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Updates in Surgery Dec 2022Transversus abdominis release (TAR) is becoming an increasingly popular approach to incisional hernia repair. As the technique has been applied to more complex hernias,...
Transversus abdominis release (TAR) is becoming an increasingly popular approach to incisional hernia repair. As the technique has been applied to more complex hernias, it appears insufficient for repairing large defects due to the impossibility to achieve a tension-free reapproximation of the peritoneum and/or the linea alba, then a bridged repair with interposed omentum, reabsorbable or coated prosthesis frequently leaving the mesh in contact with the subcutaneous space, has been proposed. To overcome these setbacks, we have developed the double peritoneal flap-TAR (DPF-TAR) technique, which entails placement of a retromuscular mesh completely isolated from either peritoneal cavity and subcutaneous space by joining both peritoneal sac halves into a double-bridged design. Of 19 patients, 17 (89%) were available for the study. Median transverse diameter of the hernia was 13,3 cm (10-17), and 10 (53%) cases had a complete failure of the linea alba. Five (26%) patients developed a surgical site occurrence (SSO). With a median follow-up of 11 (4-28) months, one (5,8%) recurrence and four (23,5%) wound bulging were diagnosed. We suggest that DPF-TAR approach can provide an effective repair using native tissues to isolate the retromuscular mesh, with acceptable failure and SSOs rates. By avoiding the need for a steep learning curve, this method may constitute a handy complement to the surgeon's armory for difficult reconstructions of the abdominal wall.
Topics: Humans; Incisional Hernia; Peritoneum; Herniorrhaphy; Surgical Mesh; Recurrence; Hernia, Ventral; Abdominal Muscles; Abdominal Wall
PubMed: 35305262
DOI: 10.1007/s13304-022-01278-6 -
World Journal of Surgery Sep 2019Repair of large ventral hernias is challenging when primary fascial closure cannot be achieved. The peritoneal flap hernioplasty, a modification of the Rives-Stoppa...
BACKGROUND
Repair of large ventral hernias is challenging when primary fascial closure cannot be achieved. The peritoneal flap hernioplasty, a modification of the Rives-Stoppa retromuscular mesh repair, addresses this problem by using the hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space. It is applicable to both midline and transverse hernias. We report the results from our institution using this repair based on a retrospective review of 251 cases.
METHODS
Patients undergoing peritoneal flap hernioplasty repair from January 1, 2010-December 31, 2014 were identified from the Lothian Surgical Audit system, a prospectively maintained computer database of all surgical procedures in the Edinburgh region of southeast Scotland. Patient demographics, clinical presentation, location of the hernia and surgical treatment were obtained from the hospital case-notes. Follow-up consisted of a clinical consultation 3 months postoperatively and a retrospective review of patient files completed December 2018. Patients presenting signs of complications were assessed during a clinical review.
RESULTS
Two hundred and fifty-one patients underwent incisional hernia repair, 68.1% in the midline and 31.9% arising through transverse incisions. Forty-three of these (17%) were recurrences referred from other centers. Mean BMI was 32.1 kg/m (range 20-59.4 kg/m). Mean defect width was 9.2 ± 4.2 cm (range 2.5-24.2 cm). Mean mesh size was 752 cm (range 150-1760 cm). Some form of abdominoplasty was performed in 59% of cases. Mean postoperative stay was 6.3 days (range 1-33 days). Mean follow-up time was 75 months (range 44-104 months). Fifty-three patients (21.1%) developed postoperative complications. Three (1.2%) developed superficial skin necrosis and 27 (10.8%) a superficial wound infection, but none developed deep mesh infection. Twelve (4.8%) developed symptomatic seroma and 11 (4.4%) a hematoma requiring surgical intervention. Seven (2.8%) patients developed recurrence within the follow-up period.
CONCLUSION
Peritoneal flap hernioplasty is an excellent and versatile method for reconstruction of large ventral hernias arising in both midline and transverse incisions. The technique is safe and associated with few complications and a very low recurrence rate.
Topics: Abdominoplasty; Adult; Aged; Aged, 80 and over; Female; Hernia, Ventral; Herniorrhaphy; Humans; Male; Middle Aged; Peritoneum; Postoperative Complications; Recurrence; Retrospective Studies; Seroma; Surgical Flaps; Surgical Mesh; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31065774
DOI: 10.1007/s00268-019-05011-0 -
Journal of Visceral Surgery Jun 2012Internal hernias account for less than 1% of acute mechanical bowel obstruction. Because of their rarety, they are often not considered in the clinical or radiologic...
Internal hernias account for less than 1% of acute mechanical bowel obstruction. Because of their rarety, they are often not considered in the clinical or radiologic diagnosis of bowel obstruction; diagnosis is often delayed, and is most often made at the time of surgery. We present images obtained during the management of a strangulated transomental internal hernia; computerized tomography permitted timely preoperative diagnosis and specifically adapted surgical therapy.
Topics: Hernia, Abdominal; Humans; Intestinal Obstruction; Jejunal Diseases; Peritoneal Cavity; Tomography, X-Ray Computed
PubMed: 22424797
DOI: 10.1016/j.jviscsurg.2012.02.002 -
Postgraduate Medical Journal Nov 2001Peritoneal encapsulation is an exceedingly rare developmental abnormality in which the small intestine is encased in an accessory peritoneal sac between the omentum and... (Review)
Review
Peritoneal encapsulation is an exceedingly rare developmental abnormality in which the small intestine is encased in an accessory peritoneal sac between the omentum and mesocolon. Two clinical signs associated with the dense fibrous layer encapsulating the intestine are described. The first is a fixed, asymmetrical distension of the abdomen, which does not vary with peristaltic activity due to the unvarying position of the fibrous capsule. The second is the difference in the consistency of the abdominal wall to palpation. The flat area is firm, due to the dense fibrous capsule and the distended area soft, due to the thin walled distended small intestine with no overlying fibrous layer.
Topics: Diagnosis, Differential; Humans; Intestinal Obstruction; Intestine, Small; Male; Middle Aged; Peritoneum; Preoperative Care
PubMed: 11677284
DOI: 10.1136/pmj.77.913.725 -
Journal of Computer Assisted Tomography 1996The purpose of this study was to determine the utility of CT in distinguishing peritoneal tuberculosis (PT) from peritoneal carcinomatosis (PC).
OBJECTIVE
The purpose of this study was to determine the utility of CT in distinguishing peritoneal tuberculosis (PT) from peritoneal carcinomatosis (PC).
MATERIALS AND METHODS
CT scans were retrospectively reviewed in 19 patients known to have PT and compared with scans in 19 patients known to have PC. CT images were evaluated for thickening (smooth versus irregular), enhancement, presence of nodules, and site of involvement on the parietal peritoneum. The existence of omental caking, nodules, and smudged patterns in the omentum, mesentery, and gastrocolic ligament was noted. The presence, distribution, and loculation of ascites were also evaluated.
RESULTS
Ascites was present in all cases of PT and PC, loculated in 10 cases (PT = 4, PC = 6), and located in the greater peritoneal sac (PT = 15, PC = 10) or in the greater and lesser sacs (PT = 4, PC = 9). Slight smooth thickening and pronounced enhancement of the parietal peritoneum were seen in 15 of 19 PT patients and in 5 of 19 PC patients (p<0.001), whereas irregular thickening was found in only 9 of 19 PC patients (p <0.001). Peritoneal nodules were present exclusively in PC (7/19) (p <0.01). The sites of the parietal peritoneum involvement were the pelvic (PT = 9, PC = 3) (p <0.05), paracolic gutters (PT = 5, PC = 6), juxtadiaphragmatic (PT = 0, PC = 9) (p <0.001), and perihepatic (PT = 6, PC = 8) regions. Omental cakes were found in 4 of 19 PT and in 7 of 19 PC patients. The smudged pattern was the most common abnormality in the omentum (PT = 9/19, PC = 11/19), gastrocolic ligament (PT = 5/19, PC = 11/19) (p <0.01), and mesentery (PT = 7/19, PC = 11/19). Isolated and discrete well defined nodules were exclusively found in the mesentery (PT = 5/19, PC = 3/19).
CONCLUSION
The most useful CT findings for distinguishing PT from PC were observed in the parietal peritoneum. The presence of a smooth peritoneum with minimal thickening and pronounced enhancement suggests PT, whereas nodular implants and irregular peritoneal thickening suggest PC.
Topics: Adolescent; Adult; Aged; Carcinoma; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Peritoneal Neoplasms; Peritoneum; Peritonitis, Tuberculous; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 8606235
DOI: 10.1097/00004728-199603000-00018 -
BMJ Case Reports Dec 2023A man in his early 20s presented to us in the outpatient department with a history of diarrhoea for 4 months. Investigations revealed elevated serum chromogranin...
A man in his early 20s presented to us in the outpatient department with a history of diarrhoea for 4 months. Investigations revealed elevated serum chromogranin levels and an intensely avid lesion in the gastrohepatic ligament in Gallium DOTATATE positron emission tomography (PET). The tumour was excised laparoscopically, and no other lesions were seen. The patient improved clinically and had a normal serum chromogranin level postoperatively. He is currently much improved at the 1year follow-up. We did an extensive workup to look for a primary tumour. It was concluded that it was a de novo tumour arising from the lesser sac. The recommended investigations in case of neuroendocrine tumour (NET) with unknown primary include blood investigations to look for the functional status of the tumour, histopathological examination, including immunohistochemistry, and radiological imaging, which must include a Gallium DOTATATE PET. An isolated NET of the lesser sac has not been reported in the literature.
Topics: Humans; Male; Chromogranins; Gallium; Neuroendocrine Tumors; Omentum; Organometallic Compounds; Peritoneal Cavity; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Tomography, X-Ray Computed; Young Adult
PubMed: 38123316
DOI: 10.1136/bcr-2023-258366 -
Gan To Kagaku Ryoho. Cancer &... Apr 2023Malignant tumor occurring in the inguinal region are relatively infrequent, and metastatic tumor is extremely rare. We report a case of inguinal hernial sac metastasis...
Malignant tumor occurring in the inguinal region are relatively infrequent, and metastatic tumor is extremely rare. We report a case of inguinal hernial sac metastasis of cecal cancer resected with TAPP approach. The case is a 80's man. One year and 6 months after cecal cancer surgery, contrast-enhanced computer tomography(CT)examination revealed a solitary tumor in the right inguinal canal. We diagnosed inguinal hernia sac metastasis of cecal cancer and performed surgery. The mass in the hernia sac was resected with the TAPP approach. Histopathological findings were consistent with peritoneal metastasis directly to the inguinal hernia sac. The patient has been alive without 2 years after metastasectomy. It is necessary to treat patients with a history of malignant disease with keeping the possibility of inguinal hernia sac metastasis in mind.
Topics: Male; Humans; Hernia, Inguinal; Peritoneum; Cecal Neoplasms; Herniorrhaphy; Cecum
PubMed: 37066475
DOI: No ID Found -
Journal de Radiologie May 2011Chemical peritonitis occurs following intraperitoneal rupture of a mature ovarian dermoid. Rupture may be acute and spontaneous, typically during pregnancy, or...
Chemical peritonitis occurs following intraperitoneal rupture of a mature ovarian dermoid. Rupture may be acute and spontaneous, typically during pregnancy, or iatrogenic. Low grade ruptures lead to parasitic peritoneal dermoid cysts, usually involving the greater omentum, cul-de-sac of Douglas and perihepatic region. Radiologists should be familiar with their appearance to correctly diagnose the condition and not mistake the disease for peritoneal carcinomatosis.
Topics: Dermoid Cyst; Female; Humans; Ovarian Neoplasms; Peritonitis; Radiography; Rupture, Spontaneous; Teratoma
PubMed: 21621104
DOI: 10.1016/j.jradio.2011.03.005 -
Cirugia Y Cirujanos 2004We describe a syndrome in which empty hernial sac, in its role of peritoneal recess, becomes distended with pus during or after general peritonitis, usually caused by... (Review)
Review
INTRODUCTION
We describe a syndrome in which empty hernial sac, in its role of peritoneal recess, becomes distended with pus during or after general peritonitis, usually caused by acute appendicitis. Until 1998, only 14 pediatric cases were described in the literature.
MATERIALS, METHODS, AND RESULTS
We presented here eight cases of patients who experienced inguinal symptoms. In four, appendectomy was performed; in four, this was secondary to necrotizing enterocolitis. Inguinal complaints, pain, and flogosis were present in first group, while pneumoperitoneum and visible duct vaginalis were present in second group.
CONCLUSIONS
These cases demonstrated that persistent patent processus vaginalis may predispose to inguinal pathology secondary to intraabdominal sepsis and represent a unique complication.
Topics: Abdomen, Acute; Appendectomy; Appendicitis; Child; Child, Preschool; Enterocolitis, Necrotizing; Erythema; Female; Hernia, Inguinal; Humans; Infant; Infant, Newborn; Inguinal Canal; Intestinal Perforation; Male; Pain; Peritoneal Cavity; Peritonitis; Pneumoperitoneum; Recurrence; Retrospective Studies; Rupture, Spontaneous
PubMed: 15175125
DOI: No ID Found -
American Journal of Surgery Jun 2010Groin or femoral hernias may be concealed behind intact peritonea when the laparoscopic transabdominal preperitoneal (TAPP) mesh technique is used. The aim of this study...
BACKGROUND
Groin or femoral hernias may be concealed behind intact peritonea when the laparoscopic transabdominal preperitoneal (TAPP) mesh technique is used. The aim of this study was to determine the causes, frequency, and surgical procedures in cases of clinically diagnosed hernias without peritoneal defects.
METHODS
A prospective controlled study comprising 1795 consecutive patients undergoing 2190 laparoscopic TAPP herniorraphies was conducted. All hernias were first subjected to clinical investigations by the surgeons. Intraoperatively, all suspicious hernias were examined with regard to the presence of peritoneal hernial sacs.
RESULTS
Of 2190 hernias, no hernia was seen transperitoneally in the laparoscopic procedures in 136 cases (6.2%). Forty-one femoral hernias (30.1%) were concealed behind intact peritonea. Forty-six lateral (33.8%) and 31 medial (22.8%) defects were sacless sliding fatty inguinal hernias.
CONCLUSIONS
When using the TAPP technique, in addition to femoral hernias, especially sacless sliding fatty inguinal hernias may be overlooked because of intact peritonea. Therefore, in cases of clinically diagnosed inguinal hernias, the preperitoneal space should be inspected intraoperatively to avoid unsatisfactory results.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Hernia, Femoral; Hernia, Inguinal; Humans; Laparoscopy; Linear Models; Male; Middle Aged; Peritoneum; Prospective Studies; Surgical Mesh; Treatment Outcome
PubMed: 19837395
DOI: 10.1016/j.amjsurg.2009.03.007