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At least 487 records · Page 27Linked to original sources

PubMedDate not supplied

Abdominal wall endometriosis: a diagnostic dilemma for surgeons.

OBJECTIVE: To report 3 cases of endometriosis of the abdominal wall, a disease which is unfamiliar to general surgeons because of the potential pitfalls in its diagnosis. CLINICAL PRESENTATION AND INTERVENTION: Three patients were referred to our general surgery clinic for abdominal masses. Incisional hernia and an abdominal mass were initially suspected in 2 patients, while a preoperative diagnosis of a rectus abdominis hematoma was made in the third because she had no history of previous surgery. Pain was a remarkable complaint in only one of the present cases. Abdominal wall endometriosis was diagnosed only upon histological examination postoperatively. In all cases, ultrasonography revealed hypoechogenic masses, and computed tomography showed that these masses had spiculations, and macroscopic views of the resected masses revealed well-demarcated margins without peritoneal involvement. All patients were treated with wide radical resections followed by polytetrafluoroethylene patch grafting. They were discharged from hospital on either the 2nd or the 3rd postoperative day uneventfully, and during follow-up there were no signs of pelvic endometriosis, as confirmed by ultrasonography, CA 125 measurement, gynecological consultation and examination. CONCLUSION: Since the diagnosis of scar endometrioma is rarely established prior to surgery, endometriosis should be included in the differential diagnosis of masses on the abdominal wall.

Adult↗

PubMed1976

Management of massive abdominal wall defects: role of porcine skin grafts.

Primary closure with "minimal tension" of an inadequately debrided massive abdominal wall defect invariably results in further necrosis and dehiscence. Rotation flaps and prosthetic materials are potentially hazardous in severely traumatized and contaminated wounds. An alternate technique, utilizing an abdominal wall pack and porcine skin graft has been used in two patients with close-range shotgun blasts and one patient with postoperative necrotizing fascitis. The combination of a biological dressing and an abdominal wall pack, stinted by strategically placed retention sutures, controls infection, promotes healthy granulation tissue, and prevents bowel erosion with fistula formation.

Abdominal Injuries↗

PubMedDate not supplied

[Endometriosis of the abdominal wall (authors' experience)].

Endometriosis is a very common gynecological disease, although the abdominal wall localization is a rare clinical problem in the everyday practice and this explains the incomplete reports in literature and the difficulty of a standard treatment. The authors report four cases of abdominal wall endometriosis, underlining how the surgical therapy represents the golden standard of decisive treatment, thanks also to prosthetic reconstruction techniques who allow more radical demolitions. On the contrary, the medical treatment should be reserved to selected cases such as especially the less symptomatic umbilical primitive diseases.

Abdominal Wall↗

PubMed1993

Prenatal diagnosis and management of anterior abdominal wall defects in the west of Scotland.

An attempt was made to identify all the cases of abdominal wall defects occurring in the West of Scotland over a 7-year period to determine the current incidence, prenatal diagnosis, management, and prognosis for fetuses and neonates with abdominal wall defects. Cases were identified because they presented either for prenatal diagnosis, or to the Department of Pathology following termination or spontaneous pregnancy loss, or as neonates to the Neonatal Surgical Department. The incidence of abdominal wall defects was found to be 1 in 2500 births. Exomphalos was diagnosed before birth in 66 per cent of cases, and in 30 per cent of cases it was associated with another major abnormality. There was a 20 per cent intact survival in the cases diagnosed prenatally who had no fetal anomaly and who opted to continue with the pregnancy. Gastroschisis was diagnosed before delivery in 70 per cent of cases, and in the group who continued with the pregnancy there was an intact survival of 77 per cent. Body stalk anomalies were all diagnosed prenatally and terminated. Maternal serum alpha-fetoprotein was elevated in 89 per cent of the cases with exomphalos and in 100 per cent of the cases with gastroschisis and body stalk anomalies in which it was tested.

Abdominal Muscles↗

PubMed1992

[Abdominal wall hematoma].

We describe three case reports of hematomas in the abdominal wall muscles and discuss etiology, diagnostic findings and treatment. Abdominal wall hematomas are uncommon, and the condition is often misdiagnosed. One of our patients was laparotomised owing to suspected appendicitis, and one patient presented a tuberculous abscess that may have been an infected hematoma. Ultrasonographic examination or CT gives the correct diagnose. Conservative management is the treatment of choice unless bleeding is severe or the course is complicated by infection.

Abdominal Muscles↗

PubMed1992

Investigation and treatment of poor drains of dialysate fluid associated with anterior abdominal wall leaks in patients on chronic ambulatory peritoneal dialysis.

Reduced dialysate fluid volume and genital and abdominal-wall oedema occurring many months after initiation of continuous ambulatory peritoneal dialysis (CAPD) has been investigated in 20 patients using computed tomographic peritoneography. Leaks into the anterior abdominal wall at the site of insertion of the Tenckhoff catheter have been demonstrated in a series of 14 patients. Nocturnal peritoneal dialysis alone led to resolution of leaks in four of the nine patients who underwent this mode of treatment. Four of the failures plus a further four patients successfully underwent either resuture of the peritoneum or replacement of the catheter. A policy for management of proven anterior abdominal-wall leaks in CAPD patients is described, consisting of nocturnal peritoneal dialysis for 2 weeks followed by surgical intervention if the former is unsuccessful.

Abdominal Muscles↗

PubMed2000

Endoscopically assisted "components separation" for closure of abdominal wall defects.

The repair of ventral hernia defects of the abdominal wall challenges both general and plastic surgeons. Ventral herniation is a postoperative complication in 10 percent of abdominal surgeries; the repair of such defects has a recurrence rate as high as 50 percent. The "components separation" technique has successfully decreased the recurrence rates of ventral abdominal hernias. However, this technique has been associated with midline dehiscence and a prolonged postoperative stay at the authors' institutions. The purpose of this study was to determine whether endoscopically assisted components separation could minimize operative damage to the vasculature of the abdominal wall and decrease postoperative wound dehiscence. The study group consisted of seven patients who underwent endoscopically assisted components separation; the control group consisted of 30 patients who underwent open components separation. The two groups were similar regarding demographic data and defect size. The endoscopic group had a higher initial success rate than the open group (100 versus 77 percent). Recurrence rates were not significantly different between the two groups. However, the endoscopically assisted components separation patients had fewer postoperative and long-term complications. In the authors' experience, endoscopically assisted components separation has proved to be a safe and effective method for the repair of complicated and recurrent midline ventral hernias.

Abdominal Muscles↗

PubMed1989

Comparison of Marlex and Gore-tex to repair abdominal wall defects in the rat.

Marlex and Gore-tex, two prosthetic materials used to close abdominal wounds, were compared with respect to strength and adhesion formation. A 2.5 X 3.5-cm full-thickness area of abdominal wall was excised in 32 CD rats. The defect was repaired using identically sized patches of Marlex or 1-mm Gore-tex, determined by alternate assignment, and sutured with continuous 4-0 Gore-tex. Adhesion formation was graded at necropsy and recorded photographically in each animal. The mean adhesion index (none = 0, maximal = 4) was 1.37 +/- 0.12 and 2.62 +/- 0.12 (mean +/- SEM) for Gore-tex and Marlex groups respectively (p less than 0.005, unpaired t-test). A template was used to fashion 2-cm coronal strips of abdominal wall for tensile-strength testing. The relative strengths were 2.67 +/- 0.14 and 3.02 +/- 0.16 kg/cm (mean +/- SEM) for the Gore-tex and Marlex groups respectively (NS). Histologically, there were more epithelioid giant cells and less collagen formation in the Gore-tex group. Abdominal wall reconstruction with Gore-tex resulted in wound strength equal to that of Marlex and fewer adhesions. Gore-tex is preferred when prosthetic material and viscera are in close proximity.

Abdominal Injuries↗

PubMed2006

Does laparoscopy used in open exploration alleviate pain associated with chronic intractable abdominal wall neuralgia?

BACKGROUND: This study aimed to assess the efficacy of diagnostic laparoscopy and open exploration of trigger points (scar revision and neurectomy) in the treatment of intractable chronic abdominal wall pain. METHODS: This prospective nonrandomized study enrolled 24 patients (21 women) with an average age of 59 +/- 11 years. Abdominal wall pain was diagnosed by excluding other causes of pain and using multiple injections of bupivacain. The patients' demographic data and long-term postoperative course (37 +/- 13 months) were carefully recorded. RESULTS: Using laparoscopy, intraabdominal adhesions close to trigger points were found and lysed in 15 patients (63%). Next, a subcutaneous nerve resection was performed. After 1 month, 33% of the patients were completely pain free, and 42% reported alleviation of pain. After 3 years, chronic abdominal pain was totally healed in 25%, diminished in 50%, and unchanged or increased in 25% of the patients. A total of 23 patients (96%) reported that surgery was beneficial for their intractable pain. CONCLUSIONS: Laparoscopy used in open exploration is beneficial for 75% of carefully selected patients with chronic abdominal wall pain.

Abdominal Pain↗

PubMed1999

The hemithigh microvascular transfer (combined anterolateral thigh flap and tensor fasciae latae flap) for a full thickness abdominal wall reconstruction: a case report.

In large, full thickness upper abdominal wall defects a free microvascular tissue transfer is the only option which will enable reconstruction of the structural integrity of the abdominal wall as well as give a good aesthetic appearance. We present a case in which such a defect was reconstructed by a 29 x 19 cm hemithigh free flap, combining the adjacent vascular territories of the anterolateral thigh flap and the tensor fasciae latae flap based on the lateral circumflex femoral artery.

Abdominal Muscles↗

PubMed1999

Influence of polyglactin-coating on functional and morphological parameters of polypropylene-mesh modifications for abdominal wall repair.

Regarding oversized mechanical properties of most of the currently available materials a new mesh was developed (ETHICON, Norderstedt, Germany) and exactly adopted to the physiology of the human abdominal wall by reducing the amount of polypropylene (weight of <30 g/m2; mesh A). The consecutive increase of pores size as well as the use of multifilaments led to a pronounced increase of flexibility. To improve the handling during operation the initial stiffness of this low-weight large pores mesh was increased by strengthening with different amounts of absorbable polyglactin (combination of glycolide and lactide) in various forms: by coating (mesh B), adding multifilament polyglactin filaments (mesh C, Vypro) or both (mesh D), respectively. To test the consequences of the different supplementary techniques all mesh variants are implanted in a rat model. Over implantation intervals of 3, 7, 14, 21 and 90 days we measured the tensile strength, the resulting stiffness and surveyed the tissue response, particularly in regard to the extent of inflammation and to the induced fibrosis. The results proved a sufficient mechanical stability of the material reduced and pure polypropylene mesh A without restriction of the mobility of the abdominal wall compared with a group that had simple laparotomy and closure. The histological analysis of the interface showed a minor inflammatory reaction and a dense vascularisation. The addition of polyglactin multifilaments (mesh C) reduces the number of macrophages and granulocytes as indicators for acute inflammation, showing generally a scar formation limited merely to the perifilamentary region. The abdominal wall compliance remained unchanged compared with mesh A. The coating of the polypropylene with polyglactin (mesh B and D) appeared to change the tissue reaction remarkably, favouring the formation of a connective tissue capsule around the whole mesh. The mechanical testing revealed an apparent protrusion with an increase of curvature of the artificial abdominal wall at rising intraabdominal pressures. The entire coating of the polypropylene surface with polyglactin induces an all embedding scar plate, filling out the pores and forming a tissue capsule. The complex interaction of tissue and implanted biomaterials with their distinct alterations of the tissue response confirms the necessity of in vivo experiments even after 'minor' modifications. Whereas the addition of polyglactin filaments appears to be favourable, the coating of polypropylene with polyglactin seems to hinder the incorporation of the mesh.

Abdominal Muscles↗

PubMed1994

Use of a hand-held Doppler to avoid abdominal wall vessels in laparoscopic surgery.

Laparoscopy in general surgery is becoming a wide-spread technique. Substantial anterior abdominal wall haemorrhage is a recognised complication of the laparoscopic technique. Ten patients were examined with an 8 MHz hand-held Doppler and the anterior abdominal wall vessels were marked on the skin. Colour flow duplex was used to confirm the presence of vessels found in this way. All 40 epigastric arteries were marked accurately and confirmed; 75 other intramural arteries were identified, although the majority were too small for duplex confirmation. The preoperative use of hand-held Doppler is a quick and non-invasive way to identify the epigastric and larger intramural arteries. Routine use of this technique to mark abdominal wall vessels in the areas of trocar insertion should reduce this complication of laparoscopic surgery.

Abdominal Muscles↗

PubMed1996

Prenatal diagnosis and management of abdominal wall defects.

The widespread use of fetal ultrasonography in routine antenatal care now allows the majority of abdominal wall defects to be identified prenatally, with subsequent opportunities for parental counseling, fetal intervention, and optimal perinatal management. Outcome is significantly affected by the presence of additional structural or chromosomal malformations; appropriate multidisciplinary counseling and management is dependent on the early identification of such anomalies in addition to accurate delineation of the abdominal wall defect itself. In cases with associated lethal or multiple severe abnormalities, parents may opt for elective termination of the pregnancy. Serial sonography is of particular value in gastroschisis, but there is little evidence that fetal manipulation or premature delivery confers any significant benefit. For all types of abdominal wall defect, optimal perinatal management is achieved in centers where neonatal medical, surgical, and anesthetic expertise is immediately available; cases diagnosed in units without these services should be considered for in utero transport to the nearest perinatal center.

Abdominal Muscles↗

PubMed2006

The role of bioprosthetics in abdominal wall reconstruction.

In several common situations, bioprosthetic materials may have distinct advantages over synthetic mesh and autologous flap or graft techniques for abdominal wall reconstruction. These off-the-shelf materials entail no donor site morbidity and are used successfully in contaminated wounds owing to their ability to resist infection, become revascularized and incorporated into host tissue, and reduce visceral adhesions. Fibrovascular incorporation into surrounding tissues and implant remodeling reduce the risks associated with a persistent foreign body, such as chronic infection, enterocutaneous fistulae, and cutaneous exposure. Disadvantages of bioprosthetic materials include higher implant cost relative to synthetic mesh, limited size of individual sheets in some cases, and risk of seroma formation. Bioprosthetic mesh has been used for abdominal wall reconstruction for approximately 5 years, so long-term studies are not available. Current laboratory and clinical evidence suggests that these materials provide a strong, durable musculofascial repair when used for abdominal wall repair. Further studies and ongoing clinical experience will be important in determining the indications for which bioprosthetic mesh will have the greatest impact. Currently available commercial products have distinct differences that result in varied clinical biologic and physiologic activity. New products and modifications to existing products may further enhance the benefits of bioprosthetic mesh, particularly in challenging cases. The use of bioprosthetic mesh has attracted interest in a relatively short period of time, with rapidly increasing indications and volume of cases successfully performed. Bioprosthetic mesh likely will play a progressively greater role in trunk reconstruction in the future.

Abdominal Wall↗

PubMed2004

[The experimental grounds and clinical application of domestic endoprosthesis "Esfil" for plasty of the abdominal wall].

An investigation of physico-mechanical properties and a histological examination of meshed endoprostheses "Esfil" ("Lintex" St.Petersburg) and nets "Prolene" ("Ethicon") implanted into the abdominal wall of 66 Chinchilla rabbits was carried out under experimental conditions. The comparative experimental investigation has shown that both materials possess sufficient physico-mechanical properties to resist intra-abdominal pressure and when implanted they cause an inconsiderable inflammatory reaction followed by the formation of a solid connective tissue capsule. The endoprosthesis "Esfil" was used for plasty of the abdominal wall in 51 patients with postoperative ventral hernias. The endoprosthesis "Esfil" was found to meet all the requirements made to endoprostheses for plasty of the abdominal wall. Its use in clinical practice allows the restoration of quality of life of such patients.

Abdominal Muscles↗

PubMed2006

[Phytotherapeutic evaluation of Jatropha gossypiifolia L. on rats ventral abdominal wall wound healing].

INTRODUCTION: The Jatropha gossypiifolia L., which is used in popular medicine is considered to have good diuretic effect in hypertension and is also used as a laxative drug. It seems to have a healing effect, although not proved till now. PURPOSE: To evaluate the influence of intraperitoneal administration of Jatropha Gossypiifolia L., in suture healing of ventral abdominal wall of rats, through tensiometric measurement, macro and microscopic aspect of post-operative period. METHODS: Forty Wistar male rats were allocated in two groups of 20 animals. After the incision and exposure of abdominal cavity 1 ml/kg/weight of 0,9% sodium chloride solution was injected in control group, and in the other one the injection was of 1 ml/kg/weight of a gross ethanol extract of Jatropha gossypiifolia L. The suture of the abdominal wall was than performed with polypropylene separated stitches. The animals were followed-up and killed in the third and seventh days. The ventral abdominal wall was macroscopically analyzed, the resistance strength to strain was measured and it was also studied the histological aspects. RESULTS: On macroscopic examination more intense adhesion was found on the group of Jatropha in both third and seventh post-operative days. The strain evaluation was meanly greater on Jatropha group also in third and seventh days. CONCLUSION: The histological comparative analysis between the different groups showed that the acute inflammatory process was meanly greater for the Jatropha group in third and seventh post-operative days. The vascular neoformation was significantly greater in third post-operative day of Jathopha group; the other histological parameters were just alike. The intraperitoneal injection of Jatropha extract did not have any significant improvement for the wound healing on ventral abdominal wall on the evaluated animals in this study, no matter if analyzed at the third or seventh post-operative days.

Abdominal Wall↗

PubMed1995

Abdominal wall haematoma mimicking visceral injury: the role of CT scanning.

Four patients are presented who were thought to have sustained visceral injury following blunt abdominal trauma. However, CT demonstrated abdominal wall haematomata and allowed nonoperative management. Similarity between the clinical findings in visceral injury and abdominal wall haematoma can lead to diagnostic difficulty. The cases illustrate the need to consider abdominal wall haematoma as a possible diagnosis in patients with blunt abdominal trauma. The place of CT in making this diagnosis is highlighted.

Abdominal Injuries↗

PubMed1989

Expanded polytetrafluoroethylene patch for the repair of large abdominal wall defects.

Expanded polytetrafluoroethylene (ePTFE) was used to repair 11 large abdominal wall defects in ten patients. Three patches were fixed to the adjacent abdominal aponeurosis with a single row of sutures; seven patches were implanted with a 1-2 cm overlap of patch and aponeurosis and a double row of sutures. Recurrent buttonhole hernias were found in two patients, in both of whom a single row of sutures had been used. This reherniation was due to insufficient anchorage of the patch to the fascia. It is concluded that ePTFE is a useful material to repair large abdominal wall defects provided the patch is fixed to the aponeurosis with an overlap and a double row of sutures to prevent buttonhole hernias.

Abdominal Muscles↗