-
The Cochrane Database of Systematic... Jan 2019Laparoscopy is a common procedure in many surgical specialties. Complications arising from laparoscopy are often related to initial entry into the abdomen.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Laparoscopy is a common procedure in many surgical specialties. Complications arising from laparoscopy are often related to initial entry into the abdomen. Life-threatening complications include injury to viscera (e.g. bowel, bladder) or to vasculature (e.g. major abdominal and anterior abdominal wall vessels). No clear consensus has been reached as to the optimal method of laparoscopic entry into the peritoneal cavity.
OBJECTIVES
To evaluate the benefits and risks of different laparoscopic entry techniques in gynaecological and non-gynaecological surgery.
SEARCH METHODS
We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, and trials registers in January 2018. We also checked the references of articles retrieved.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that compared one laparoscopic entry technique versus another. Primary outcomes were major complications including mortality, vascular injury of major vessels and abdominal wall vessels, visceral injury of bladder or bowel, gas embolism, solid organ injury, and failed entry (inability to access the peritoneal cavity). Secondary outcomes were extraperitoneal insufflation, trocar site bleeding, trocar site infection, incisional hernia, omentum injury, and uterine bleeding.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, assessed risk of bias, and extracted data. We expressed findings as Peto odds ratios (Peto ORs) with 95% confidence intervals (CIs). We assessed statistical heterogeneity using the I² statistic. We assessed the overall quality of evidence for the main comparisons using GRADE methods.
MAIN RESULTS
The review included 57 RCTs including four multi-arm trials, with a total of 9865 participants, and evaluated 25 different laparoscopic entry techniques. Most studies selected low-risk patients, and many studies excluded patients with high body mass index (BMI) and previous abdominal surgery. Researchers did not find evidence of differences in major vascular or visceral complications, as would be anticipated given that event rates were very low and sample sizes were far too small to identify plausible differences in rare but serious adverse events.Open-entry versus closed-entryTen RCTs investigating Veress needle entry reported vascular injury as an outcome. There was a total of 1086 participants and 10 events of vascular injury were reported. Four RCTs looking at open entry technique reported vascular injury as an outcome. There was a total of 376 participants and 0 events of vascular injury were reported. This was not a direct comparison. In the direct comparison of Veress needle and Open-entry technique, there was insufficient evidence to determine whether there was a difference in rates of vascular injury (Peto OR 0.14, 95% CI 0.00 to 6.82; 4 RCTs; n = 915; I² = N/A, very low-quality evidence). Evidence was insufficient to show whether there were differences between groups for visceral injury (Peto OR 0.61, 95% CI 0.06 to 6.08; 4 RCTs; n = 915: I² = 0%; very low-quality evidence), or failed entry (Peto OR 0.45, 95% CI 0.14 to 1.42; 3 RCTs; n = 865; I² = 63%; very low-quality evidence). Two studies reported mortality with no events in either group. No studies reported gas embolism or solid organ injury.Direct trocar versus Veress needle entryTrial results show a reduction in failed entry into the abdomen with the use of a direct trocar in comparison with Veress needle entry (OR 0.24, 95% CI 0.17 to 0.34; 8 RCTs; N = 3185; I² = 45%; moderate-quality evidence). Evidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.59, 95% CI 0.18 to 1.96; 6 RCTs; n = 1603; I² = 75%; very low-quality evidence), visceral injury (Peto OR 2.02, 95% CI 0.21 to 19.42; 5 RCTs; n = 1519; I² = 25%; very low-quality evidence), or solid organ injury (Peto OR 0.58, 95% Cl 0.06 to 5.65; 3 RCTs; n = 1079; I² = 61%; very low-quality evidence). Four studies reported mortality with no events in either group. Two studies reported gas embolism, with no events in either group.Direct vision entry versus Veress needle entryEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.39, 95% CI 0.05 to 2.85; 1 RCT; n = 186; very low-quality evidence) or visceral injury (Peto OR 0.15, 95% CI 0.01 to 2.34; 2 RCTs; n = 380; I² = N/A; very low-quality evidence). Trials did not report our other primary outcomes.Direct vision entry versus open entryEvidence was insufficient to show whether there were differences between groups in rates of visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.50; 2 RCTs; n = 392; I² = N/A; very low-quality evidence), solid organ injury (Peto OR 6.16, 95% CI 0.12 to 316.67; 1 RCT; n = 60; very low-quality evidence), or failed entry (Peto OR 0.40, 95% CI 0.04 to 4.09; 1 RCT; n = 60; very low-quality evidence). Two studies reported vascular injury with no events in either arm. Trials did not report our other primary outcomes.Radially expanding (STEP) trocars versus non-expanding trocarsEvidence was insufficient to show whether there were differences between groups in rates of vascular injury (Peto OR 0.24, 95% Cl 0.05 to 1.21; 2 RCTs; n = 331; I² = 0%; very low-quality evidence), visceral injury (Peto OR 0.13, 95% CI 0.00 to 6.37; 2 RCTs; n = 331; very low-quality evidence), or solid organ injury (Peto OR 1.05, 95% CI 0.07 to 16.91; 1 RCT; n = 244; very low-quality evidence). Trials did not report our other primary outcomes.Other studies compared a wide variety of other laparoscopic entry techniques, but all evidence was of very low quality and evidence was insufficient to support the use of one technique over another.
AUTHORS' CONCLUSIONS
Overall, evidence was insufficient to support the use of one laparoscopic entry technique over another. Researchers noted an advantage of direct trocar entry over Veress needle entry for failed entry. Most evidence was of very low quality; the main limitations were imprecision (due to small sample sizes and very low event rates) and risk of bias associated with poor reporting of study methods.
Topics: Abdominal Wall; Blood Vessels; Female; Gynecologic Surgical Procedures; Humans; Intestines; Intraoperative Complications; Laparoscopy; Male; Peritoneal Cavity; Randomized Controlled Trials as Topic; Urinary Bladder
PubMed: 30657163
DOI: 10.1002/14651858.CD006583.pub5 -
Journal of Applied Physiology... Dec 2004A single abdominal cross-sectional computerized axial tomography and magnetic resonance image is often obtained in studies examining adipose tissue (AT) distribution. An...
A single abdominal cross-sectional computerized axial tomography and magnetic resonance image is often obtained in studies examining adipose tissue (AT) distribution. An abdominal image might also provide additional useful information on total body skeletal muscle (SM) and AT volumes with related physiological insights. We therefore investigated the relationships between abdominal SM and AT areas from single images and total body component volumes in a large and diverse sample of healthy adult subjects. Total body SM and AT volumes were derived by whole body multislice magnetic resonance imaging in 123 men [age (mean +/- SD) of 41.6 +/- 15.8 yr; body mass index of 25.9 +/- 3.4 kg/m(2)] and 205 women (age of 47.8 +/- 18.7 yr; body mass index of 26.7 +/- 5.6 kg/m(2)). Single abdominal SM and AT slice areas were highly correlated with total body SM (r = 0.71-0.92; r = 0.90 at L(4)-L(5) intervertebral space) and AT (r = 0.84-0.96; r = 0.94 at L(4)-L(5) intervertebral space) volumes, respectively. R(2) increased by only 5.7-6.1% for SM and 2.7-4.4% for AT with the inclusion of subject sex, age, ethnicity, scanning position, body mass index, and waist circumference in the model. The developed SM and AT models were validated in an additional 49 subjects. To achieve equivalent power to a study measuring total body SM or AT volumes, a study using a single abdominal image would require 17-24% more subjects for SM and 6-12% more subjects for AT. Measurement of a single abdominal image can thus provide estimates of total body SM and AT for group studies of healthy adults.
Topics: Abdomen; Adipose Tissue; Adult; Aged; Body Composition; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Predictive Value of Tests; Reproducibility of Results
PubMed: 15310748
DOI: 10.1152/japplphysiol.00744.2004 -
The Medical Journal of Malaysia Jun 2010Foetus-in-fetu is a rare condition in which a calcified mass is in the abdomen of its host, a newborn or an infant. We report a case of a newborn in whom abdominal...
Foetus-in-fetu is a rare condition in which a calcified mass is in the abdomen of its host, a newborn or an infant. We report a case of a newborn in whom abdominal radiograph and ultrasonography revealed a mass in which the contents favour a foetus-in-fetu. Diagnosis was confirmed by macroscopic examination that showed a soft tissue mass resembling a foetus, attached to the membranous sac. It was covered entirely with intact skin. There were two malformed lower limbs with a rudimentary digit and one malformed upper limb.
Topics: Abdomen; Fetus; Humans; Upper Extremity
PubMed: 23756803
DOI: No ID Found -
PloS One 2016Obesity is a major risk factor for hypertension, and abdominal fat in particular has been more strongly associated with cardiovascular diseases and its prevalence has...
BACKGROUND
Obesity is a major risk factor for hypertension, and abdominal fat in particular has been more strongly associated with cardiovascular diseases and its prevalence has increased in Brazilian indigenous populations.
OBJECTIVE
The objective of this study was to estimate the prevalence of hypertension among indigenous women and its association with total and abdominal obesity after adjustment for confounding factors.
METHODS
This cross-sectional study evaluated indigenous non-pregnant women aged 20-59 years living in two villages of the indigenous reserve of Dourados, state of Mato Grosso do Sul, Brazil. Data were collected by trained interviewers. Households were visited and were selected by simple random sampling using SPSS software version 21. The casting of lots was performed from a list of households located on a map of villages. To locate the selected households, a Global Positioning System device was used. A questionnaire was used to obtain data on socio-demographic, lifestyle and health-related variables and to obtain anthropometric data on weight, height, and waist circumference (WC). Blood pressure was measured twice during home visits.
RESULTS
Data were collected between June and October 2013 with 362 women. Most of them were aged <40 years (66.3%) and had low educational level (≤4 years of schooling, 82.0%), had overweight/obesity (74.0%), WC ≥80 cm (83.7%), and family history of hypertension (60.5%). The prevalence of hypertension was 42.0% (CI 95%: 37.0-47.2). In the multivariable analysis, respondents with WC 80-87 cm and ≥88 cm showed approximately 2 times higher prevalence rates of hypertension compared with those with WC <80 cm after adjusting for confounding factors. There was no association between body mass index (BMI) and hypertension in this study.
CONCLUSIONS
The overall prevalence of hypertension was high and associated only with abdominal adiposity but not with BMI.
Topics: Abdomen; Adiposity; Adult; Body Mass Index; Brazil; Cross-Sectional Studies; Female; Humans; Hypertension; Middle Aged; Obesity, Abdominal; Population Groups; Prevalence; Waist Circumference; Young Adult
PubMed: 27294870
DOI: 10.1371/journal.pone.0155528 -
BJS Open Jul 2023Sarcopenia refers to the progressive age- or pathology-associated loss of skeletal muscle. When measured radiologically as reduced muscle mass, sarcopenia has been shown... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sarcopenia refers to the progressive age- or pathology-associated loss of skeletal muscle. When measured radiologically as reduced muscle mass, sarcopenia has been shown to independently predict morbidity and mortality after elective abdominal surgery. However, the European Working Group on Sarcopenia in Older People (EWGSOP) recently updated their sarcopenia definition, emphasizing both low muscle 'strength' and 'mass'. The aim of this systematic review and meta-analysis was to determine the prognostic impact of this updated consensus definition of sarcopenia after elective abdominal surgery.
METHODS
MEDLINE, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched for studies comparing prognostic outcomes between sarcopenic versus non-sarcopenic adults after elective abdominal surgery from inception to 15 June 2022. The primary outcomes were postoperative morbidity and mortality. Sensitivity analyses adjusting for confounding patient factors were also performed. Methodological quality assessment of studies was performed independently by two authors using the QUality in Prognosis Studies (QUIPS) tool.
RESULTS
Twenty articles with 5421 patients (1059 sarcopenic and 4362 non-sarcopenic) were included. Sarcopenic patients were at significantly greater risk of incurring postoperative complications, despite adjusted multivariate analysis (adjusted OR 1.56, 95 per cent c.i. 1.39 to 1.76). Sarcopenic patients also had significantly higher rates of in-hospital (OR 7.62, 95 per cent c.i. 2.86 to 20.34), 30-day (OR 3.84, 95 per cent c.i. 1.27 to 11.64), and 90-day (OR 3.73, 95 per cent c.i. 1.19 to 11.70) mortality. Sarcopenia was an independent risk factor for poorer overall survival in multivariate Cox regression analysis (adjusted HR 1.28, 95 per cent c.i. 1.13 to 1.44).
CONCLUSION
Consensus-defined sarcopenia provides important prognostic information after elective abdominal surgery and can be appropriately measured in the preoperative setting. Development of targeted exercise-based interventions that minimize sarcopenia may improve outcomes for patients who are undergoing elective abdominal surgery.
Topics: Adult; Humans; Aged; Sarcopenia; Consensus; Abdomen; Muscle Strength; Elective Surgical Procedures
PubMed: 37542472
DOI: 10.1093/bjsopen/zrad065 -
Clinical Medicine & Research Mar 2020Percussion is derived from the Latin word to hear and to touch. Percussion of the abdomen is used to detect areas of tenderness, dullness within an area of tenderness...
BACKGROUND
Percussion is derived from the Latin word to hear and to touch. Percussion of the abdomen is used to detect areas of tenderness, dullness within an area of tenderness suggestive of a mass, shifting dullness representing fluid or blood, splenic, hepatic and bladder enlargement, and free air in the peritoneum. Covered are abdominal signs of percussion attributed as medical eponyms from the time-period beginning in the mid-late nineteenth century. Described is historical information behind the sign, descriptions of the sign, and implication in modern clinical practice.
DATA SOURCES
PubMed, Medline, online Internet word searches, textbooks, and references from other source text. PubMed was searched using the Medical Subject Heading (MeSH) of the name of the eponyms and text words associated with the sign.
CONCLUSION
Percussion signs defined as medical eponyms were important discoveries adopted by physicians prior to the advent of radiographs and other imaging and diagnostic techniques. The signs perfected during this time-period provided important clinical cues as to the presence of air within the peritoneum or rupture of the spleen.
Topics: Abdomen; Eponyms; History, 19th Century; Humans; Palpation; Physicians
PubMed: 31324736
DOI: 10.3121/cmr.2018.1428 -
Medical Ultrasonography Nov 2017Abdominal wall endometriosis (AWE) is a rare condition defined by the presence of endometrial tissue in the subcutaneous fatty layer and the muscles of the abdominal... (Review)
Review
Abdominal wall endometriosis (AWE) is a rare condition defined by the presence of endometrial tissue in the subcutaneous fatty layer and the muscles of the abdominal wall. It is usually caused by the dissemination of endometrial tissue in the wound at the time of obstetrical and gynecological surgeries. AWE is rare and difficult to diagnose. The most frequent clinical presentation is that of a palpable subcutaneous mass near surgical scars associated with cyclic pain and swelling during menses. AWE may be an underreported pathology partly because it has scarcely received attention in the radiologic literature. Its frequency is expected to rise along with the increasing rate of cesarean deliveries; thus, it is important that physicians or sonographers are familiar with this pathology. The purpose of our review is to present the latest data regarding risk factors, clinical and imagisticfindings, and management of AWE.
Topics: Abdominal Wall; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Ultrasonography
PubMed: 29197920
DOI: 10.11152/mu-1248 -
Radiographics : a Review Publication of... 2017Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies that can arise at any location in the body and affect all age groups. These sarcomas are most... (Review)
Review
Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies that can arise at any location in the body and affect all age groups. These sarcomas are most common in the extremities, trunk wall, retroperitoneum, and head and neck. In the adult population, soft-tissue sarcomas arising in the abdomen and pelvis are often large masses at the time of diagnosis because they are usually clinically silent or cause vague or mild symptoms until they invade or compress vital organs. In contrast, soft-tissue sarcomas arising from the abdominal wall come to clinical attention earlier in the course of disease because they cause a palpable mass, abdominal wall deformity, or pain that is more clinically apparent. The imaging features of abdominal and pelvic sarcomas and abdominal wall sarcomas can be nonspecific and overlap with more common pathologic conditions, making diagnosis difficult or, in some cases, delaying diagnosis. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor (GIST) are the most common intra-abdominal primary sarcomas. Any soft-tissue sarcoma can arise in the abdominal wall. Knowledge of the classification and pathologic features of soft-tissue sarcomas, the anatomic locations where they occur, and their cross-sectional imaging features helps the radiologist establish the diagnosis or differential diagnosis so that patients with soft-tissue sarcomas can receive optimal treatment and management. In part 1 of this article, the most common soft-tissue sarcomas (liposarcoma, leiomyosarcoma, and GIST) are reviewed, with a discussion on anatomic locations, classification, clinical considerations, and differential diagnosis. Part 2 will focus on the remainder of the soft-tissue sarcomas occurring in the abdomen and pelvis.
Topics: Abdominal Cavity; Diagnosis, Differential; Humans; Pelvis; Sarcoma; Soft Tissue Neoplasms
PubMed: 28287938
DOI: 10.1148/rg.2017160157 -
BMJ Case Reports Feb 2012A middle-aged-woman presented with symptoms and signs of acute abdomen. Clinically a suspicion of acute appendicitis was raised, although the abdominal x-ray and...
A middle-aged-woman presented with symptoms and signs of acute abdomen. Clinically a suspicion of acute appendicitis was raised, although the abdominal x-ray and ultrasound were normal. She was managed conservatively, which she failed to respond. In the view of persisting pain, a contrast enhanced CT (CECT) was done. CECT showed a whirling mass of fatty and fibrous tissue adherent to the anterior abdominal wall suggestive of omental torsion and the diagnosis was confirmed on laparotomy and she underwent excision of the ischaemic omentum. Omental torsion though rare, should be included in the differential diagnosis of acute abdomen. High index of suspicion is required to diagnose this entity. CECT abdomen shows the classical finding of fatty mass with whirling pattern. It is seldom considered in the differential diagnosis preoperatively based on clinical findings and the diagnosis is only established during the surgical procedure.
Topics: Abdomen, Acute; Female; Humans; Middle Aged; Omentum; Peritoneal Diseases; Tomography, X-Ray Computed; Torsion Abnormality
PubMed: 22665571
DOI: 10.1136/bcr.12.2011.5447 -
Journal of Ayub Medical College,... 2022Papillary renal cell carcinoma comprises around 15% of all renal cell carcinomas. Patients are usually asymptomatic, and 25 percent of individuals have advanced...
Papillary renal cell carcinoma comprises around 15% of all renal cell carcinomas. Patients are usually asymptomatic, and 25 percent of individuals have advanced locoregional disease at presentation. Papillary renal cell carcinoma presenting as a huge abdominal cystic mass is uncommon and is reported rarely in literature. We present a case of renal cell carcinoma presenting with abdominal pain, distention, and constipation. A retroperitoneal cystic lesion measuring 23.4×23.8 cm cyst was reported on ultrasonography as potential cause of the symptoms. We now talk about the case of a 57- year-old male who presented to us with abdominal pain, distension, and constipation. He also had a history of on and off low-grade fever for the last seven months. A computed topography (CT scan) of the abdomen and pelvis with intravenous and oral contrast revealed a large retroperitoneal cystic mass extending from the left hypochondrium to the left kidney and into the pelvis crossing the midline. Internal calcific foci, enhancing septa, irregularly thickened walls and hyperdense nodules were also demonstrated. A radical left nephrectomy via a midline laparotomy was performed electively. The cystic mass was excised and the specimen was sent for histopathological evaluation which revealed papillary renal cell carcinoma with PAX-8 and CK-7 positivity. Patient made an uneventful recovery post-operatively and was discharged. Cystic tumors of renal origin can rarely present as a huge abdominal cystic mass confusing them for masses of intestinal or hepatic origin. Timely diagnosis can be made with a detailed history, examination, imaging studies and histopathology, and instigate timely intervention.
Topics: Male; Humans; Middle Aged; Carcinoma, Renal Cell; Kidney Neoplasms; Kidney; Abdominal Pain; Abdomen
PubMed: 36566423
DOI: 10.55519/JAMC-04-10865