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Fertility and Sterility May 2012To demonstrate the abdominal wall anatomy necessary to perform a single port laparoscopic procedure. Single port laparoscopic (SPL) surgery has reduced the number of...
OBJECTIVE
To demonstrate the abdominal wall anatomy necessary to perform a single port laparoscopic procedure. Single port laparoscopic (SPL) surgery has reduced the number of sites required to perform laparoscopic surgery. However, the incision at the umbilicus is larger than conventional laparoscopic surgery.
DESIGN
Video presentation of clinical article. The video uses animation and surgical cases to demonstrate the relevant abdominal wall anatomy to establish surgical access for a single site or single port laparoscopy.
RESULT(S)
This video demonstrates the regional anatomy pertinent to the anterior abdominal wall, specifically of the umbilicus. The umbilicus is a focal point of fusion of the anterior abdominal wall muscles that allows entry into the peritoneal cavity. For this procedure there are 2 incisions possible, a small midline intra-umbilical one and an omega incision. The video demonstrates each technique. Introduction of a port into this single incision is demonstrated with 2 different trocar systems. These trocar systems show how the limitations of using a single site may be reduced.
CONCLUSION(S)
The abdominal wall anatomy is unique at the umbilicus and allows optimal placement of a single trocar to allow laparoscopic surgery. Video is available at http://fertstertforum.com/2012974caravalho/.
Topics: Abdominal Wall; Humans; Laparoscopy; Umbilicus
PubMed: 22542145
DOI: 10.1016/j.fertnstert.2012.03.049 -
International Journal of Environmental... Nov 2020Caesarean section (CS) is the most prevalent surgical procedure in women. The incidence of surgical site infection (SSI) after CS remains high but recent observations... (Review)
Review
Caesarean section (CS) is the most prevalent surgical procedure in women. The incidence of surgical site infection (SSI) after CS remains high but recent observations of CS wounds using infrared thermography has shown promise for the technique in SSI prognosis. Although thermography is recognised as a 'surrogate' of skin perfusion, little is known of the relationship between skin temperature and skin perfusion in the context of wound healing. To assess the extent of literature regarding the application of infrared thermography and mapping of abdominal cutaneous perfusion after CS. Wide eligibility criteria were used to capture all relevant studies of any design, published in English, and addressing thermal imaging or skin perfusion mapping of the abdominal wall. The CINAHL and MEDLINE databases were searched, with two independent reviewers screening the title and abstracts of all identified citations, followed by full-text screening of relevant studies. Data extraction from included studies was undertaken using a pre-specified data extraction chart. Data were tabulated and synthesised in narrative format. : From 83 citations identified, 18 studies were considered relevant. With three additional studies identified from the reference lists, 21 studies were screened via full text. None of the studies reported thermal imaging and cutaneous perfusion patterns of the anterior abdominal wall. However, two observational studies partially met the inclusion criteria. The first explored analysis methodologies to 'interrogate' the abdominal thermal map. A specific thermal signature ('cold spots') was identified as an early 'flag' for SSI risk. A second study, by the same authors, focusing on obesity (a known risk factor for SSI after CS) showed that a 1 °C lower abdominal skin temperature led to a 3-fold odds of SSI. There is a significant gap in knowledge on how to forewarn of wound complications after CS. By utilising the known association between skin temperature and blood flow, thermographic assessment of the wound and adjacent thermal territories has potential as a non-invasive, independent, imaging option with which to identify tissue 'at risk'. By identifying skin 'hot' or 'cold' spots, commensurate with high or low blood flow regions, there is potential to shed light on the underlying mechanisms leading to infective and non-infective wound complications.
Topics: Abdominal Wall; Cesarean Section; Female; Humans; Perfusion; Pregnancy; Surgical Wound Infection; Thermography
PubMed: 33238522
DOI: 10.3390/ijerph17228693 -
Journal of Travel Medicine Oct 2023
Topics: Humans; Abdominal Wall; Echinococcosis
PubMed: 37462529
DOI: 10.1093/jtm/taad094 -
Journal of Minimally Invasive Gynecology Sep 2023More than 13 million laparoscopic procedures are performed globally every year. The LevaLap 1.0 device may facilitate safe abdominal access when using the Veress needle...
STUDY OBJECTIVE
More than 13 million laparoscopic procedures are performed globally every year. The LevaLap 1.0 device may facilitate safe abdominal access when using the Veress needle for initial abdominal insufflation during laparoscopic surgery. We undertook this study to test the hypothesis that use of the LevaLap 1.0 would increase the distance from the abdominal wall to underlying viscera and the retroperitoneum, including from major vessels.
DESIGN
Prospective cohort study.
SETTING
Referral center.
PATIENTS
Eighteen patients scheduled to undergo an interventional radiology procedure under general anesthesia and muscle relaxation.
INTERVENTIONS
Application of the LevaLap 1.0 device on the umbilicus and on Palmer's point, during computed tomography scanning.
MEASUREMENTS
Distance from the abdominal wall to the underlying bowel and to retroperitoneal blood vessels and more distant intra-abdominal organs before and after vacuum was applied to the LevaLap 1.0.
MAIN RESULTS
The device did not significantly increase the distance from the abdominal wall to the immediate underlying bowel. Alternatively, the LevaLap 1.0 created a significant increase in the distance between the abdominal wall at the access point and more distant intra-abdominal organs at the umbilicus and at Palmer's point (mean ± SD: +3.91 ± 2.32 cm, p = .001, and +3.41 ± 3.12 cm, p = .001, respectively). At the umbilicus, the device increased the distance between the abdominal wall and the anterior wall of the vena cava by +5.32 ± 1.22 cm (p = .004) or the anterior wall of the aorta by 5.49 ± 1.40 cm (p = .004). At Palmer's point, the device increased the distance between the anterior abdominal wall and the colon and/or small bowel by 2.13 ± 1.81 cm (p = .023). No adverse events were reported.
CONCLUSIONS
The LevaLap 1.0 increased the distance between abdominal wall and major retroperitoneal blood vessels by >5 cm, promoting safer access during Veress needle insufflation when performing laparoscopic surgery.
Topics: Humans; Abdominal Wall; Prospective Studies; Viscera; Laparoscopy; Abdominal Muscles
PubMed: 37192723
DOI: 10.1016/j.jmig.2023.05.004 -
World Journal of Emergency Surgery :... Oct 2023High-level evidence regarding the technique of abdominal wall closure for patients undergoing emergency midline laparotomy is sparse. Therefore, we conducted a... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
High-level evidence regarding the technique of abdominal wall closure for patients undergoing emergency midline laparotomy is sparse. Therefore, we conducted a randomized controlled trial (RCT) to evaluate the efficacy and safety of two commonly applied abdominal wall closure strategies after primary emergency midline laparotomy.
METHODS/DESIGN
CONTINT was a multi-center pragmatic open-label exploratory randomized controlled parallel trial. Two different abdominal wall closure strategies in patients undergoing primary midline laparotomy for an emergency surgical intervention with a suspected septic focus in the abdominal cavity were compared: the continuous, all-layer suture and the interrupted suture technique. The primary composite endpoint was burst abdomen within 30 days after surgery or incisional hernia within 12 months. As reliable data on this composite primary endpoint were not available for patients undergoing emergency surgery, it was planned to initially recruit 80 patients and conduct an interim analysis after these had completed the 12 months follow-up.
RESULTS
From August 31, 2009, to June 28, 2012, 124 patients were randomized of whom 119 underwent surgery and were analyzed according to the intention-to-treat (ITT) principal. The primary composite endpoint did not differ between the continuous suture (C: 27.1%) and the interrupted suture group (I: 30.0%). None of the individual components of the primary endpoint (reoperation due to burst abdomen after 30 days (C: 13.5%, I: 15.1%) and reoperation due to incisional hernia (C: 3.0%, I:11.1%)) differed between groups. Time needed for fascial closure was longer in the interrupted suture group (C: 12.8 ± 4.5 min, I: 17.4 ± 6.1 min). BMI was associated with burst abdomen during the first 30 days with an OR of 1.17 (95% CI 1.04-1.32).
CONCLUSION
This RCT showed no difference between continuous suture with slowly absorbable suture versus interrupted rapidly absorbable sutures after primary emergency midline laparotomy in rates of postoperative burst abdomen and incisional hernia after one year. However, the trial was stopped after the interim analysis due to futility as there was no chance to show superiority of one suture technique.
Topics: Humans; Incisional Hernia; Abdominal Wall; Laparotomy; Sutures; Abdominal Cavity
PubMed: 37848901
DOI: 10.1186/s13017-023-00517-4 -
BioMed Research International 2017The aim of our study was to investigate the impact of abdominal wall reconstruction surgery on tissue anatomy and to explore how flap surgery influences the patient's...
BACKGROUND
The aim of our study was to investigate the impact of abdominal wall reconstruction surgery on tissue anatomy and to explore how flap surgery influences the patient's immune status.
METHODS
Experimental abdominal wall defects were created in 8 (swine) animal models. The animals were divided into two groups: 4 swine were euthanized one month after surgery for the biopsies retrieval purpose and the other 4 swine were kept alive and the collection of blood samples has been done 6 months after surgery. In order to evaluate the relative gene expression in operated-on animal cohorts we compared them with samples from 4 healthy swine used as controls.
RESULTS
The inflammatory process was present in all types of repairs. Collagen I deposition was higher in the flap repairs. The expression level for the genes related to immune response after 6 months from surgery was relatively similar to the control group except minor alteration registered in the case of two swine models.
CONCLUSION
Our findings indicate a less pronounced proinflammatory response to surgical trauma in animal models after flap surgery. The postoperative levels of the inflammatory cytokines did not show significant differences after abdominal wall reconstruction using flap surgery.
Topics: Abdominal Muscles; Abdominal Wall; Abdominal Wound Closure Techniques; Animals; Disease Models, Animal; Humans; Immune System; Plastic Surgery Procedures; Surgical Flaps; Swine; Wound Healing
PubMed: 29201900
DOI: 10.1155/2017/2421585 -
Ugeskrift For Laeger Nov 2020Closure of an emergency abdominal midline laparotomy is related to potentially serious complications. Main concerns are surgical site infection, wound dehiscence and... (Review)
Review
Closure of an emergency abdominal midline laparotomy is related to potentially serious complications. Main concerns are surgical site infection, wound dehiscence and incisional hernia. In this review, new studies and guidelines are summed up to a set of recommendations applicable to the Danish surgical departments. Surgical strategies concerning primary closure of an emergency laparotomy as well as a strategy towards wound dehiscence are suggested. Suture techniques, negative pressure wound therapy and reinforcement of the abdominal wall with mesh are the topics reviewed.
Topics: Abdominal Wall; Abdominal Wound Closure Techniques; Humans; Incisional Hernia; Laparotomy; Surgical Mesh; Suture Techniques
PubMed: 33215586
DOI: No ID Found -
Journal of the Mechanical Behavior of... Jan 2022Ventral hernia repair is a common surgical procedure in abdominal surgery in which surgical mesh has become an essential tool to improve outcomes. To avoid recurrences...
Ventral hernia repair is a common surgical procedure in abdominal surgery in which surgical mesh has become an essential tool to improve outcomes. To avoid recurrences the mesh needs to mimic the mechanical behavior of the abdominal wall. In this scenario the mechanical properties at the interface between the mesh and its surrounding tissue is critical for the performance of the device and, therefore, the success after surgery. We aimed to characterize and compare the mechanical behavior of the patented prototype mesh Spider and four commercial meshes at the mesh-tissue interface. The prototype mesh was designed based on the hypothesis that the best performance for a large-sized defect in a ventral hernia is obtained when the mesh presents an isotropic behavior. In contrast, commercial meshes presented significant anisotropic behavior. Mechanical properties of the meshes were characterized through uniaxial tensile tests. Longitudinal and transverse axes were defined for each mesh, and samples were cut in each axis orientation. Samples underwent uniaxial tensile testing, from which the elastic modulus in each axis was determined. The degree of anisotropy was calculated as the ratio between the elastic modulus in each axis. An in silico model of the ventral hernia defect was designed to simulate the mesh-tissue interface behavior via finite element method. Meshes were modeled by an hyperelastic orthotropic constitutive model, which allowed isotropic symmetry as particular case for the prototype mesh. Abdominal wall was modeled using a Neo-Hookean model. Once the simulations were launched, mesh-tissue interface behavior was evaluated through the difference between Von Mises stress values on either size of the interface, both on the external and the internal face of the mesh and abdominal wall. Mechanical response was anisotropic for all commercial meshes and isotropic for the Spider prototype. Among commercial, Ultrapro was highly anisotropic. Tests revealed Gore-Tex to be the stiffest, followed by Repol Angimesh, Spider and Ultrapro; Duramesh™ was found to be the most compliant. Concerning mesh-tissue behavior, simulation results revealed the Spider prototype and Duramesh™ to be the best; Spider due to its uniformity and lower stress difference thanks to its nearly isotropic behavior, and Duramesh™ due to its compliant behavior. Our results suggest that the compromise between stiffness and anisotropy must be considered in order to improve the mechanical performance of the meshes, bearing in mind that for large-sized ventral defects, nearly isotropic mesh ensures better performance.
Topics: Abdominal Wall; Benchmarking; Surgical Mesh
PubMed: 34736025
DOI: 10.1016/j.jmbbm.2021.104909 -
The Pan African Medical Journal 2022Abdominal wall endometriosis is the development of endometrial tissue in the anterior abdomen usually due to an operation in which the uterus is manipulated. We herein...
Abdominal wall endometriosis is the development of endometrial tissue in the anterior abdomen usually due to an operation in which the uterus is manipulated. We herein delineate the presentation, clinical investigation, and surgical treatment of an abdominal wall endometriosis case. A 42-year-old female presented with acute abdominal pain in the lower quadrants in the margins of an old cesarean scar. Two masses in the abdominal wall highly suspected of consisting of endometrial tissue were found during the investigation of the patient. These ones were removed in surgery and endometrial tissue secondary to previous cesarean section was confirmed after histological analysis. Consequently, although rare, if a painful mass in a surgical scar, such as a Pfannenstiel incision, is found in women of reproductive age with a history of obstetric surgery, the differential diagnosis shall include endometriosis. There is a portion of cases in which endometriosis recurs within five years following conservative surgery.
Topics: Abdominal Wall; Adult; Cesarean Section; Cicatrix; Endometriosis; Female; Humans; Neoplasm Recurrence, Local; Pregnancy
PubMed: 35685105
DOI: 10.11604/pamj.2022.41.193.33536 -
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