scholarly journals Intra-Operative Total Bowel Washing: A New Method to Improve the Outcome of Gastroschisis Primary Repair

2020 ◽  
Vol 30 (3) ◽  
Author(s):  
Ahmad Mohammadipour ◽  
Mehran Hiradfar ◽  
Reza Shojaeian
Keyword(s):  
Gastrointestinal Tract ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Primary Repair ◽  
Abdominal Cavity ◽  
Abdominal Wall Reconstruction ◽  
Operation Time ◽  
Oral Feeding ◽  
Main Challenge ◽  
Significant Difference

Background: Gastroschisis is an abdominal wall defect that is managed by surgical reduction of herniated bowel into the abdominal cavity and abdominal wall reconstruction. Loss of abdominal domain is the main challenge that may complicate the process of gastroschisis management. Objectives: This article is about innovative manure called total bowel washing (TBW) that may improve the outcome of gastroschisis primary repair. Methods: All neonates with gastroschisis who met the study inclusion criteria between 2006 - 2019 were enrolled and divided into two groups of conventional and TBW method of gastroschisis management. In TBW group, bowls were washed with warm saline and after a gentle enterolysis, the whole gastrointestinal tract was irrigated via a gastric tube and evacuated completely from thick meconium until the watery stool started to come out of anus slightly. Primary abdominal wall closure was performed after loop by loop bowel reduction. Gastroschisis management outcome was compared between the two groups. Results: 15 neonates were allocated in each group. Demographic and anthropometric variables were compared and any significant difference wasn’t reported between the two groups. We observed a significantly better outcome in terms of faster GI rehabilitation, shorter time to oral feeding tolerance, less need to silo placement and shorter NICU and hospital stay in TBW method. Operation time was slightly longer in TBW group while the difference was not significant statistically. Conclusions: Total bowel washing and complete evacuation of gastrointestinal tract from thick meconium will increase the success rate of primary repair and improve the outcome of gastroschisis management.

How safe is the use of prosthetic materials in the repair of abdominal-wall defects in malnourished subjects?

Open Medicine ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Mehmet Karahan ◽  
Hakan Kulacoglu ◽  
Duray Seker ◽  
Zafer Ergul ◽  
Aysel Kiziltay ◽  
...  
Keyword(s):  
Wound Healing ◽  
Abdominal Wall ◽  
Polypropylene Mesh ◽  
Histopathological Examination ◽  
Abdominal Wall Defect ◽  
Infectious Complications ◽  
Abdominal Wall Defects ◽  
Tissue Samples ◽  
Significant Difference ◽  
Histopathological Studies

AbstractIncisional hernias and abdominal-wall defects consume large amounts of healthcare resources. Use of mesh is effective in treatment of these disorders and can decrease the rate of recurrence. This experimental study focused on the safety of mesh use in the setting of malnutrition, a condition that impairs wound healing. Rats were divided into two groups: normally fed and food-restricted. An abdominal-wall defect, 2 by 2 cm, was covered with polypropylene mesh, 2.5 by 2.5 cm. After sacrifice of the rats at the 21st and 60th days, tissue samples were sent for tensiometric and histopathological studies. No significant difference in infectious complications was observed between the two groups. Tensiometry revealed no significant differences between the groups. On histopathological examination, the only difference noted was in the vascularization scores of normally fed rats. For malnourished subjects that survived after surgery, the use of polypropylene mesh appeared safe in the closure of abdominal-wall defects, with no increase in infection rate and satisfactory wound healing.

scholarly journals Resection and Abdominal Wall Reconstruction of a Desmoid Tumor with Endometrioma Features

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Jaqueline Majors ◽  
Nathaniel F. Stoikes ◽  
Reza Nejati ◽  
Jeremiah L. Deneve
Keyword(s):  
Abdominal Wall ◽  
Soft Tissue Tumor ◽  
Abdominal Mass ◽  
Abdominal Cavity ◽  
Abdominal Wall Reconstruction ◽  
Pathologic Finding ◽  
Desmoid Tumors ◽  
History Of ◽  
Well Differentiated ◽  
Palpable Abdominal Mass

Desmoid tumors are rare, musculoaponeurotic mesenchymal origin tumors arising from the proliferation of well-differentiated fibroblasts. Desmoid tumors may arise from any location with the abdominal cavity, abdominal wall and extremity locations being most frequent. We present the case of a 35-year-old female with a history of endometriosis who presented palpable abdominal mass and cyclic abdominal pain. Resection was performed for a presumed desmoid soft tissue tumor. Final pathology demonstrated desmoid histology admixed with abdominal wall endometriosis (endometrioma). This unique pathologic finding has only been rarely reported and is discussed with a brief review of the literature.

scholarly journals 798 A Rare Complication and Unexpected Pathology Following an Anterior Exenteration – A Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Robertson ◽  
G Lazaraviciute ◽  
L Kerr ◽  
D Hendry
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Rare Complication ◽  
Endometrial Adenocarcinoma ◽  
Abdominal Wall Reconstruction ◽  
Emergency Laparotomy ◽  
Proximal Thigh ◽  
Urachal Adenocarcinoma

Abstract We present a case report of an unexpected pathology in addition to a rare complication in a 62-year-old female following an anterior exenteration and an abdominal wall reconstruction. Initial biopsies characterised the malignancy as a potential urachal adenocarcinoma, but the final pathology revealed a solitary endometrial adenocarcinoma metastasis from endometrial cancer 6 years previously. Due to the nature of the tumour, an abdominal wall resection was required, and reconstruction involved a pedicled thigh flap. Post-operatively the small bowel herniated under the flap and this resulted in true mechanical small bowel obstruction. The loop of herniated bowel is visible on CT imaging in the area of the proximal thigh. The patient returned to theatre for an emergency laparotomy and the abdominal wall defect was closed instead with a surgical implant derived from animal tissue. The patient made an excellent recovery, was discharged home, and continues to do well. This patient is an example of excelling in adversity.

scholarly journals Effect of endoscopic resection on short-term surgical outcomes of subsequent laparoscopic gastrectomy: a meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Dong Peng ◽  
Yu-Xi Cheng ◽  
Gang Liao
Keyword(s):  
Endoscopic Resection ◽  
Laparoscopic Gastrectomy ◽  
Surgical Outcomes ◽  
Meta Analysis ◽  
Operation Time ◽  
Oral Feeding ◽  
Cochrane Library ◽  
Short Term ◽  
Significant Difference ◽  
Grade Ii

Abstract Background Endoscopic resection (ER) might affect subsequent laparoscopic gastrectomy (LG) because of the electrical coagulation, but the effect remains controversial. The purpose of this meta-analysis was to analyze the effect of ER on the short-term surgical outcomes of subsequent LG. Materials and methods The PubMed, EMBASE, and Cochrane Library databases were searched to find eligible studies published from inception to March 21, 2021. Short-term surgical outcomes were compared between the ER-LG group and the LG-only group. The registration ID of this current meta-analysis on PROSPERO is CRD42021238031. Results Nine studies involving 3611 patients were included in this meta-analysis. The LG-only group had a higher T stage (T1-T2: OR=2.42, 95% CI=1.09 to 5.34, P=0.03; T3-T4: OR=0.41, 95% CI=0.19 to 0.91, P=0.03) than the ER-LG group. The ER-LG group showed a shorter operation time than the LG-only group (MD=−5.98, 95% CI=−10.99 to −0.97, P=0.02). However, no difference was found in operation time after subgroup analysis of propensity score matching studies. No significant difference was found in intraoperative blood loss, time to first oral feeding, or postoperative hospital stay between the ER-LG group and the LG-only group. And no significance was found in overall complications (OR=1.16, 95% CI=0.89 to 1.50, P=0.27), complications of grade ≥ II (OR=1.11, 95% CI=0.71 to 1.73, P=0.64), complications of grade ≥ III b (OR=1.47, 95% CI=0.49 to 4.43, P=0.49) between the ER-LG group and the LG-only group. Conclusions ER did not affect subsequent LG in terms of short-term outcomes, and the ER-LG group might have a shorter operation time than the LG-only group.

Management of Complex Abdominal Wall Defects Using Acellular Porcine Dermal Collagen

2010 ◽  
Vol 76 (1) ◽  
pp. 96-100 ◽  
Author(s):  
Luis Felipe Chavarriaga ◽  
Edward Lin ◽  
Albert Losken ◽  
Michael W. Cook ◽  
Louis O. Jeansonne ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Primary Repair ◽  
Abdominal Wall Reconstruction ◽  
Long Term Results ◽  
Wound Complications ◽  
Abdominal Wall Defects ◽  
Mesh Placement ◽  
Postoperative Wound ◽  
Porcine Dermal Collagen ◽  
Dermal Collagen

Multiple techniques have been used for the repair of complex abdominal wall defects after recurrent incisional hernias with varying rates of success. Primary repair has been associated with high recurrence rates, and prosthetic mesh placement is contraindicated in contaminated surgical fields. The development of biologic prostheses has changed the approach to these difficult problems. This study evaluates the management of complex abdominal wall defects using acellular porcine dermal collagen. Between August 2006 and May 2007, 18 patients underwent abdominal wall reconstruction for complex defects with acellular porcine dermal collagen (CollaMend™; Bard Inc., Warwick, RI). Patient demographics, preoperative risk factors, previous herniorrhaphy attempts, postoperative complications, recurrences, and long-term results were retrospectively reviewed. Records were reviewed at a mean follow up of 7.3 months; the recurrence rate was 44.4 per cent. A total of 38.9 per cent (seven of 18) developed a postoperative wound complications, including infection in 22.2 per cent (four of 18). All of the patients with infection required prosthesis removal as a result of encapsulation rather than incorporation of the biologic prosthesis. Acellular porcine dermal collagen has the potential for reconstruction of abdominal wall defects with postoperative wound occurrences comparable with other biologic materials. Encapsulation of the material was a major problem in cases with wound infection that required graft removal rather than local wound measures. Hernia recurrence and dehiscence of the graft were problems in noncompromised surgical fields.

scholarly journals CRITICAL ANALYSIS OF EXPERIMENTAL MODEL FOR STUDY OF ADHESIONS AFTER INCISIONAL HERNIAS INDUCED IN RATS’ AND REPAIR OF ABDOMINAL WALL WITH DIFFERENT BIOMATERIALS

2015 ◽  
Vol 28 (3) ◽  
pp. 178-182 ◽  
Author(s):  
Leonardo Carvalho SERIGIOLLE ◽  
Renato Lamounier BARBIERI ◽  
Helbert Minuncio Pereira GOMES ◽  
Daren Athiê Boy RODRIGUES ◽  
Sarah do Valle STUDART ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Experimental Model ◽  
Primary Repair ◽  
Statistical Significance ◽  
Abdominal Cavity ◽  
Incisional Hernia Repair ◽  
Greater Omentum ◽  
Abdominal Wall Defects ◽  
Hernia Sac ◽  
Incisional Hernias

Background: Adhesions induced by biomaterials experimentally implanted in the abdominal cavity are basically studied by primary repair of different abdominal wall defects or by the correction of incisional hernias previously performed with no precise definition of the most appropriate model. Aim: To describe the adhesions which occur after the development of incisional hernias, before the prosthesis implantation, in an experimental model to study the changes induced by different meshes. Methods: Incisional hernias were performed in 10 rats with hernia orifices of standardized dimensions, obtained by the median incision of the abdominal wall and eversion of the defect edges. Ten days after the procedure adhesions of abdominal structures were found when hernias were repaired with different meshes. Results: The results showed hernia sac well defined in all rats ten days after the initial procedure. Adhesions of the greater omentum occurred in five animals of which two also showed adhesions of small bowel loops besides the omentum, and another two showed liver adhesions as well as the greater omentum, numbers with statistical significance by Student's t test (p<0.05). Conclusion: Although it reproduces the real clinical situation, the choice of experimental model of incisional hernia repair previously induced implies important adhesions, with possible repercussions in the evaluation of the second operation, when different implants of synthetic materials are used.

SP7.2.1 Simultaneous intestinal surgery does not increase complication or recurrence rates after complex abdominal wall reconstruction

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Alison Wallace ◽  
Jeffrey Garner
Keyword(s):  
Abdominal Wall ◽  
Operating Time ◽  
Abdominal Wall Reconstruction ◽  
Recurrent Hernia ◽  
Ileoanal Pouch ◽  
Intestinal Surgery ◽  
Recurrence Rates ◽  
Operative Outcomes ◽  
Significant Difference ◽  
Chi Squared

Abstract Aims To compare post-operative outcomes in patients undergoing elective complex abdominal wall reconstruction (CAWR) alone vs. CAWR plus simultaneous intestinal surgery. Methods All patients undergoing elective CAWR over a 10-year period in our unit were identified from a prospectively maintained database and divided into those who had concomitant intestinal surgery (resection, ileoanal-pouch formation, stoma reversal, etc) and those who did not. Simple adhesiolysis, cholecystectomy and gynaecological procedures were not classed as ‘intestinal surgery’. Differences between groups were determined using the paired-t test and the (n-1) Chi-squared test. Results 59 patients underwent elective CAWR, 16 with intestinal surgery and 43 without. The two groups had similar baseline demographics with no significant differences in age, BMI, sex or hernia size. The commonest post-operative complications were pneumonia (33.9%) and wound infections (25.4%) but there were no significant differences in any complication between groups. There was zero 30 and 90 day mortality in either group. The mean operating time in the intestinal group (IG) was significantly longer compared to the CAWR-only group (5.4 +/- 1.3hrs vs 4.1 +/- 1.8hrs, p = &lt;0.05). There was no statistically significant difference between groups in rates of surgical site occurrence (37.5% IG vs 55.81% CAWR-only), mesh infections (0% IG vs 6.98% CAWR-only) or recurrent hernia (6.24% IG vs 9.30% CAWR-only) over a median follow up of 3.0 (0.1-7.8) years. Conclusion Performing simultaneous intestinal surgery during complex abdominal wall repair is safe and does not increase the risk of recurrence or mesh infections in a specialist abdominal reconstruction unit.

Abdomen

2011 ◽  
pp. 56-92
Author(s):  
Dr Mark Harrison
Keyword(s):  
Gastrointestinal Tract ◽  
Abdominal Wall ◽  
Biliary Tract ◽  
Spermatic Cord ◽  
Abdominal Cavity ◽  
Inguinal Region ◽  
Posterior Abdominal Wall

4.1 Abdominal wall, 56 4.2 Inguinal region, 58 4.3 Testis, epididymis, and spermatic cord, 59 4.4 Topography of the abdominal cavity, 61 4.5 Peritoneum, 62 4.6 Gastrointestinal tract, 63 4.7 Liver and biliary tract, 71 4.8 Pancreas, 75 4.9 Spleen, 76 4.10 Posterior abdominal wall, ...

scholarly journals Comparison of T Tube Ileostomy and Bishop Koop Ileostomy for the Management of Uncomplicated Meconium Ileus

2017 ◽  
Vol 6 (3) ◽  
pp. 56 ◽  
Author(s):  
Md. Samiul Hasan ◽  
Ashrarur Rahman Mitul ◽  
Sabbir Karim ◽  
Kazi Md Noor-ul Ferdous ◽  
Kabirul Islam
Keyword(s):  
Operation Time ◽  
Oral Feeding ◽  
Meconium Ileus ◽  
Safe Procedure ◽  
Interventional Study ◽  
T Tube ◽  
Tube Removal ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Meconium ileus is a common cause of neonatal intestinal obstruction. Various surgical procedures are in practice for uncomplicated meconium ileus. Bishop Koop ileostomy allows distal passage of gut content and uses the distal absorptive area. T tube ileostomy avoids the need for gut resection and formal closure of stoma. The aim of this prospective interventional study was to compare the outcome of T-tube ileostomy and Bishop Koop ileostomy for the treatment of uncomplicated meconium ileus.Materials and methods: It was a prospective interventional study from January 2015 to December 2016. Patients were randomly assigned to the T-tube ileostomy group (group A) and Bishop Koop ileostomy group (group B). The patients were followed up for 6 weeks post-operatively. Surgical outcomes between the two groups were compared.Results: The age range of the patients was 1 to 7 days; majority of the patients were males. Mean operation time of group A (60.76±5.81 minutes) and group B (87.05±6.49 minutes) showed significant difference (p =0.0001). After operation, mean time to start bowel movements in group A (4.90±1.41days) and group B (6.53±2.58 days) showed significant difference (p= 0.020). Times to establish oral feeding, irrigation tube removal and postoperative complications showed no significant difference. All patients that survived in the group B required formal stoma closure, while in the group A stomas closed spontaneously. One patient in the group A had intraperitoneal leakage leading to mortality after second operation. Four patients had leakage in the group B; 2 of them died.Conclusions: T-tube ileostomy was found as an effective and safe procedure for the management of uncomplicated meconium ileus.

scholarly journals Blood Vessel Matrix Seeded with Cells: A Better Alternative for Abdominal Wall Reconstruction—A Long-Term Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Maciej Nowacki ◽  
Arkadiusz Jundziłł ◽  
Łukasz Nazarewski ◽  
Andrzej Kotela ◽  
Tomasz Kloskowski ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Abdominal Wall Reconstruction ◽  
Assessment Method ◽  
Group Iii ◽  
Long Term Study ◽  
Group I ◽  
Triton X ◽  
And Control

Purpose. The aim of this study was to present abdominal wall reconstruction using a porcine vascular graft seeded with MSC (mesenchymal stem cells) on rat model.Material and Methods. Abdominal wall defect was prepared in 21 Wistar rats. Acellular porcine-vascular grafts taken from aorta and prepared with Triton X were used. 14 aortic grafts were implanted in place, of which 7 grafts were seeded with rat MSC cells (Group I), and 7 were acellular grafts (Group II). As a control, 7 standard polypropylene meshes were used for defect augmentation (Group III). The assessment method was performed by HE and CD31 staining after 6 months. The mechanical properties have been investigated by Zwick&Roell Z0.5.Results. The strongest angiogenesis and lowest inflammatory response were observed in Group I. Average capillaries density was 2.75, 0.75, and 1.53 and inflammatory effect was 0.29, 1.39, and 2.72 for Groups I, II, and III, respectively. The means of mechanical properties were12.74±1.48,7.27±1.56, and14.4±3.7 N/cm in Groups I and II and control, respectively.Conclusions. Cell-seeded grafts have better mechanical properties than acellular grafts but worse than polypropylene mesh. Cells improved mechanical and physiological properties of decellularized natural scaffolds.

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