lesions underwent histopathological examination. RESULTS: The histological findings showed 16/17 metastatic nodules and one suture granuloma. Lesions had variable size (15-55 mm), roundish shape, ill-defined margins (60% cases) and hypoechoic solid echotexture. All were characterised by marked contrast medium uptake on CT examination. US-guided aspiration biopsy precisely defined the metastatic nature of the nodules in 16/17 cases. In the patient with suture granuloma, both CT and US findings suggested malignancy; however, cytology showed only scant fibrous material. The anterior abdominal wall was the most common site of metastatic disease (14 lesions). CONCLUSIONS: US enables an accurate detection and diagnosis of metastatic nodules along the surgical scar. Fine needle aspiration biopsy represents, in our opinion, the most suitable procedure for providing an accurate diagnosis of this condition.

Abdominal Neoplasms↗