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PubMedDate not supplied

Congenital abdominal wall defects: an update.

OBJECTIVE: To review published peer-reviewed literature regarding abdominal wall defects including gastroschisis and omphalocele. METHODS: Review of published peer-reviewed literature using Med Line 1985-2003 and textbooks. RESULTS: Gastroschisis and omphalocele literature is reviewed using pathology, incidence and epidemiology, prenatal evaluation, pregnancy and delivery management, postnatal outcome and fetal therapy. CONCLUSION: Gastroschisis and omphalocele are common abdominal wall defects and have significant morbidity and mortality.

Animals↗
PubMedDate not supplied

[Plastic repair of the anterior abdominal wall in bladder exstrophy].

In 1987-1993 surgical treatment for exstrophy of the bladder was performed in 35 children at the age 8 months--3 years. All the patients underwent one-stage transplantation of the ureters into the semi-isolated segment of the sigmoid colon with antireflux protection of the ostia, bladder extirpation and repair of the anterior abdominal wall. The most difficult stage of the intervention is repair of the abdominal wall defect after removal of the large bladder. Related complications arising in 16% of the surgical patients impose the problem of the technique of safe filling of the abdominal wall defect. In 16 patients with large bladder its demucosation was followed by strengthening of the detrusor muscles with the help of interrupted sutures with fixation to underdeveloped oblique abdominal muscles. The skin defects was filled by raised movable skin flaps on both sides of the divided pubis. The above technique reduced the number of postoperative complications three times. Intestinal eventration was not observed. The wound suppuration and partial defect of the sutures occurred in 1 case. The rest 15 children exhibited healing with minimal scarring and good cosmetic effect.

Abdominal Muscles↗
PubMed1995

Abdominal Wall Lifting Devices as Alternatives to Pneumoperitoneum.

Conventional laparoscopy requires pneumoperitoneum to elevate the abdominal wall for exposure. A continuous insufflation of a noncombustible gas in a sealed environment is essential. Undesirable physiological side effects have been observed with CO2 pneumoperitoneum. Furthermore, it has been necessary to retrain surgeons to use specialized instruments in order to operate on video images. Japanese and American investigators have recently used mechanical devices without pneumoperitoneum to elevate the abdominal wall for laparoscopic surgery. With their gasless technique, conventional instruments can be used, direct visualization of abdominal viscera is possible, and digital examination of abdominal contents can be performed without the fear o losing exposure. Since these procedures are being performed in a isobaric abdominal cavity, the risk of body fluid contamination to operating team is diminished when compared to open or traditional laparoscopic surgery. With this technique, transition from open to laparoscopic surgery is minimal; it should be added to the training of future surgeons.

Journal Article↗
PubMed1993

Ultrasound image properties influenced by abdominal wall thickness and composition.

The influence of different examination conditions on the ultrasound B-scan was investigated using a tissue-mimicking phantom and a computerized ultrasound system. Several fat-muscle combinations simulated differences in abdominal wall thickness and composition. The analysis of the ultrasound images was performed by use of statistical parameters applied in ultrasound tissue characterization, thereby the influence of the abdominal wall thickness and composition on the ultrasound image brightness, microtexture, and macrotexture (image sharpness) was studied. An increasing fat path caused a decrease in ultrasound image brightness and microtexture. The macrotexture was largely unaffected. Muscle tissue alone had a weak influence on the microtexture parameters. Our results show that an increase in the fat layer of the abdominal wall causes a darker, unsharp image and may lead to false diagnoses, especially in adiposity. Furthermore, fat-muscle combinations caused a decrease in image brightness and contrast. The decrease in these image properties was dependent on the thickness of the combination as well as on the frequency of the transducer. The effects were stronger for high-frequency transducers.

Abdominal Muscles↗
PubMed2005

Abdominal wall and thigh abscess resulting from the penetration of ascending colon cancer.

An unusual case is described in which an abdominal wall and thigh abscess was an initial symptom of ascending colon cancer. A 76-year-old woman was referred to our hospital for investigation of fever and abdominal and thigh swelling. Computed tomography revealed a right abdominal wall, retroperitoneal, psoas and thigh abscess formation suspected to be caused by colon perforation. Due to the patient's poor general condition, local drainage of the abscess was performed on the following day of hospitalization. Histological examination of necrotic tissues removed form the retroperitoneal cavity demonstrated adenocarcinoma of the colon. The patient subsequently underwent right hemicolectomy with lymph nodal dissection after 19 days of the drainage procedure and was transferred to another hospital on the 49th day following the second surgery.

Abdominal Wall↗
PubMed1977

Desmoid tumors of the abdominal wall.

Desmoid tumors are musculo-aponeurotic fibromatoses which most commonly occur in the abdominal wall. They do not metastasize but local recurrence is common. The treatment of choice is wide local excision of the mass and surrounding normal tissue. We have described a rare desmoid tumor which involved the abdominal wall as well as small and large bowel. En bloc intestinal resections were required for complete tumor extirpation.

Abdominal Muscles↗
PubMed1979

Use of Teflon mesh for repair of abdominal wall defects in neonates.

Since 1975, we have employed Teflon mesh sutured to the fascial rim in four newborns with giant omphaloceles, with approximation of skin flaps over the mesh. By stabilizing the anterior abdominal wall, the Teflon mesh has prevented formation of large ventral hernias. The mesh has been retained in place for a year or longer, until the growth of the child permits excision of the prosthesis and fascial approximation without difficulty. A similar technique has been successfully employed in a fifth neonate following transabdominal correction of congenital bilateral eventration of the diaphragm to avoid unacceptable increase in intra-abdominal pressure with primary closure of the abdominal wall. The Teflon mesh appears ideally suited for this technique. It is well incorporated into the fascial rim with minimal foreign body reaction. At the time of secondary repair, the mesh can easily excised from the smooth underlying pseudomembrane covering the bowel. All infants achieved stable abdominal walls by this technique. Three patients have undergone excision of the Teflon mesh and fascial repair at 12, 15, and 36 mo of age without difficulty.

Abdominal Muscles↗
PubMed2005

Lateral thermal damage to rat abdominal wall after harmonic scalpel application.

BACKGROUND: Use of the Harmonic Scalpel transduces a lower amount of energy to tissues, thereby limiting the potential for lateral thermal damage and deep penetration because only low temperatures are reached. The working principle of the Harmonic Scalpel is the transformation of electric power into the longitudinal mechanical movement of the instrument tip. This study aimed to determine the effects from varying durations of Harmonic Scalpel application on the experimental model of rat abdominal wall without skin. METHODS: After the rats had been anesthetized, and a laparotomy was performed. The Harmonic Scalpel shears were used on the muscular part of the abdominal wall without skin. Different durations of output power 3 were applied: a single 5-s application, a single 10-s application, and a regimen of two sequential 5-s applications. Each animal in each group of 10 received five individual activations, after which the animals were killed. Tissue samples were fixed and embedded in paraffin before sections were taken and stained. Using light microscopy and morphometric imaging analysis, the width of tissue lateral thermal damage was measured from the point of Harmonic Scalpel incision. RESULTS: The rat abdominal wall showed lateral thermal damage over a mean width of 0.0522 +/- 0.0097 mm after a 5-s Harmonic Scalpel application, a damage width of 0.1544 +/- 0.0419 mm after a 10-s application, and a damage width of 0.1020 +/- 0.0430 mm after a 5-s application followed by 5 s of inactivity and another 5 s of activity. These differences in thermal damage width between all the groups are statistically significant. CONCLUSIONS: The findings lead to the conclusion that tissue lateral thermal damage after Harmonic Scalpel application at standard output power is greater when a longer sustained period of application is used. Lateral thermal damage also is greater if the Harmonic Scalpel application time is continuous rather than of the same total duration with a brief midpoint interruption.

Abdominal Injuries↗
PubMed2006

Treatment of large incisional abdominal wall hernias, using a modified preperitoneal prosthetic mesh repair.

Very large and complex incisional hernias, especially those with loss of abdominal wall, can be a very interesting and perplexing problem, which present a particular challenge to the surgeon. The reported technique was developed and refined by one of our surgeons, between 1998 and 1999 for the repair of incisional hernias in a selected group of patients with large defects, often with a major loss of abdominal wall, overweight and previous attempts for incisional hernia repair. The technique involves a modified preperitoneal approach and was used on 43 eligible patients between 1999 and 2002. There were 30 females and 13 males at a mean age of 61 years. The median ASA score of the group was 2, with a mean BMI of 30.4 and a mean hernia surface area of 162 cm(2). One-third of the patients had one or more previous incisional hernia repair. Mean operating time was 190 min with an average hospital stay of 5.7 days. Postoperative complications occurred in 28% of the patients, most of which were minor and did not necessitate admission to the intensive care unit. None of the patients died. Wound infections occurred in 9.3%, was associated with an increased risk for cutaneous sinus formation, but not for mesh removal or hernia recurrence. A recurrence rate of 12.5% was found after a mean follow-up period of 46 months. We advocate this procedure for the repair of large, complex incisional hernias with loss of abdominal domain in patients with significant risk factors for recurrence.

Abdominal Wall↗
PubMed2006

Laparoscopic repair for recurrent abdominal wall hernia after TRAM flap breast reconstruction: case report of 2 patients.

BACKGROUND: The transverse rectus abdominis musculocutaneous (TRAM) flap is an appealing option for women choosing between various breast reconstructive techniques as it results in an autologous reconstructed breast that is soft and mimics a natural breast. Despite these benefits, there are complications with this procedure, such as pain at the donor site, longer scars, and most frequently the occurrence of abdominal wall hernia or bulge, which has been reported in up to 20%-40% of patients. METHODS: In this case report, we share our experience with 2 patients who had multiple open hernia repairs, 5 between the 2 of them, after their TRAM flap surgery. Each of these 5 repairs was performed with a Prolene mesh overlay, but not one lasted for more than 6 months. After reviewing our patients' records and our surgical options, we decided to proceed with laparoscopic repair of their recurrent hernias. RESULTS: The patients are now at postoperative follow-up of 12 months and 15 months, with no evidence of recurrence. DISCUSSION: Laparoscopic surgery has many benefits, such as shorter hospitalization and decreased pain. For our patients, it also resulted in a more beneficial and longer-lasting repair. We believe that this is partly due to the mechanics of the repair, which allows the abdominal contents to buttress the mesh against the abdominal wall. In addition, we believe that this technique reinforces the posterior sheath, which may not be accomplished in an open repair. This is important as most hernias after TRAM flap surgery occur below the arcuate line. From our experience with these 2 patients, we now advocate the use of laparoscopic repair as a treatment option for those who present with recurrent abdominal wall hernia or bulge after their TRAM flap surgery and believe with more experience it will become a first-line treatment.

Abdominal Wall↗
PubMed1998

Abdominal wall defects: anatomic classification and a scheme for management.

Defects created after excision of abdominal wall tumors pose a challenge to the reconstructive surgeon. The task is made more difficult by the wide variety of flaps available for this purpose. We present a simple classification of abdominal wall defects and our choice of flaps for reconstruction. The abdomen was divided into six regions for the purpose of reconstruction. The deep inferior epigastric artery flap alone is the flap of choice for central supraumbilical defects. For lateral supraumbilical defects the latissimus dorsi flap fulfills all the requirements. Infraumbilical defects, central or lateral, are ideally suited to reconstruction by unilateral or bilateral tensor fascia lata flaps. Patients representing each scenario are presented.

Abdominal Muscles↗
PubMedDate not supplied

[Abscess of the abdominal wall: a rare presentation of xanthogranulomatous pyelonephritis].

A young psychiatric patient presented with a purulent collection in the lower abdominal wall. Simple drainage failed to heal the abdominal wall abscess, and the presence of a primary septic focus was suspected. Full investigation showed a right renal pelvis calculus with xanthogranulomatous pyelonephritis complicated by a retroperitoneal abscess. Recovery was complete after a nephrectomy. A review of the published literature demonstrated the rarity of this presentation, although even more curious cases have been described, including a urinobronchial fistula, as well as catastrophic cases presenting with a massive haemorrhage. Authors are unanimous that ultrasonography should be the first examination, the scanner being also of primordial value for the diagnosis and demonstration of the retroperitoneal spaces ans fascia. Treatment requires both rapid and radical surgical intervention.

Abscess↗
PubMed2005

[Multiple synchronous intrathoracic neurilemmomas who had a past history of neurilemmoma on the abdominal wall; report of a case].

A 66-year-old female, who had received a surgery of the neurilemmoma on the abdominal wall 6 years ago, was referred to our hospital because of a chest X-ray abnormality. Chest computed tomography (CT) revealed 3 tumors in the left chest wall. One tumor arised from the 7th intercostal nerve and 2 tumors from 8th nerve. These tumors were surgically removed by video-assisted thoracic surgery. These tumors are histopathologically diagnosed as neurilemmoma and have the same characteristics with previously resected abdominal wall tumor.

Abdominal Wall↗
PubMed2006

Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas.

PURPOSE: Preoperative external-beam radiation therapy (preop RT) in the management of Retroperitoneal Liposarcomas (RPLS) typically involves the delivery of radiation to the entire tumor mass: yet this may not be necessary. The purpose of this study is to evaluate a new strategy of preop RT for RPLS in which the target volume is limited to the contact area between the tumoral mass and the posterior abdominal wall. METHODS AND MATERIALS: Between June 2000 and Jan 2005, 18 patients with the diagnosis of RPLS have been treated following a pilot protocol of pre-op RT, 50 Gy in 25 fractions of 2 Gy/day. The Clinical Target Volume (CTV) has been limited to the posterior abdominal wall, region at higher risk for local relapse. A Three-Dimensional conformal (3D-CRT) and an Intensity Modulated (IMRT) plan were generated and compared; toxicity was reported following the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events v3.0. RESULTS: All patients completed the planned treatment and the acute toxicity was tolerable: 2 patients experienced Grade 3 and 1 Grade 2 anorexia while 2 patients developed Grade 2 nausea. IMRT allows a better sparing of the ipsilateral and the contralateral kidney. All tumors were successfully resected without major complications. At a median follow-up of 27 months 2 patients developed a local relapse and 1 lung metastasis. CONCLUSIONS: Our strategy of preop RT is feasible and well tolerated: the rate of resectability is not compromised by limiting the preop CTV to the posterior abdominal wall and a better critical-structures sparing is obtained with IMRT.

Abdominal Wall↗