-
The Cochrane Database of Systematic... Oct 2004There is a variety of techniques for closing the abdominal wall during caesarean section. Some methods may be better in terms of postoperative recovery and other... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is a variety of techniques for closing the abdominal wall during caesarean section. Some methods may be better in terms of postoperative recovery and other important outcomes.
OBJECTIVES
To compare the effects of alternative techniques for closure of the rectus sheath and subcutaneous fat on maternal health and healthcare resource use.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register (September 2003), MEDLINE (1966 to September 2003), EMBASE (1980 to September 2003), CINAHL (1983 to September 2003) and CAB Health (1973 to September 2003), and the reference lists of included articles.
SELECTION CRITERIA
Randomised trials making any of the following comparisons: (a) any suturing technique or material used for closure of the rectus sheath versus any other; (b) closure versus non-closure of subcutaneous fat; (c) any suturing technique or material used for closure of the subcutaneous fat versus any other; (d) any type of needle for repair of the abdominal wall in caesarean section versus any other; (e) any other comparison of methods of abdominal wall closure.
DATA COLLECTION AND ANALYSIS
Both reviewers evaluated trials for eligibility and methodological quality without consideration of their results.
MAIN RESULTS
Seven studies involving 2056 women were included. The risk of haematoma or seroma was reduced with fat closure compared with non-closure (relative risk (RR) 0.52, 95% confidence interval (CI) 0.33 to 0.82), as was the risk of 'wound complication' (haematoma, seroma, wound infection or wound separation) (RR 0.68, 95% CI 0.52 to 0.88). No difference in the risk of wound infection alone or other short-term outcomes was found. No long-term outcomes were reported. There was no difference in the risk of wound infection between blunt needles and sharp needles in one small study. No studies were found examining suture techniques or materials for closure of the rectus sheath or subcutaneous fat.
IMPLICATIONS FOR PRACTICE
Closure of the subcutaneous fat may reduce wound complications but it is unclear to what extent these differences affect the well-being and satisfaction of the women concerned.
IMPLICATIONS FOR RESEARCH
Further trials are justified to investigate whether the apparent increased risk of haematoma or seroma with non-closure of the subcutaneous fat is real. These should use a broader range of short- and long-term outcomes, and ensure that they are adequately powered to detect clinically important differences. Further research comparing blunt and sharp needles is justified, as are trials evaluating suturing materials and suturing techniques for the rectus sheath.
Topics: Abdominal Wall; Cesarean Section; Female; Humans; Pregnancy; Suture Techniques
PubMed: 15495122
DOI: 10.1002/14651858.CD004663.pub2 -
International Journal of Surgical... Aug 2023Pleomorphic rhabdomyosarcoma (RMS) is an aggressive and rare malignant neoplasm with a poor prognosis. As its name suggests, this tumor exhibits extensive pleomorphism...
Pleomorphic rhabdomyosarcoma (RMS) is an aggressive and rare malignant neoplasm with a poor prognosis. As its name suggests, this tumor exhibits extensive pleomorphism with features of skeletal muscle differentiation. Due to its rarity, its diagnosis is often a clinical and pathological challenge. Since only small case series and a few scattered case reports exist in the literature, the impact of different demographic features, tumor site, and/or treatment modality on patient outcomes has yet to be extensively studied. We report a case of a pleomorphic RMS presenting atypically as an abdominal wall mass. We have also analyzed the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database to determine the factors affecting the outcome of this neoplasm. Moreover, we present a review and summary of pleomorphic RMS cases arising from the abdominal wall reported in the English language literature. We found two hundred and forty-two cases of pleomorphic RMS in the SEER database. The majority of the patients were diagnosed after the age of 40, with the age of diagnosis showing a unimodal distribution. The majority of the patients were Caucasian (82%) and male (59%). Age of diagnosis, tumor stage, and surgical management significantly affected the patients' outcome, while patients' ethnicity, sex, or tumor site did not affect the outcome. We only found five previously reported cases of pleomorphic RMS arising from the abdominal wall. Pleomorphic RMS arising from the abdominal wall is extremely rare. Our data sheds light on the factors affecting the outcome of pleomorphic RMS. We have also discussed the challenges involving the histopathological diagnosis of this rare neoplasm and how to best approach this task.
Topics: Humans; Male; Abdominal Wall; Rhabdomyosarcoma; Diagnosis, Differential
PubMed: 35707991
DOI: 10.1177/10668969221105622 -
Annals of Plastic Surgery Aug 2009Perforator flap breast reconstruction potentially offers patients greater postoperative abdominal strength compared with traditional TRAM techniques. Our purpose was to... (Review)
Review
Perforator flap breast reconstruction potentially offers patients greater postoperative abdominal strength compared with traditional TRAM techniques. Our purpose was to perform a systemic review of the published literature regarding abdominal wall function following breast reconstruction and compare outcomes between pedicle TRAM, free TRAM, and perforator flap procedures. We used the MEDLINE, EMBASE, CINAHL, the Cochrane Network, and HAPI databases from January 1966 through November 1, 2007 to identify potentially relevant studies. Inclusion criteria included studies that evaluated subjective or objective functional abdominal outcomes for postmastectomy patients receiving either pedicle TRAM, free TRAM, or deep inferior epigastric perforator (DIEP) flaps. All study designs were included in the review-prospective studies, cross-sectional studies, and retrospective case series. Our search yielded 20 studies on abdominal wall function after autogenous tissue breast reconstruction. Objective measures of abdominal wall function using isometric dynamometry revealed that pedicle TRAM patients experienced up to a 23% deficit, whereas free TRAM patients experienced up to an 18% deficit in trunk flexion. For trunk extension, pedicle TRAM patients experienced up to a 14% deficit, whereas free TRAM patients experienced minimal to no deficits. However, none of the comparative studies of pedicle and free TRAM procedures found significant differences in abdominal wall function between the 2 groups. Studies that compared free TRAM to DIEP flaps found significantly higher flexion abilities in the DIEP groups, with one study reporting an advantage in measures of extension for DIEP flaps. Functional deficits assessed by physiotherapy measures revealed that patients with pedicle TRAM reconstructions experienced the greatest deficit in rectus and oblique muscle function (up to 53%). Free TRAM groups experienced minimal deficit in rectus muscle function, whereas DIEP flaps returned to baseline for both rectus and oblique muscle function. Subjective measures of abdominal wall function were similar across unipedicle TRAM, free TRAM, and DIEP flap procedures. Patients with bilateral pedicle TRAM reconstruction suffered up to a 40% deficit in trunk flexion and up to a 9% deficit in trunk extension. Patients with bilateral pedicle or free TRAM reconstruction also experienced a significant decrease in the ability to perform sit-ups and a significant decrease in activities of daily living, recreational, and laborious activities. With the exception of those who had bipedicled TRAM or bilateral free TRAM procedures, most women reported return to their preoperative function without a decrease in their ability to perform activities of daily living. Although some studies report an objective advantage of DIEP flaps, this does not appear to translate to detriments in the performance of activities of daily living. However, the current data have limitations in study design and generalizability. A multicenter, longitudinal study is needed to assess objective and subjective outcomes in patients with pedicle TRAM, free TRAM, and perforator flaps using standardized and validated measures.
Topics: Abdomen; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Surgical Flaps
PubMed: 19593108
DOI: 10.1097/SAP.0b013e31818c4a9e -
Hernia : the Journal of Hernias and... Aug 2011Our objective was to analyze the advantages and inconveniences associated with the use of fibrin sealant compared with mechanical means for mesh fixation following... (Comparative Study)
Comparative Study Review
PURPOSE
Our objective was to analyze the advantages and inconveniences associated with the use of fibrin sealant compared with mechanical means for mesh fixation following abdominal-wall surgery.
METHODS
Literature search was conducted in MedLine, EMBASE, and Cochrane Library Plus databases. Articles were randomized clinical trials, nonrandomized comparative studies, and case series containing at least ten patients.
RESULTS
The fibrin sealant was shown to be biocompatible with the surrounding tissue. In patients treated with fibrin sealant, lower prevalence of acute and chronic postoperative pain was observed, and less hemorrhagic complications occurred. There are no data on the influence of fibrin sealant on seroma decrease. Efficiency in experimental models was similar to that observed for mechanical methods of fixation. Also, adhesions with fibrin sealant were less than that for mechanical methods.
CONCLUSIONS
Compared with mechanical methods, fibrin sealant is an efficacious alternative for mesh fixation postsurgery of the abdominal wall.
Topics: Abdominal Wall; Animals; Fibrin Tissue Adhesive; Hernia, Abdominal; Humans; Pain, Postoperative; Surgical Mesh; Sutures; Tissue Adhesives
PubMed: 21452012
DOI: 10.1007/s10029-011-0809-x -
The Journal of Trauma and Acute Care... Apr 2020The aim of this systematic review and meta-analysis was to evaluate whether computed tomography (CT) scan adds any diagnostic value in the evaluation of stab wounds of... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
The aim of this systematic review and meta-analysis was to evaluate whether computed tomography (CT) scan adds any diagnostic value in the evaluation of stab wounds of the anterior abdominal wall as compared with serial clinical examination (SCE).
METHODS
PubMed, EMBASE, Cochrane Library, and MEDLINE via Ovid were systematically searched for records published from 1980 to 2018 by two independent researchers (M.G., R.L.). Quality assessment, data extraction, and analysis were performed according to the Cochrane Handbook for Systematic Reviews of Interventions. Mantel-Haenszel method with odds ratio (OR) and 95% confidence interval (95% CI) as the measure of effect size was used for meta-analysis.
RESULTS
Three studies (1 randomized controlled trial and 2 observational studies) totaling 319 patients were included in the meta-analysis. Overall laparotomy rate was 12.8% (22 of 172 patients) in SCE versus 19% (28 of 147 patients) in CT. This difference was not significant (OR [95% CI], 0.63 [0.34-1.16]; p = 0.14). Negative laparotomy rate was 3.5% (6 of 172 patients) in SCE versus 5.4% (8 of 147 patients) in CT. The difference was not significant (OR [95% CI], 0.61 [0.20-1.83]; p = 0.37).
CONCLUSION
This meta-analysis compared SCE with CT scan in patients presenting with stab wounds of the anterior abdominal wall and provided level II evidence showing no additional benefit in CT scan. Further observational and experimental clinical studies are needed to confirm the findings of this meta-analysis.
LEVEL OF EVIDENCE
Systematic review and meta-analysis, level II.
Topics: Abdominal Injuries; Abdominal Wall; Feasibility Studies; Humans; Injury Severity Score; Physical Examination; Tomography, X-Ray Computed; Wounds, Stab
PubMed: 32205824
DOI: 10.1097/TA.0000000000002587 -
Annals of Plastic Surgery Feb 2018Mesh infection after abdominal hernia repair is a devastating complication that affects general and plastic surgeons alike. The purpose of this study was 3-fold: (1) to... (Review)
Review
BACKGROUND
Mesh infection after abdominal hernia repair is a devastating complication that affects general and plastic surgeons alike. The purpose of this study was 3-fold: (1) to determine current evidence for treatment of infected abdominal wall mesh via systematic review of literature, (2) to analyze our single-institution experience with treatment of infected mesh patients, and (3) to establish a framework for how to approach this complex clinical problem.
METHODS
Literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, followed by single-institution retrospective analysis of infected mesh patients.
RESULTS
A total of 3565 abstracts and 92 full-text articles were reviewed. For qualitative and quantitative assessment, articles were subdivided on the basis of treatment approach: "conservative management," "excision of mesh with primary closure," "single-stage reconstruction," "immediate staged repair," and "repair in contaminated field." Evidence for each treatment approach is presented. At our institution, most patients (40/43) were treated by excision of infected mesh and single-stage reconstruction with biologic mesh. When the mesh was placed in a retrorectus or underlay fashion, 21.4% rate of hernia recurrence was achieved. Bridged repairs were highly prone to recurrence (88.9%; P = 0.001), but the bridging biologic mesh seemed to maintain domain and potentially contribute to a more effective repair in the future. Of the patients who underwent additional ("secondary") repairs after recurrence, 75% were eventually able to achieve "hernia-free" state.
CONCLUSIONS
This study reviews the literature and our single-institution experience regarding treatment of infected abdominal wall mesh. Framework is developed for how to approach this complex clinical problem.
Topics: Adult; Aged; Algorithms; Female; Follow-Up Studies; Hernia, Abdominal; Herniorrhaphy; Humans; Male; Middle Aged; Pseudomonas Infections; Retrospective Studies; Staphylococcal Infections; Surgical Mesh; Surgical Wound Infection; Treatment Outcome
PubMed: 28671890
DOI: 10.1097/SAP.0000000000001189 -
Plastic and Reconstructive Surgery Nov 2012Reconstruction of the anterior abdominal wall is a complex procedure that can be complicated by contamination, loss of domain, previous scarring or radiotherapy, and... (Review)
Review
BACKGROUND
Reconstruction of the anterior abdominal wall is a complex procedure that can be complicated by contamination, loss of domain, previous scarring or radiotherapy, and reduced availability of local tissues. With the introduction of acellular dermal matrices to clinical use, it was hoped that many of the problems associated with previous synthetic materials could be overcome. With their enhanced biocompatibility, acellular dermal matrices are believed to integrate with surrounding tissues while demonstrating resistance to infection, extrusion, erosion, and adhesion formation.
METHODS
The MEDLINE database was reviewed, including all publications as of December 31, 2011, using the search terms "dermal matrix" or "human dermis" or "porcine dermis" or "bovine dermis," applying the limits "human" and "English language." Prospective and retrospective clinical articles were identified.
RESULTS
A total of 40 eligible articles were identified and included in this review. Thirty-five of the studies were level IV; the remaining studies were level III. Acellular dermal matrix was used to reconstruct the abdominal wall in a wide range of clinical settings, including trauma, tumor resection, sepsis, and hernia repairs. The operative methods varied widely among clinical studies. While the heterogeneity of the patient populations and techniques limited interpretation of the data, concerns were identified regarding high rates of hernia recurrence with acellular dermal matrix use.
CONCLUSION
High-quality data derived from level I, II, and III studies are necessary to determine the indications for acellular dermal matrix use and the optimal surgical techniques to maximize outcomes in abdominal wall reconstruction.
Topics: Abdominal Injuries; Abdominal Neoplasms; Abdominal Wall; Acellular Dermis; Clinical Trials as Topic; Collagen; Evidence-Based Medicine; Hernia, Ventral; Herniorrhaphy; Humans; Polypropylenes; Postoperative Complications; Prospective Studies; Plastic Surgery Procedures; Recurrence; Retrospective Studies; Surgical Mesh; Surgical Wound Dehiscence; Surgical Wound Infection; Treatment Outcome; Wound Healing
PubMed: 23096969
DOI: 10.1097/PRS.0b013e3182605cfc -
Surgical Endoscopy Dec 2021In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO pneumoperitoneum and open surgery for general surgery and gynaecological procedures.
METHODS
A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications.
SECONDARY OUTCOMES
operative times and length of stay. The inverse variance random-effects model was used to synthesise data.
RESULTS
63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45-2.40] or gynaecological surgery RR 0.66 [0.14-3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26-60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD - 18.74 [CI - 29.23, - 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD - 3.94 [CI - 5.93, - 1.95] and gynaecology MD - 1.75 [CI - 2.64, - 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low.
CONCLUSION
Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.
Topics: Abdomen; Female; Gynecologic Surgical Procedures; Humans; Insufflation; Laparoscopy; Treatment Outcome
PubMed: 34398284
DOI: 10.1007/s00464-021-08677-7 -
The British Journal of Surgery Jan 2006The aim was to determine whether systemic antibiotic prophylaxis prevented wound infection after repair of abdominal wall hernia with mesh. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim was to determine whether systemic antibiotic prophylaxis prevented wound infection after repair of abdominal wall hernia with mesh.
METHODS
This was a systematic review of the available literature identified from multiple databases using the terms 'hernia' and 'antibiotic prophylaxis'. Randomized placebo-controlled trials of antibiotic prophylaxis in abdominal wall mesh hernia repair with explicitly defined wound infection criteria and a minimum follow-up of 1 month were included. After independent quality assessment and data extraction, data were pooled for meta-analysis using a random-effects model.
RESULTS
The search process identified eight relevant trials. Two papers on umbilical, incisional or laparoscopic hernias, and six concerning inguinal and femoral (groin) hernias were suitable for meta-analysis. The incidence of infection after groin hernia repair was 38 (3.0 per cent) of 1277 in the placebo group and 18 (1.5 per cent) of 1230 in the antibiotic group. Antibiotic prophylaxis did not significantly reduce the incidence of infection: odds ratio 0.54 (95 per cent confidence interval 0.24 to 1.21); number needed to treat was 74. The number of deep infections was six (0.6 per cent) in the placebo group and three (0.3 per cent) in the antibiotic prophylaxis group: odds ratio 0.50 (95 per cent c.i. 0.12 to 2.09).
CONCLUSION
Antibiotic prophylaxis did not prevent the occurrence of wound infection after groin hernia surgery. More trials are needed for complete evidence in other areas of abdominal wall hernia.
Topics: Antibiotic Prophylaxis; Hernia, Abdominal; Hernia, Femoral; Hernia, Inguinal; Humans; Middle Aged; Randomized Controlled Trials as Topic; Surgical Mesh; Surgical Wound Infection
PubMed: 16252314
DOI: 10.1002/bjs.5186 -
Hernia : the Journal of Hernias and... Feb 2019Transversus abdominis release (TAR), as a type of posterior component separation, is a new myofascial release technique in complex ventral hernia repair. TAR preserves...
BACKGROUND
Transversus abdominis release (TAR), as a type of posterior component separation, is a new myofascial release technique in complex ventral hernia repair. TAR preserves rectus muscle innervation, creates an immense retromuscular plane and allows bilaminar ingrowth of the mesh. The place of the TAR within the range of established anterior component separation techniques (CST) is unclear. Aim of this systematic literature review is to estimate the position of the TAR in the scope of ventral hernia repair techniques.
METHODS
MEDLINE, Embase, Pubmed and the Cochrane controlled trials register and Science citation index were searched using the following terms: 'posterior component separation', 'transversus abdominis release', 'ventral hernia repair', 'complex abdominal wall reconstruction'. To prevent duplication bias, only studies with a unique cohort of patients who underwent transversus abdominis release for complex abdominal wall reconstruction were eligible. Postoperative complications and recurrences had to be registered adequately. The rate of surgical site occurrences and recurrences of the TAR were compared with those after anterior CST, published earlier in two meta-analyses.
RESULTS
Five articles met our strict inclusion criteria, describing 646 TAR patients. Methodological quality per study was good. Mean hernia surface was 509 cm and 88% of the hernias were located in the midline. Preoperative risk stratification was distributed in low risk (10%), co-morbid (55%), potentially contaminated (32%) and infected (3%). Pooled calculations demonstrated a mean SSO rate of 15% after TAR (20-35% after anterior CST) and a mean 2-year hernia recurrence rate of 4% (13% after anterior CST). Mean hernia surface was 300 cm in anterior component separation studies.
CONCLUSION
This review demonstrates that the transversus abdominis release is a good alternative for anterior CST in terms of SSO and recurrence, especially in very large midline ventral hernias.
Topics: Abdominal Muscles; Abdominal Wall; Abdominoplasty; Hernia, Ventral; Herniorrhaphy; Humans; Postoperative Complications; Recurrence; Reoperation
PubMed: 30539311
DOI: 10.1007/s10029-018-1870-5