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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 -
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 -
Ugeskrift For Laeger Mar 2018
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Humans; Laparotomy; Postoperative Complications; Suture Techniques
PubMed: 29559073
DOI: No ID Found -
Schweizer Archiv Fur Tierheilkunde Feb 2011The ultrasonographic appearance of the normal abdominal wall in the flank region was investigated before and after exploratory laparotomy in five cows (group A). The...
The ultrasonographic appearance of the normal abdominal wall in the flank region was investigated before and after exploratory laparotomy in five cows (group A). The results were compared with those after surgical correction of left displaced abomasum in 10 cows (group B) and of caecal dilatation in another 10 cows (group C). We hypothesized that in group C and group B, wound healing would be impaired because of the higher risk of complications compared to group A. A 10.0 MHz linear transducer was used to examine the abdominal wall immediately before exploratory laparotomy and for 10 days (groups B, C) or 30 days (group A) postoperatively. The thickness of the individual layers of the abdominal wall was determined. The skin and the individual muscle layers could be well differentiated via ultrasonography in all the cows preoperatively. In group A, the total thickness of the abdominal wall ranged from 2.80 to 3.40 cm; the skin and the subcutaneous tissues were 0.60 to 0.80 cm, the external abdominal oblique muscle 0.50 to 0.70 cm, the internal abdominal oblique muscle 0.50 to 0.70 cm, the transverse abdominal muscle 0.50 to 0.75 cm, and the transverse fascia and peritoneum were 0.20 to 0.30 cm. Groups B and C had similar findings. There was no significant difference in the course of healing, the thickness of the abdominal wall or thickness of the individual layers during healing among the three groups of cows. Features of healing included subcutaneous emphysema in 19 cows, seroma in 19 and haematoma in 2 cows. However, the occurrence of these events did not differ significantly among the three groups. Ultrasonographic examination of the wound on day 10 postoperatively was unremarkable in 24 cows. A seroma was still present on day 15 postoperatively in one cow of group B.
Topics: Abdominal Wall; Animals; Cattle; Cattle Diseases; Female; Laparotomy; Ultrasonography; Wound Healing
PubMed: 21274833
DOI: 10.1024/0036-7281/a000153 -
International Journal of Surgery... 2013We briefly outline the history of hernia surgery development from the Ebers Papyrus to modern prosthetic repairs. The rapid evolution of anatomical, physiological and... (Review)
Review
We briefly outline the history of hernia surgery development from the Ebers Papyrus to modern prosthetic repairs. The rapid evolution of anatomical, physiological and pathogenetic concepts has involved the rapid evolution of surgical treatments. From hernia sack cauterization to sack ligation, posterior wall repair (Bassini), and prosthetic reinforcement there has been an evident improvement in surgical treatment results that has stimulated surgeons to find new technical solutions over time. The introduction of prosthetic repair, the laparoscopic revolution, the impact of local anesthesia and the diffusion of day surgery have been the main advances of the last 50 years. Searching for new gold standards, the introduction of new devices has also led to new complications and problems. Research of the last 10 years has been directed to overcome prosthetic repair complications, introducing every year new meshes and materials. Lightweight meshes, composite meshes and biologic meshes are novelties of the last few years. We also take a look at future trends.
Topics: Abdominal Wall; Hernia, Abdominal; Humans; Laparoscopy; Prostheses and Implants
PubMed: 24380545
DOI: 10.1016/S1743-9191(13)60008-4 -
Journal of Reconstructive Microsurgery Jul 2022Abdominal wall vascularized composite allotransplantation (AW-VCA) is a novel reconstructive technique used for large abdominal wall defects in combination with... (Review)
Review
BACKGROUND
Abdominal wall vascularized composite allotransplantation (AW-VCA) is a novel reconstructive technique used for large abdominal wall defects in combination with intestinal transplantation (ITx) or multivisceral abdominal transplantation (MVTx). Since the introduction of this procedure, several studies have been published reporting their experience. This study aims to present a scoping review looking at all available evidence-based medicine information to understand the most current surgical techniques and clinical outcomes.
METHODS
This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension for scoping reviews checklist. A comprehensive research strategy of several databases was conducted.
RESULTS
A total of 31 studies were included in this review, which comprised animal, cadaveric, and human studies. In human studies, four surgical techniques with high flap survival rates and low complication rates were found. In cadaveric studies, it was shown that the use of iliofemoral cuff-based flaps provided adequate tissue perfusion to the abdominal wall graft. Also, the use of thoracolumbar nerves have been described to provide functionality to the AW-VCA and prevent long-term muscle atrophy.
CONCLUSION
AW-VCA is a safe and efficient alternative for patients with large and complex abdominal wall defects. The future holds a promising evolution of a functional AW-VCA, though surgeons must face and overcome the challenge of distorted anatomy frequently present in this population. Forthcoming studies with a better level of evidence are required to evaluate functionality and differences between surgical techniques.
Topics: Abdominal Wall; Animals; Cadaver; Graft Rejection; Humans; Plastic Surgery Procedures; Surgical Flaps; Vascularized Composite Allotransplantation
PubMed: 34905782
DOI: 10.1055/s-0041-1740121 -
European Journal of Vascular and... Jun 2023
Topics: Humans; United States; Abdominal Wall; Incisional Hernia; Laparoscopy; Surgeons; Herniorrhaphy; Hernia, Ventral; Abdominal Wound Closure Techniques; Surgical Mesh
PubMed: 36804613
DOI: 10.1016/j.ejvs.2023.02.009 -
Hernia : the Journal of Hernias and... Dec 2022Telemedicine has emerged as a viable option to in-person visits for the evaluation and management of surgical patients. Increased integration of telemedicine has allowed...
PURPOSE
Telemedicine has emerged as a viable option to in-person visits for the evaluation and management of surgical patients. Increased integration of telemedicine has allowed for greater access to care for specific patient populations but relative outcomes are unstudied. Given these limitations, we sought to evaluate the efficacy of telemedicine-based new patient preoperative encounters in comparison to in-person encounters.
METHODS
We performed a retrospective analysis of adult patients undergoing new patient evaluations from April 2020 to October 2021. Telemedicine visits consist of both video and telephone-based encounters. Visit types, patient demographics, preoperative diagnosis, travel time to the hospital, and prior imaging availability were reviewed.
RESULTS
A total of 276 new patient encounters were conducted (n = 108, 39% telemedicine). Indications for evaluation included inguinal hernia (n = 81, 30%), ventral hernia (n = 149, 54%) and groin or abdominal pain (n = 30, 11%). Patients undergoing telehealth evaluations were more likely to have greater travel distance to the hospital (91 km vs 29 km, p = 0.002) and have CT image-confirmed diagnoses at the initial visit (73 vs 47%, p < 0.001). Patients who were evaluated for a recurrent or incisional hernia were more likely to be seen through a telemedicine encounter (69 vs 45%, p < 0.001).
CONCLUSIONS
We report the efficacy of telemedicine-based consultations for new patient preoperative evaluations related to hernia repair and abdominal wall reconstruction. Telemedicine is a useful modality for preoperative evaluation of new patients with hernia and advanced abdominal wall reconstruction needs. Understanding this patient population will allow us to optimize telemedicine encounters for new patients and improve access to care for patients in remote locations.
Topics: Adult; Humans; Herniorrhaphy; Abdominal Wall; Retrospective Studies; Hernia, Ventral; Telemedicine; Referral and Consultation
PubMed: 35723771
DOI: 10.1007/s10029-022-02624-8 -
BMJ Case Reports Sep 2018
Topics: Abdominal Wall; Adenocarcinoma; Adult; Cystoscopy; Humans; Lymph Node Excision; Male; Radiography, Abdominal; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 30219781
DOI: 10.1136/bcr-2018-226207 -
BMC Gastroenterology May 2022The value of CT (computed tomography) sinography in evaluating abdominal wall sinus tracts is currently unclear. The present study aims to investigate the accuracy of CT...
BACKGROUND
The value of CT (computed tomography) sinography in evaluating abdominal wall sinus tracts is currently unclear. The present study aims to investigate the accuracy of CT sinography in diagnosing the extent of abdominal sinus and analyze the reasons for misdiagnosis.
MATERIALS AND METHODS
64 patients with abdominal sinus tract formation (including fistula) undergoing CT sinography in our hospital from January 2018 to November 2020 were retrospectively analyzed. The CT images were blindly and independently re-assessed by two radiologists with 5- and 18-years work experience, respectively. Whether the sinus tract was confined to the abdominal wall or had invaded the abdominal cavity, and whether there was fistula formation were evaluated. The accuracy of CT sinography in diagnosing sinus invasion in the abdominal cavity and fistula formation was calculated. The agreements of CT sinography-surgical results and inter-observer were assessed using weighted-kappa statistics.
RESULTS
The weighted- Kappa of inter-observer agreement (0.825, P < 0.001) and CT sinography-surgical results (0.828, P < 0.001) were both perfect. The diagnostic accuracy, sensibility, and specificity of sinus tract confined to the abdominal wall were 90.6% (95% CI: 80.7-96.5), 85.7% (95% CI: 67.3-96.0), and 94.4% (95% CI: 81.3-99.3), respectively. The diagnostic accuracy, sensibility, and specificity of fistula formation were 93.8% (95% CI: 84.8-98.3), 89.5% (95% CI: 66.9-98.7), and 95.6% (95% CI: 84.9-99.5), respectively. A total of 4 cases of sinus tract confined to the abdominal wall were misdiagnosed as invading the abdominal cavity, 2 cases of sinus tract invading the abdominal cavity were misdiagnosed as confined to the abdominal wall, 2 cases of enterocutaneous fistula were missed, 1 case of enterocutaneous fistula was misdiagnosed, 1 case of vesico-cutaneous fistula was misdiagnosed, and no cases of vesico-cutaneous fistula were missed.
CONCLUSIONS
CT sinography can accurately assess the extent of an abdominal sinus tract and reveal fistula formation, despite some inevitable misdiagnosis and missed diagnosis. Radiologists should find more clues to improve the diagnostic accuracy.
Topics: Abdominal Wall; Cutaneous Fistula; Humans; Intestinal Fistula; Missed Diagnosis; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 35505325
DOI: 10.1186/s12876-022-02291-0