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European Journal of Orthopaedic Surgery... Aug 2018Although successful and well-established procedures, hip operations whether elective or trauma are coupled with a variety of complications. Among the most uncommon... (Review)
Review
Although successful and well-established procedures, hip operations whether elective or trauma are coupled with a variety of complications. Among the most uncommon complications are injuries to intra-abdominal or intra-pelvic organs which could prove potentially life-threatening. While there are various reports of such injuries in the literature, we aimed to perform a systematic review in order to examine the causes and relationships between intra-abdominal and intra-pelvic complications and the mechanism of injury, the pattern of presentation, identification, the course of management and outcomes. We identified 69 reports describing a total of 84 complications in intra-pelvic and intra-abdominal contents in 75 patients. These involved six major categories, including the intestinal tract, the urinary tract, the genital tract, the vascular system, the viscera and peripheral nerves. The most commonly injured system was the urinary (33.33%), followed by the vascular (29.76%) and the intestinal (22.62%). Among these systems, the most prevalent complications involved injury to the urinary bladder (32.14%), the large intestine (68.42%) and the external iliac artery (44%). The majority of recorded complications were postoperative with 71 incidents in 63 cases (84.52%). In intra-operative complications the most prevalent injury was due to hardware penetration (53.85%), while in postoperative it was due to hardware migration (92.06%). The management of injuries varied widely, with the most common approach being open exploration and direct repair (77.33%). The reported management outcomes included death (8%) and Girdlestone resection (2.67%), while the majority of the patients healed uneventfully (82.67%) owing mostly to immediate intervention. Despite being rare, such complications may still occur in a variety of settings and may subsequently lead to potential life-threatening situations. Thus, in order to avoid catastrophic outcomes we emphasize the need for prompt identification, immediate intervention and a multidisciplinary approach when necessary.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Fracture Fixation, Internal; Fractures, Bone; Hip; Hip Fractures; Hip Injuries; Hip Joint; Humans; Joint Diseases
PubMed: 29435655
DOI: 10.1007/s00590-018-2154-6 -
Surgical and Radiologic Anatomy : SRA Mar 2015Although several studies have reported that the peritoneum does not contribute to the formation of a fascia between the urogenital organs and rectum, Denonvilliers'...
Although several studies have reported that the peritoneum does not contribute to the formation of a fascia between the urogenital organs and rectum, Denonvilliers' fascia (DF), a fascia between the mesorectum and prostate (or vagina) in adults, is believed to be a remnant of the peritoneum. Remnants of the peritoneum, however, were reportedly difficult to detect in other fusion fasciae of the abdominopelvic region in mid-term fetuses. To examine morphological changes of the pelvic cul-de-sac of the peritoneum, we examined 18 male and 6 female embryos and fetuses. A typical cul-de-sac was observed only at 7 weeks, whereas, at later stages, the peritoneal cavity did not extend inferiorly to the level of the prostatic colliculus or the corresponding structure in females. The cul-de-sac had completely disappeared in front of the rectum at 8 weeks and homogeneous and loose mesenchymal tissue was present in front of the rectum at the level of the colliculus at 12-16 weeks. We found no evidence that linearly arranged mesenchymal cells developed into a definite fascia. Therefore, the development of the DF in later stages of fetal development may result from the mechanical stress on the increased volumes of the mesorectum, seminal vesicle, prostate and vagina and/or enlarged rectum. Therefore, we considered the DF as a tension-induced structure rather than a fusion fascia. Fasciae around the viscera seemed to be classified into (1) a fusion fascia, (2) a migration fascia and (3) a tension-induced fascia although the second and third types are likely to be overlapped.
Topics: Cadaver; Fascia; Female; Fetus; Humans; Male; Pelvis; Peritoneum; Rectum; Stress, Mechanical
PubMed: 25008480
DOI: 10.1007/s00276-014-1336-0 -
Frontiers in Surgery 2023Multivisceral transplantation of pelvic organs would be a potential treatment for severe pelvic floor dysfunction with fecal and urinary incontinence, extensive perineal...
BACKGROUND
Multivisceral transplantation of pelvic organs would be a potential treatment for severe pelvic floor dysfunction with fecal and urinary incontinence, extensive perineal trauma, or congenital disorders. Here, we describe the microsurgical technique of multivisceral transplantation of pelvic organs, including the pelvic floor, in rats.
DONOR OPERATION
We performed a perineal (including the genitalia, anus, muscles, and ligaments) and abdominal incision. The dissection progressed near the pelvic ring, dividing ligaments, muscles, external iliac vessels, and pudendal nerves, allowing pelvic floor mobilization. The aorta and vena cava were isolated distally, preserving the internal iliac and gonadal vessels. The graft containing the skin, muscles, ligaments, bladder, ureter, rectum, anus and vagina, uterus and ovarian (female), or penile, testis and its ducts (male) was removed , flushed, and cold-stored.
RECIPIENT OPERATION
The infrarenal aorta and vena cava were isolated and donor/recipient aorta-aorta and cava-cava end-to-side microanastomoses were performed. After pelvic floor and viscera removal, we performed microanastomoses between the donor and the recipient ureter, and the rectum and pudenda nerves. The pelvic floor was repositioned in its original position (orthotopic model) or the abdominal wall (heterotopic model). We sacrificed the animals 2 h after surgery.
RESULTS
We performed seven orthotopic and four heterotopic transplantations. One animal from the orthotopic model and one from the heterotopic model died because of technical failure. Six orthotopic and three heterotopic recipients survived up to 2 h after transplantation.
CONCLUSION
The microsurgical technique for pelvic floor transplantation in rats is feasible, achieving an early survival rate of 81.82%.
PubMed: 37151860
DOI: 10.3389/fsurg.2023.1086651 -
Journal of Nepal Health Research Council Nov 2022Due to the risk of pleural injury leading to thoracic complications, many urologist still hesitate to perform supracostal puncture during percutaneous nephrolithotomy....
BACKGROUND
Due to the risk of pleural injury leading to thoracic complications, many urologist still hesitate to perform supracostal puncture during percutaneous nephrolithotomy. Our aim of this study was to evaluate the thoracic complications in supracostal access percutaneous nephrolithotomy.
METHODS
This is a retrospective analysis of 101 patients who were treated with supracostal access percutaneous nephrolithotomy at our institute from September 2013 and December 2019. Indications for supracostal punctures were staghorn 28(27.7%), middle calyceal stones 10(9.9%), pelvic stones 29(28.7%), complex inferior calyceal stones 26(25.7%), upper calyceal stone 10(9.9%)and upper ureteric stone17(16.8%).The intercostal space between the 11th and 12th ribs was used in all the cases.
RESULTS
Among the 101 patients who undergone percutaneous nephrolithotomy by supracostal access, three patients (2.97%) had pleural injury. Among them one patient developed hydrothorax and needed chest tube insertion and remaining two patients had minimal pneumo thorax with blunting of costo-phrenic angle, which was managed conservatively. The lung parenchymal or other viscera injury was not observed in our study. Most punctures were, a single supracostal superior calyceal access 18(17.8%) and middle posterior calyceal access 88(82.2%), except for staghorn and multiple complex lower calyceal calculi needed multiple tracts 23(22.8%). Complete clearance was observed in 77(76.2%) patients.
CONCLUSIONS
The supracostal puncture was a safe and effective approach with high stone clearance rate and acceptable morbidity in selected cases of staghorn, upper ureteral, and upper calyceal calculi. It should be adapted whenever needed and should not be avoided due to fear of chest complications.
Topics: Humans; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Retrospective Studies; Nepal; Kidney Calculi; Treatment Outcome; Postoperative Complications
PubMed: 36550713
DOI: 10.33314/jnhrc.v20i02.3950 -
Radiographics : a Review Publication of... 2020Surgical mesh is used most frequently for tension-free repair of abdominal wall hernias in adults, because the rate of hernia recurrence is lower with mesh than with... (Review)
Review
Surgical mesh is used most frequently for tension-free repair of abdominal wall hernias in adults, because the rate of hernia recurrence is lower with mesh than with primary soft-tissue repair. Since the introduction of polypropylene mesh in the middle of the 20th century, many mesh materials and configurations for specific surgical procedures have been developed. In addition to abdominal wall hernia repair, mesh may be used for repair of diaphragmatic hernias, urinary incontinence in women (female slings), genitourinary prolapse (vaginal mesh and sacrocolpopexy), rectal prolapse (rectopexy), and postprostatectomy male urinary incontinence (male slings). General mesh repair complications include chronic pain; fluid collections such as seromas, hematomas, and abscesses; adhesions that may lead to intestinal blockage; erosion into solid or hollow viscera including enterocutaneous fistulizing disease; and mesh failure characterized by mesh shrinkage, detachment, and migration with repair malfunction. Several mesh complications are often diagnosed with imaging, primarily with CT and less frequently with MRI and US, despite variable mesh visibility at imaging. This article reviews the common surgical mesh applications in the abdomen and pelvis, discusses imaging of mesh repair complications, and provides complication treatment highlights.RSNA, 2020.
Topics: Herniorrhaphy; Humans; Pelvic Organ Prolapse; Postoperative Complications; Surgical Mesh; Urinary Incontinence
PubMed: 32125951
DOI: 10.1148/rg.2020190106 -
Cureus May 2019According to current scientific standards, the fascia is a connective tissue derived from two separate germ layers, the mesoderm (trunk and limbs, part of the neck) and... (Review)
Review
According to current scientific standards, the fascia is a connective tissue derived from two separate germ layers, the mesoderm (trunk and limbs, part of the neck) and the ectoderm (cervical tract and skull). The fascia has the property of maintaining the shape and function of its anatomical district, but it also can adapt to mechanical-metabolic stimuli. Smooth muscle and non-voluntary striated musculature originated from the mesoderm have never been properly considered as a type of fascia. They are some of the viscera present in the mediastinum, in the abdomen and in the pelvic floor. This text represents the first article in the international scientific field that discusses the inclusion of some viscera in the context of what is considered fascia, thanks to the efforts of our committee for the definition and nomenclature of the fascial tissue of the Foundation of Osteopathic Research and Clinical Endorsement (FORCE).
PubMed: 31312576
DOI: 10.7759/cureus.4651 -
Journal of Surgical Case Reports Feb 2024Endosalpingiosis a condition of ectopic glandular epithelium diagnosed histologically, most commonly on pelvic and abdominal peritoneum, that can be associated with...
Endosalpingiosis a condition of ectopic glandular epithelium diagnosed histologically, most commonly on pelvic and abdominal peritoneum, that can be associated with abdominal pain mimicking appendicitis. There is evidence emerging that endosalpingiosis may be associated with serous ovarian malignancies. Here we describe a case of perforated appendicitis with concurrent endosalpingiosis. Further research is required to better elucidate the association between endosalpingiosis and malignancy, and the implications of a concurrent presentation with a hollow viscus perforation.
PubMed: 38426183
DOI: 10.1093/jscr/rjae091 -
Actas Urologicas Espanolas Mar 2018with the widespread use of minimally invasive techniques, robot-assisted urologic surgery has become widely adopted. Despite their infrequency, visceral and... (Review)
Review
INTRODUCTION
with the widespread use of minimally invasive techniques, robot-assisted urologic surgery has become widely adopted. Despite their infrequency, visceral and gastrointestinal complications could be life-threatening.
OBJECTIVES
To identify the main gastrointestinal injuries that occur in a robot-assisted urologic surgery. To know the overall incidence and how is their management.
ACQUISITION OF THE EVIDENCE
Search in PubMed of articles related to visceral and gastrointestinal complications in robot-assisted urology surgery, written in English or Spanish. Relevant publications as well literature reviews and chapters from books were reviewed.
SYNTHESIS OF THE EVIDENCE
Along with vascular injuries, visceral and gastrointestinal lesions are among most dangerous complications. A complete preoperative study to individualize each patient characteristics and the correct use of imaging could help us to avoid complications in the first place. To know all the risky steps in the different robotic urologic procedures will let us anticipate the damage. Knowledge of main and most dangerous injuries in the different abdominal and pelvic organs is fully recommended. Early diagnosis and evaluation of lesions will let us an acute management during surgery. Recognition delay could change a repairable injury into a life-threatening situation.
CONCLUSIONS
Despite the undeniable benefits of robotic approach, there are minor and major gastrointestinal injuries that all urologic surgeons must know. Those related with trocar placement are especially important. Immediate diagnosis and management is mandatory.
Topics: Digestive System; Digestive System Fistula; Electrocoagulation; Gastrointestinal Diseases; Humans; Intraoperative Complications; Minimally Invasive Surgical Procedures; Postoperative Complications; Preoperative Care; Risk Factors; Robotic Surgical Procedures; Surgical Instruments; Urinary Fistula; Urologic Surgical Procedures; Viscera
PubMed: 28478913
DOI: 10.1016/j.acuro.2016.12.010 -
Arab Journal of Urology Mar 2019: To identify various predisposing factors, the clinical presentation, and the management of vaginal mesh-related complications, with special emphasis on mesh exposure... (Review)
Review
: To identify various predisposing factors, the clinical presentation, and the management of vaginal mesh-related complications, with special emphasis on mesh exposure and the indications for and results of vaginal mesh removal. : A systematic literature review was performed using a search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. PubMed was queried for studies regarding aetiology, risk factors, and management of vaginal mesh exposure from 1 January 2008 to June 2018. Full-text articles were obtained for eligible abstracts. Relevant articles were included, and the cited references were used to identify relevant articles not previously included. : A total of 102 abstracts were identified from the PubMed search criteria. An additional 45 studies were identified based on review of the cited references. After applying eligibility criteria and excluding impertinent articles, 58 studies were included in the final analysis. : Numerous studies have found at least some degree of symptomatic improvement regardless of the amount of mesh removed. Focal areas of exposure or pain can be successfully managed with partial mesh removal with low rates of complications. With partial mesh removal, many patients will ultimately require subsequent mesh removal procedures. For this reason, complete mesh excision is an alternative for patients with diffuse vaginal pain, large mesh exposure, and extrusion of mesh into adjacent viscera. However, when considering complete mesh removal, it is important to counsel patients regarding possible complications of removal and the increased risk of recurrent stress urinary incontinence and pelvic organ prolapse postoperatively. : MUS: midurethral sling; OR: odds ratio; POP: pelvic organ prolapse; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-analyses; SUI: stress urinary incontinence; TOT: transobturator; TVT: tension-free vaginal tape.
PubMed: 31258942
DOI: 10.1080/2090598X.2019.1589787