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Chirurgia (Bucharest, Romania : 1990) 2020The risk of developing an abdominal wall hernia is high in the cirrhotic patient, due to the association of ascites, hypoalbuminemia and amyotrophy in connection with... (Review)
Review
The risk of developing an abdominal wall hernia is high in the cirrhotic patient, due to the association of ascites, hypoalbuminemia and amyotrophy in connection with undernutrition frequently associated with cirrhosis. Thus, almost 20% of cirrhotic patients develop an umbilical hernia. Parietal surgery is more at risk in cirrhotic patients and its indications must be discussed on a case-by-case basis. The objective of this work was to review the entire literature on wall surgery in order to best define the surgical indications and the specifics of their management. The bibliographic research was done on Pubmed over the period from January 1995 to December 2019, using French and English as publication languages. The keywords retained were "hernia" [Mesh] and "liver cirrhosis" [Mesh]. In an elective situation, preoperative ascites control is recommended. A parietal prosthesis can be used, even in the case of uninfected ascites, preferably in the retromuscular position. Laparoscopy should be used with caution, due to the bleeding risk. No recommendation can be made on the use of prophylactic intra-abdominal drainage. The literature data do not allow the trans-jugular route portosystemic shunt recommendation, nor the use of a peritoneal-vesical pump to decrease the volume of ascites before parietal surgery in cirrhotic patients.
Topics: Abdominal Wall; Ascites; Hernia, Umbilical; Hernia, Ventral; Herniorrhaphy; Humans; Liver Cirrhosis
PubMed: 32369717
DOI: 10.21614/chirurgia.115.2.140 -
Journal of Travel Medicine Oct 2023
Topics: Humans; Abdominal Wall; Echinococcosis
PubMed: 37462529
DOI: 10.1093/jtm/taad094 -
The Kaohsiung Journal of Medical... Nov 2023In order to accurately monitor graft immunology, we have developed a method for performing intestine and abdominal wall transplantation heterotopically in miniature...
In order to accurately monitor graft immunology, we have developed a method for performing intestine and abdominal wall transplantation heterotopically in miniature swine. The procedure consisted of simultaneous segmental terminal ileum and full-thickness abdominal wall transplantation in Lanyu miniature swine, with the intestinal and the abdominal wall grafts being placed on the recipient's bilateral rear flank. Five transplantations were technically successful. One animal died on the first post-transplant day due to anesthesia-related issues, three abdominal wall and four intestinal grafts survived, while one abdominal wall graft failed due to vascular thrombosis. Acute cellular rejection (ACR) of the intestinal graft could occur preceding, simultaneously with or following ACR of the abdominal wall graft. Our experimental model demonstrates the technical feasibility of heterotopic intestine and abdominal wall transplantation in miniature swine without grafting in gastrointestinal continuity. This model could be suitable for further studies of graft immunology.
Topics: Swine; Animals; Swine, Miniature; Abdominal Wall; Intestines; Ileum; Graft Rejection
PubMed: 37573495
DOI: 10.1002/kjm2.12742 -
Pediatric Surgery International Jul 2021Several studies have reported high prevalence of undescended testis (UDT) among boys with congenital abdominal wall defects (AWD). Due to rarity of AWDs, however, true...
PURPOSE
Several studies have reported high prevalence of undescended testis (UDT) among boys with congenital abdominal wall defects (AWD). Due to rarity of AWDs, however, true prevalence of testicular maldescent among these boys is not known. We conducted a national register study to determine the prevalence of UDT among Finnish males with an AWD.
METHODS
All male infants with either gastroschisis or omphalocele born between Jan 1, 1998 and Dec 31, 2015 were identified in the Register of Congenital Malformations. The data on all performed operations were acquired from the Care Register for Health Care. The register data were examined for relevant UDT diagnosis and operation codes.
RESULTS
We identified 99 males with gastroschisis and 89 with omphalocele. UDT was diagnosed in 10 (10.1%) infants with gastroschisis and 22 (24.7%) with omphalocele. Majority of these required an operation; 8/99 (8.1%) gastroschisis and 19/89 (21.3%) omphalocele patients. UDT is more common among AWD patients than general population with the highest prevalence in omphalocele.
CONCLUSIONS
Cryptorchidism is more common among boys with an AWD than general population. Furthermore, omphalocele carries significantly higher risk of UDT and need for orchidopexy than gastroschisis. Due to high prevalence testicular maldescent, careful follow-up for UDT is recommended.
Topics: Abdominal Wall; Cryptorchidism; Finland; Hernia, Umbilical; Humans; Infant; Male; Population Surveillance; Prevalence; Registries
PubMed: 33517489
DOI: 10.1007/s00383-021-04863-9 -
World Journal of Emergency Surgery :... Oct 2023High-level evidence regarding the technique of abdominal wall closure for patients undergoing emergency midline laparotomy is sparse. Therefore, we conducted a... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
High-level evidence regarding the technique of abdominal wall closure for patients undergoing emergency midline laparotomy is sparse. Therefore, we conducted a randomized controlled trial (RCT) to evaluate the efficacy and safety of two commonly applied abdominal wall closure strategies after primary emergency midline laparotomy.
METHODS/DESIGN
CONTINT was a multi-center pragmatic open-label exploratory randomized controlled parallel trial. Two different abdominal wall closure strategies in patients undergoing primary midline laparotomy for an emergency surgical intervention with a suspected septic focus in the abdominal cavity were compared: the continuous, all-layer suture and the interrupted suture technique. The primary composite endpoint was burst abdomen within 30 days after surgery or incisional hernia within 12 months. As reliable data on this composite primary endpoint were not available for patients undergoing emergency surgery, it was planned to initially recruit 80 patients and conduct an interim analysis after these had completed the 12 months follow-up.
RESULTS
From August 31, 2009, to June 28, 2012, 124 patients were randomized of whom 119 underwent surgery and were analyzed according to the intention-to-treat (ITT) principal. The primary composite endpoint did not differ between the continuous suture (C: 27.1%) and the interrupted suture group (I: 30.0%). None of the individual components of the primary endpoint (reoperation due to burst abdomen after 30 days (C: 13.5%, I: 15.1%) and reoperation due to incisional hernia (C: 3.0%, I:11.1%)) differed between groups. Time needed for fascial closure was longer in the interrupted suture group (C: 12.8 ± 4.5 min, I: 17.4 ± 6.1 min). BMI was associated with burst abdomen during the first 30 days with an OR of 1.17 (95% CI 1.04-1.32).
CONCLUSION
This RCT showed no difference between continuous suture with slowly absorbable suture versus interrupted rapidly absorbable sutures after primary emergency midline laparotomy in rates of postoperative burst abdomen and incisional hernia after one year. However, the trial was stopped after the interim analysis due to futility as there was no chance to show superiority of one suture technique.
Topics: Humans; Incisional Hernia; Abdominal Wall; Laparotomy; Sutures; Abdominal Cavity
PubMed: 37848901
DOI: 10.1186/s13017-023-00517-4 -
Taiwanese Journal of Obstetrics &... Sep 2020To compare fetal anterior abdominal wall thickness (AAWT) between women with and without GDM during third trimester and to determine accuracy of AAWT to predict large...
OBJECTIVES
To compare fetal anterior abdominal wall thickness (AAWT) between women with and without GDM during third trimester and to determine accuracy of AAWT to predict large for gestational age (LGA) infants.
MATERIALS AND METHODS
A total of 250 pregnant women, including 125 women with GDM and 125 women without GDM, were enrolled. Tansabdominal ultrasonographic examinations were performed at 28-30, 32-34 and 36-38 weeks. In addition to standard fetal biometries, AAWT was measured. Patient characteristics and ultrasonographic measurements were compared between groups. Sensitivity and specificity of AAWT for identifying LGA were evaluated.
RESULTS
While standard fetal biometries were comparable, mean fetal AAWT in GDM women were significantly higher than those without GDM at 28-30 weeks (2.8 ± 0.8 vs. 2.6 ± 0.6, p = 0.006) and 32-34 weeks (4.0 ± 0.9 vs. 3.5 ± 0.8, p = 0.042). LGA infants had significantly higher fetal AAWT at each time point only in GDM women. Using cut off values of AAWT of ≥2.0, 3.0, and 4.0 mm at 28-30, 32-34, and 36-38 weeks, sensitivity for LGA diagnosis in GDM women were 94.4%, 93.9%, and 89.3%, respectively. The use of abdominal circumference (AC) at >90th percentile showed lower sensitivity but higher specificity, regardless of GDM status. Combination of both measurements increased sensitivity to approximately 90% or higher in every time point, especially among GDM women.
CONCLUSION
Significant increase in fetal AAWT was observed in GDM women at 28-30 and 32-34 weeks. Fetal AAWT significantly increased among LGA infants and had higher sensitivity than AC in identifying LGA during third trimester. In GDM women at 28-30 weeks, AAWT ≥2.0 mm and AC >90th percentile had 97.2% sensitivity for LGA diagnosis.
Topics: Abdominal Wall; Adult; Case-Control Studies; Diabetes, Gestational; Female; Fetal Macrosomia; Humans; Infant, Newborn; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; ROC Curve; Ultrasonography, Prenatal
PubMed: 32917316
DOI: 10.1016/j.tjog.2020.07.008 -
Complementary Medicine Research 2023Myofascial trigger points are among the often-overlooked causes of anterior abdominal wall pain and primer dysmenorrhea. It is crucial to evaluate patients with a...
Myofascial trigger points are among the often-overlooked causes of anterior abdominal wall pain and primer dysmenorrhea. It is crucial to evaluate patients with a myofascial perspective in addition to a good history and a detailed physical examination. Myofascial trigger points of the abdominal oblique muscles and rectus abdominis muscle should be considered for patients with abdominal wall pain and primer dysmenorrhea. It should also be kept in mind that myofascial pain syndrome may be the primary pathology responsible for the pain, or it may be an entity accompanying another underlying pathology.
Topics: Female; Humans; Trigger Points; Dysmenorrhea; Abdominal Wall; Myofascial Pain Syndromes; Fibromyalgia
PubMed: 36893743
DOI: 10.1159/000530035 -
Ugeskrift For Laeger Nov 2020Closure of an emergency abdominal midline laparotomy is related to potentially serious complications. Main concerns are surgical site infection, wound dehiscence and... (Review)
Review
Closure of an emergency abdominal midline laparotomy is related to potentially serious complications. Main concerns are surgical site infection, wound dehiscence and incisional hernia. In this review, new studies and guidelines are summed up to a set of recommendations applicable to the Danish surgical departments. Surgical strategies concerning primary closure of an emergency laparotomy as well as a strategy towards wound dehiscence are suggested. Suture techniques, negative pressure wound therapy and reinforcement of the abdominal wall with mesh are the topics reviewed.
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Humans; Incisional Hernia; Laparotomy; Surgical Mesh; Suture Techniques
PubMed: 33215586
DOI: No ID Found -
The Pan African Medical Journal 2022Abdominal wall endometriosis is the development of endometrial tissue in the anterior abdomen usually due to an operation in which the uterus is manipulated. We herein...
Abdominal wall endometriosis is the development of endometrial tissue in the anterior abdomen usually due to an operation in which the uterus is manipulated. We herein delineate the presentation, clinical investigation, and surgical treatment of an abdominal wall endometriosis case. A 42-year-old female presented with acute abdominal pain in the lower quadrants in the margins of an old cesarean scar. Two masses in the abdominal wall highly suspected of consisting of endometrial tissue were found during the investigation of the patient. These ones were removed in surgery and endometrial tissue secondary to previous cesarean section was confirmed after histological analysis. Consequently, although rare, if a painful mass in a surgical scar, such as a Pfannenstiel incision, is found in women of reproductive age with a history of obstetric surgery, the differential diagnosis shall include endometriosis. There is a portion of cases in which endometriosis recurs within five years following conservative surgery.
Topics: Abdominal Wall; Adult; Cesarean Section; Cicatrix; Endometriosis; Female; Humans; Neoplasm Recurrence, Local; Pregnancy
PubMed: 35685105
DOI: 10.11604/pamj.2022.41.193.33536 -
Journal of Robotic Surgery Oct 2021When approaching complex abdominal wall hernias at either index operation or a subsequent reoperation for recurrent incarcerated abdominal wall hernias, a majority of...
When approaching complex abdominal wall hernias at either index operation or a subsequent reoperation for recurrent incarcerated abdominal wall hernias, a majority of surgeons consider mesh placement a key step in the prevention of a future recurrence. While the laparoscopic and open approaches show no significant difference in hernia recurrence, the laparoscopic approach to complex abdominal wall hernias does reduce surgical-site infection, postoperative ileus, improves short-term quality-of-life scores, and reduces hospital length of stay (Davies et al. in Am Surg 78(8):888-892, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500604/ , 2012, McGreevy et al. in Surg Endosc 17(11):1778-1780, https://www.ncbi.nlm.nih.gov/pubmed/12958679 , 2003, Bittner et al. in Surg Endosc 33:3069-3139, https://doi.org/10.1007/s00464-019-06907-7 , 2019). In this paper, we describe a robotic approach with a pulley technique to the fixation of polypropylene mesh in complex abdominal wall reconstruction. Our primary aim is to offer a new perspective to the re-creation of challenging abdominal walls and to encourage other surgeons to gain proficiency in the robotic approach. Additionally, the material cost to the technique is lower than that of self-expanding or deployable mesh reinforcements used in other laparoscopic approaches. Over time, as an institution breaks even on the cost of a robot with their return on investment, this technique offers potential cost-saving.
Topics: Abdominal Wall; Hernia, Ventral; Humans; Laparoscopy; Robotic Surgical Procedures; Surgical Mesh
PubMed: 33113093
DOI: 10.1007/s11701-020-01161-9