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Seminars in Ultrasound, CT, and MR Apr 2002The classification of abdominal wall hernias is often made difficult by confusing eponymous and anatomic nomenclature. In this article, we review the anatomy that... (Review)
Review
The classification of abdominal wall hernias is often made difficult by confusing eponymous and anatomic nomenclature. In this article, we review the anatomy that defines the various types of hernias. The specific cross-sectional radiologic features required to correctly identify each type are then emphasized. The appropriate clinical context and the merits of the various imaging techniques available for the investigation of abdominal wall hernias are also discussed.
Topics: Abdominal Wall; Anatomy, Cross-Sectional; Hernia, Ventral; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 11996228
DOI: 10.1016/s0887-2171(02)90001-6 -
Oncology Research and Treatment 2022Resection of large anterior abdominal wall tumors causes large full-thickness abdominal wall defects, and the repair of these defects remains a challenging point.
BACKGROUND
Resection of large anterior abdominal wall tumors causes large full-thickness abdominal wall defects, and the repair of these defects remains a challenging point.
METHODS
Between July 2016 and February 2021, we retrospectively reviewed the internal database registry of the Oncology Center, Mansoura University (OCMU), Egypt, for patients with large abdominal wall defects after abdominal wall tumors resection and repair with omental flaps and synthetic polypropylene (PP) mesh. Thirty-two patients met the inclusion criteria. They were analyzed for demographics and operative data including defect size, mesh size, intra-abdominal tumor extension, and postoperative outcomes and complications.
RESULTS
Thirty-Two patients with abdominal wall neoplasm underwent local resection in our center and the defect was closed with an omental flap and PP mesh. The mean operative time was 143.75 ± 30.77 min. The mean size of the abdominal wall defect was 50.8 cm2 (range: 25-90 cm2). The meshes used in reconstruction had a mean size of 89.5 cm2 (range: 55-130 cm2). The median follow-up period of the patients was 13.5 months (range: 5-54 months). Postoperative complications included infection (n = 4 cases), seroma (n = 2 cases), hematoma (n = 1 case), and abnormal sensation (n = 5 cases). Tumor recurrence was reported in 2 cases, and no cases developed incisional hernia during the follow-up period.
CONCLUSION
Immediate use of omental flap with synthetic PP mesh for reconstruction of abdominal wall defects is a feasible technique and has avoided the complications associated with the use of synthetic mesh alone.
Topics: Abdominal Neoplasms; Abdominal Wall; Humans; Neoplasm Recurrence, Local; Polypropylenes; Postoperative Complications; Retrospective Studies; Surgical Flaps; Surgical Mesh
PubMed: 35537417
DOI: 10.1159/000524871 -
Annals of Plastic Surgery Sep 2021There is currently no description of abdominal domain changes in small bowel transplantation population or consensus of criteria regarding which patients are at high...
BACKGROUND
There is currently no description of abdominal domain changes in small bowel transplantation population or consensus of criteria regarding which patients are at high risk for immediate postoperative abdominal wall complications or would benefit from abdominal wall vascularized composite allotransplantation.
METHODS
A retrospective chart review was performed on 14 adult patients receiving intestinal or multivisceral transplantation. Preoperative and postoperative computed tomography scans were reviewed, and multiple variables were collected regarding abdominal domain and volume and analyzed comparing postoperative changes and abdominal wall complications.
RESULTS
Patients after intestinal or multivisceral transplantation had a mean reduction in overall intraperitoneal volume in the immediate postoperative period from 9031 cm3 to 7846 cm3 (P = 0.314). This intraperitoneal volume was further reduced to an average of 6261 cm3 upon radiographic evaluation greater than 1 year postoperatively (P = 0.024). Patients with preexisting abdominal wound (P = 0.002), radiation, or presence of ostomy (P = 0.047) were significantly associated with postoperative abdominal wall complications. No preoperative radiographic findings had a significant association with postoperative abdominal wall complications.
CONCLUSIONS
Computed tomography imaging demonstrates that intestinal and multivisceral transplant patients have significant reduction in intraperitoneal volume and domain after transplantation in the acute and delayed postoperative setting. Preoperative radiographic abdominal domain was not able to predict patients with postoperative abdominal wall complications. Patients with abdominal wounds, ostomies, and preoperative radiation therapy were associated with acute postoperative abdominal complications and may be considered for need of reconstructive techniques including abdominal wall transplantation.
Topics: Abdominal Wall; Adult; Humans; Organ Transplantation; Plastic Surgery Procedures; Retrospective Studies; Vascularized Composite Allotransplantation
PubMed: 33559994
DOI: 10.1097/SAP.0000000000002708 -
Physics in Medicine and Biology Oct 2021Ventral incisional hernia repair is one of the most common surgical procedures. The characterization of the abdominal wall layer mechanical properties is the first step...
Ventral incisional hernia repair is one of the most common surgical procedures. The characterization of the abdominal wall layer mechanical properties is the first step towards personalized treatment. This study investigates the capability of elastography to assess these properties using anandmodel of abdominal wall layers. Two experiment approaches are considered: shear wave elastography imaging and guided wave dispersion characterization, where the latter is used as a reference. Results show measurement biases in the shear wave elastography approach in such a layer structure configuration. Methods to overcome these biases are suggested to improve and to correct the elastography approach for abdominal wall layers and similar anatomical structures.
Topics: Abdominal Wall; Bias; Elasticity Imaging Techniques; Phantoms, Imaging
PubMed: 34560674
DOI: 10.1088/1361-6560/ac29cd -
Plastic and Reconstructive Surgery Sep 2018
Topics: Abdominal Wall; Humans; Plastic Surgery Procedures
PubMed: 30138257
DOI: 10.1097/PRS.0000000000004881 -
Computer Methods and Programs in... Apr 2022Biomechanical assessment of the abdominal wall represents a major prerequisite for a better understanding of physiological and pathological situations such as hernia,...
BACKGROUND AND OBJECTIVE
Biomechanical assessment of the abdominal wall represents a major prerequisite for a better understanding of physiological and pathological situations such as hernia, post-delivery recovery, muscle dystrophy or sarcopenia. Such an assessment is challenging and requires muscular deformations quantification which have been very scarcely reported in vivo. In the present study, we intended to characterize abdominal wall deformations in passive and active conditions using dynamic MRI combined to a semiautomatic segmentation procedure.
METHODS
Dynamic deformations resulting from three complementary exercises i.e. forced breathing, coughing and Valsalva maneuver were mapped in a transversal abdominal plane and so for twenty healthy volunteers. Real-time dynamic MRI series were acquired at a rate of 182 ms per image, then segmented semi-automatically to follow muscles deformation through each exercise. Circumferential and radial strains of each abdominal muscle were computed from the geometrical characteristics' quantification, namely the medial axis length and the thickness. Muscular radial displacement maps were computed using image registration.
RESULTS
Large variations in circumferential and radial strains were observed for the lateral muscles (LM) but remained low for the rectus abdominis muscles (RA). Contraction phases of each exercise led to LM muscle shortening down to -9.6 ± 5.9% during Valsalva maneuver with a 16.2 ± 9.6% thickness increase. Contraction also led to inward radial displacement of the LM up to 9.9 ± 4.1 mm during coughing. During maximal inhalation, a significant 10.0 ± 6.6% lengthening was quantified for LM while a significant thickness decrease was computed for the whole set of muscles (-14.7 ± 6.6% for LM and -7.3 ± 6.5% for RA). The largest displacement was observed for the medial part of RA (17.9 ± 8.0 mm) whereas the posterior part of LM underwent limited motion (2.8 ± 2.3 mm). Displacement rate and correlation between muscle thickness and medial axis length during each exercise provided insights regarding subject-specific muscle function.
CONCLUSIONS
Dynamic MRI is a promising tool for the assessment of the abdominal wall motion and deformations. The corresponding metrics which have been continuously recorded during the exercises provided global and regional quantitative information. These metrics offer perspectives for a genuine clinical evaluation tool dedicated to the assessment of abdominal muscles function in both healthy subjects and patients.
Topics: Abdominal Muscles; Abdominal Wall; Humans; Magnetic Resonance Imaging; Muscle Contraction; Respiration
PubMed: 35231757
DOI: 10.1016/j.cmpb.2022.106667 -
ANZ Journal of Surgery May 2021Heterotopic ossification (HO) refers to the development of extra-skeletal bone in muscle and soft tissues, following tissue insult secondary to surgery or trauma. This...
BACKGROUND
Heterotopic ossification (HO) refers to the development of extra-skeletal bone in muscle and soft tissues, following tissue insult secondary to surgery or trauma. This pathological process is considered as the result of severe inflammatory cell cascade initiated after local trauma and subsequent attempt at tissue repair involving resident mesenchymal cells. We present a series of 12 cases of abdominal HO (AHO), over 8 years, following damage control laparotomies (DCLs).
METHODS
Medical records of 50 patients who underwent DCLs at Alice Springs Hospital between 2010 and 2018 were retrospectively reviewed for AHO. Demographic data were extracted. Abdominal X-rays and computed tomography scans of 47 patients were reviewed for AHO.
RESULTS
Twelve patients (25%) developed AHO of varying diversity ranging from small insignificant lesions to clinically palpable lesions in the abdominal wall. Data revealed relatively younger male preponderance. DCL for severe acute pancreatitis (SAP) was associated with AHO (P < 0.1, 90% CI). Longer periods of ventilation, intensive care unit stay and admission to hospital were strongly associated with AHO (P < 0.01, 95% CI). Occurrence of AHO with SAP was significantly higher compared to patients without SAP (relative risk 3.54, P < 0.001). Only two patients required surgical excision of HO prior to definitive closure of the abdomen.
CONCLUSION
The authors conclude that AHO occurred more frequently in younger males. DCL for SAP was a significant risk factor. Extended periods of ventilation, intensive care unit stay and hospital admission were strongly associated with the development of AHO. Preoperative detection of HO is essential prior to planning definitive closure of the abdomen.
Topics: Abdominal Wall; Acute Disease; Humans; Laparotomy; Male; Ossification, Heterotopic; Pancreatitis; Retrospective Studies
PubMed: 33475229
DOI: 10.1111/ans.16596 -
Plastic and Reconstructive Surgery Jun 2017Candidates for multivisceral transplantation present with complex defects often beyond traditional reconstructive options. In this study, the authors describe a...
BACKGROUND
Candidates for multivisceral transplantation present with complex defects often beyond traditional reconstructive options. In this study, the authors describe a dissection technique for a total abdominal wall vascularized composite flap. In addition, the authors suggest a classification system for complex abdominal wall defects.
METHODS
Forty fresh, cadaveric hemiabdomens were dissected, with care taken to preserve the iliofemoral, deep circumflex iliac, superficial circumflex iliac, deep inferior epigastric, and superficial inferior epigastric arteries and corresponding veins. Perfusion patterns of the flaps were then studied using computed tomographic angiography.
RESULTS
The deep circumflex iliac, superficial circumflex iliac, deep inferior epigastric, and superficial inferior epigastric arteries were identified along a 5-cm cuff of the iliofemoral artery centered on the inguinal ligament. Perfusion with an intact deep circumflex iliac artery yielded improvement in lateral perfusion based on computed tomographic angiography.
CONCLUSIONS
The authors propose an algorithm for abdominal wall reconstruction based on defect size and abdominal wall perfusion, and their technique for harvesting a total vascularized composite abdominal wall flap for allotransplantation. Total abdominal wall transplantation should be considered in the subset of patients already receiving visceral organ transplants who also have concomitant abdominal wall defects.
Topics: Abdominal Muscles; Abdominal Wall; Adult; Cadaver; Dissection; Female; Humans; Male; Middle Aged; Myocutaneous Flap; Plastic Surgery Procedures; Risk Assessment
PubMed: 28538578
DOI: 10.1097/PRS.0000000000003327 -
Khirurgiia 2020Conventional «open» procedures for ventral hernias and diastasis recti are widely known, used everywhere and have a great number of author's improvements related to... (Review)
Review
Conventional «open» procedures for ventral hernias and diastasis recti are widely known, used everywhere and have a great number of author's improvements related to surgeon's experience, availability of modern information, equipment and materials. K. LeBlanc and W. Booth (1993) reported IPOM-method with non-adhesive coating that is considered a milestone in surgery of anterior abdominal wall and ventral hernia. This technique has gained recognition among surgeons around the world due to its technical simplicity, minimal invasiveness and high reproducibility. However, certain disadvantages of this technique have been shown over the past time that justified advisability of searching for another methods of anterior abdominal wall reinforcement. Thus, E-Milos, LIRA, TESAR, eTEP, REPA, TARM, TARUP techniques are currently available. This review is devoted to technical features of these techniques, their potential advantages and disadvantages.
Topics: Abdominal Wall; Hernia, Abdominal; Hernia, Ventral; Herniorrhaphy; Humans; Minimally Invasive Surgical Procedures; Reproducibility of Results; Surgical Mesh
PubMed: 33047591
DOI: 10.17116/hirurgia202010188 -
Hernia : the Journal of Hernias and... Apr 2022
Topics: Abdominal Wall; Herniorrhaphy; Humans
PubMed: 35182286
DOI: 10.1007/s10029-022-02577-y