Abdominal Incision Site Research Articles

Bladder filling test, cystoscopy, or both for checking bladder perforation in tension-free-vaginal tape operations

Background/Aim: Tension-free-vaginal tape (TVT) has been widely used for treatment of stress urinary incontinence as a mid-urethral sling operation. Cystoscopy is routinely performed during tension-free-vaginal tape operations to check for bladder perforation or injury. This study aims to check the applicability and accuracy of the bladder filling test for predicting bladder perforation in tension-free-vaginal tape operations. Methods: Between 2015 and 2020, 285 women who had TVT operations were subject to evaluation. Out of 285 cases, 23 cases were suspected subjectively by the operating surgeons to have visible or occult bladder perforation during the TVT procedure. A routine cystoscopy was performed at the end of all operations. Additionally, before the routine cystoscopy, in cases suspected of a visible or occult bladder perforation, the bladder was filled with 500 ml saline or diluted methylene blue dye through a urinary catheter (bladder filling test) to check for occult bladder perforation that might not be visualized by cystoscopy. Any fluid leakage through the paraurethral dissected canals or from the abdominal incisions was observed for the possibility of bladder perforation. The accuracy of the bladder filling test was compared to cystoscopy to diagnose bladder perforation in suspected cases. In addition, all cases were followed up for three months to record any cases with late or occult bladder perforations missed in the diagnosis using cystoscopy or the bladder filling test perioperatively. Results: Out of 23 cases suspected subjectively by the operating surgeons to have visible or occult bladder perforation, 11 had visible bladder perforations (3.9%) confirmed by both cystoscopy and the bladder filling test. After the filling test, leakage at the abdominal incision site and/or para-urethral dissected canal was observed in all cases with bladder perforation. No leakage was observed in the remaining patients (n = 12) suspected of, but not diagnosed with bladder perforation by cystoscopy. The bladder filling test did confirm the same diagnosis revealed by cystoscopy in all suspected cases. Conclusion: The bladder filling test was found to be very sensitive in predicting bladder perforation at tension-free-vaginal tape operations compared to cystoscopy. This test can decrease the need for routine cystoscopy at tension-free-vaginal tape insertion, and cystoscopy can be limited to cases with leakage in the bladder filling test.

Lumboperitoneal Shunt Preference in Treatment of Patients with Normal Pressure Hydrocephalus

Objective: To demonstrate the advantages of Lumboperitoneal (LP) shunt surgery applied to patients with normal pressure hydrocephalus (NPH).Methods: Preoperative, intraoperative and postoperative data of 20 patients who underwent LP shunt surgery for NPH between 01/01/2012 and 07/04/2022 at the Neurosurgery Clinic of Ordu University Training and Research Hospital were analyzed. The demographic, clinical and laboratory data of the patients as well as their medical records were reviewed. Patients who underwent LP shunt with the diagnosis of normal pressure hydrocephalus in our clinic were screened retrospectively, and the success rates and complications after the surgical intervention applied to these patients were recorded.Results: Statistically significant improvements were recorded in Modified Ranking Scale Scores and Mini-Mental State Examination Scores at the end of the first year. The incidence of Gait Disturbance did not differ significantly by gender, The incidence of dementia did not differ significantly by gender, The incidence of urinary incontinence showed a significant change according to gender While all of the women diagnosed with normal pressure hydrocephalus had urinary incontinence in the preoperative period, this rate was seen in only 66.7% of the men. Gait disturbance improved in 80%, urinary incontinence in 60%, and cognitive functions in 60% of patients. No neurogenic complication developed in our operated patients. Wound infection occurred at the abdominal incision site in only two patients (10%). Subcutaneous hematoma occurred in the abdominal region in one patient (5%). Conclusion: LP shunt surgery has a lower complication rate than VP shunt surgery and is a more easily applicable surgical technique. LPS surgery is a safe and minimally invasive treatment method. It has lower complication rates compared to VPS . LPS surgery is an effective surgical technique. It can be used as an alternative to the VPS procedure in the treatment of NPH patients

Tumor recurrence in a previous abdominal incision site in a patient with endometrial adenocarcinoma: A case report

Endometrial cancer is frequently diagnosed at an early stage and exhibits a good prognosis. However, 10%–15% of tumors recur usually within 3 years. Common sites of recurrence are the vaginal vault and pelvis. Only a number of case reports exist for tumor recurrence in a previous incision site. We present a case of a 71-year-old Filipino woman, a diagnosed case of Endometrial Adenocarcinoma Stage III A, FIGO Grade 1, who underwent surgical management, chemotherapy, and radiation therapy 9 years prior, presenting with an abdominal mass at the inferior aspect of the previous surgical scar with the foul-smelling discharge of 1-year duration. Physical examination revealed a 6 cm × 4 cm, friable, movable, nontender abdominal mass, with associated edema of the mons pubis. Surgical resection showed that the mass was confined to the abdominal wall, with no extension beneath the fascia and no evidence of tumor in the pelvic and abdominal cavity. Histological examination revealed a moderately differentiated adenocarcinoma in the abdominal wall, confirming tumor recurrence in an atypical location, probably arising from the previous incision site.

Postoperative incisional cryoanalgesia for robotic hysterectomy

Objectives: Cryoanalgesia has the ability to reduce local inflammation by producing isolated vasoconstriction and decreasing nerve conduction velocity. This process could theoretically decrease nociception at incision sites for postoperative patients and reduce need for opioid pain medications. The objective of this study was to obtain and compare Visual Analog Pain Scores (VAS) for robotic hysterectomy patients in the first postoperative 24 hours with and without application of cryoanalgesia to abdominal incision sites.

Mystery or Mycobacterium? Lessons learned from a challenging incision site infection

An eight-month-old female domestic short hair cat underwent routine ovariohysterectomy and was adopted from a shelter nine days later. A refractory infection associated with the abdominal incision site proved unresponsive...

The clinical characteristics and surgical approach of scar endometriosis: A case series of 14 women.

Scar endometriosis, also referred to as abdominal wall endometriosis (AWE), is a rare form of endometriosis that usually develops in the scar after obstetric or gynecological surgeries, including cesarean section (CS). Recently, the occurrence of scar endometriosis has been increasing together with the increase of CS incidence. Scar endometriosis can be clinically misdiagnosed as hernia, lipoma, or hematoma. Here we retrospectively analyzed the clinical aspects of scar endometriosis and surgical approach in 14 patients from a tertiary hospital, who were treated by surgery, between 2012 and 2017. The mean age was 32.71 ± 8.61 years (range: 19-45). Palpable mass and cyclic pain at the scar site were the most common complaints. Twelve patients had previously undergone CS, and two patients had undergone a surgery of ovarian endometrioma. The preoperative diagnosis was determined with ultrasonography (US), magnetic resonance imaging (MRI), or computed tomography (CT). Preoperatively, scar endometriosis was diagnosed in 12/14 patients (85.7%), while 2 patients (14.3%) were diagnosed with inguinal hernia. The treatment was surgical excision in all patients; in addition, mesh repair surgery was performed in 1 patient with recurrent scar endometriosis. Postoperatively, endometriosis was confirmed by histology in all patients. The average size of endometriomas was 24.71 ± 6.67 mm (range: 11-35). No woman had concurrent pelvic endometriosis. In the follow-up period (mean: 9 months) the recurrence of endometriosis was not observed. Scar endometriosis should be considered in all women of reproductive age presenting with cyclic pain and swelling in their abdominal incision sites.

Septic peritonitis secondary to a perforating gastric foreign body in an Irish Sport Horse gelding

SummaryA 17‐year‐old Irish Sport Horse gelding was referred to the University College Dublin Veterinary Hospital for low‐grade colic that had been nonresponsive to medical treatment. Diagnostic investigation revealed a marked septic peritonitis. The inciting cause was detected by gastroscopy to be a perforating foreign body in the pylorus of the stomach from a briar of a blackthorn plant (Prunus spinosa spp.). Successful removal of the foreign body was achieved surgically via gastrotomy. The horse subsequently developed a multi‐drug resistant abdominal incision site infection, which was successfully managed over a 2‐month period. Abdominal incisional herniation occurred thereafter. Six months post‐operatively, the horse was back in light work and no further adverse sequelae had been noted.

Incisional hernia repair after caesarean section: a population-based study.

Incisional hernias occur at surgical abdominal incision sites, but the association with caesarean section (CS) has not been examined. To determine whether CS is a risk factor for incisional hernia repair. Population-based cohort study in Australia using linked birth and hospital data for women who gave birth from 2000 to 2011. Survival analysis was used to explore the association between CS and subsequent incisional hernia repair. Analyses were adjusted for confounding factors, including other abdominal surgery. The main outcome measure was surgical repair of an incisional hernia. Of 642,578 women, 217,555 (33.9%) had at least one CS and 1,554 (0.2%) women had a subsequent incisional hernia repair. The rate of incisional hernia repair in women who had ever had a caesarean section was 0.47%, compared to 0.12% in women who never had a caesarean section. After controlling for the duration of follow-up and known explanatory variables (eg other abdominal surgery, parity and multiple pregnancy), the adjusted hazard ratio (aHR) was 2.73 (95% confidence interval (CI) 2.45-3.06, P<0.001). Incisional hernia repair risk increased with number of caesarean sections: women with two CS had a threefold increased risk of incisional hernia repair, which increased to sixfold after five CS (aHR=6.29, 95% CI 3.99-9.93, P<0.001) compared to women with no CS. There was a strong association between maternal CS and subsequent incisional hernia repair, which increased as the number of CSs increased, but the absolute risk of incisional hernia repair was low.

Preoperative analgesia with local lidocaine infiltration for abdominal hysterectomy pain management

Objective To evaluate the impact of preemptive local analgesia at the incision site in reducing pain in women undergoing abdominal hysterectomy for a benign myomatous uterus. Study design In this prospective, randomized, double-blinded, placebo-controlled study, 20 mL of 1% lidocaine or 0.9% saline was injected at the abdominal incision site prior to the performance of the hysterectomy. Thirty-two women were enrolled in the study, 16 received preemptive analgesia while 14 were treated by placebo; 2 were excluded. All operations were performed under general anesthesia. The standard postoperative pain treatment consisted of oral analgesia with ibuprofen (400 mg) in liquid-filled capsules. Morphine (10 mg) was used for rescue analgesia. Pain intensity was self-evaluated with the use of a 100 mm visual analog scale. Results Compared to the placebo group, women who received preemptive analgesia with lidocaine 1% perceived a significant reduction in postoperative pain in the first hours after surgery (2 h: 50.1 ± 27.9 versus 70.6 ± 22.6, p = 0.043; 5 h: 42.5 ± 25.2 versus 64.6 ± 28.3, p = 0.043; 8 h: 31.2 ± 22.4 versus 53.3 ± 30.3, p = 0.031). Conclusion Preemptive analgesia with lidocaine 1% is a simple, cheap and efficient mode to reduce pain in the first hours after hysterectomy.

Efficacy of Seprafilm for reducing reoperative risk in pediatric surgical patients undergoing abdominal surgery

Background The safety and efficacy of Seprafilm (Genzyme Corporation, Cambridge, Mass) in adult surgery patients have been established. The aim of this study was to evaluate the safety and efficacy of Seprafilm in pediatric surgical patients. Methods One hundred twenty-two pediatric abdominal surgery patients were enrolled. Sixty-seven patients received Seprafilm application. Of these patients, 18 again received Seprafilm at abdominal closure during a second surgery, and of the 18, 4 received Seprafilm at closure after a third surgery. Of the 55 control patients who did not receive Seprafilm, 14 had a second surgery, and of these 14 patients, 4 had a third surgery. Adverse events, operation time, and blood loss were compared with assessed Seprafilm safety. Seprafilm efficacy evaluations included incidence and severity of adhesions in those patients who required relaparotomy. Results The incidence (Seprafilm, 40.9%; control, 82.4%) and severity (Seprafilm: 59.1%, grade 0; control: 17.6%, grade 0) of adhesions under the abdominal incision site were significantly reduced in the Seprafilm group ( P = .007 and P = .0009, respectively). In addition, mean relaparotomy operation time was significantly shorter for Seprafilm patients ( P = .004). At relaparotomy, blood loss/body weight ratio for Seprafilm patients compared with control patients showed a trend toward but did not reach significance ( P = .09). Conclusions Decreased incidence and severity of postsurgical adhesions with Seprafilm in pediatric patients may lead to reduction of the risks associated with subsequent operation.

True occult bladder perforation during placement of tension-free vaginal tape

Bladder perforation is one of the most common complications of the trans-vaginal tape (TVT) procedure, and is generally identified on routine intra-operative cystoscopy. We present a case of occult bladder perforation occurring during the TVT procedure that could not be identified by cystoscopy. A 57-year-old woman underwent TVT placement for treatment of stress urinary incontinence. A bladder perforation, suspected because of clear fluid at one of the abdominal incision sites, could not be identified with cystoscopy, but was confirmed with bladder installation of sterile infant formula. The tape was removed and the bladder was drained for 48 h. The patient's recovery was uneventful and she subsequently underwent TVT placement without complication. Cystoscopy alone may be inadequate for identification of some bladder perforations during the TVT procedure. Awareness of alternative methods of identification is essential.

8-Ply Small Intestinal Submucosa Tension-Free Sling:: Spectrum of Postoperative Inflammation

We report a series of postoperative inflammatory reactions of a tension-free pubourethral sling procedure using an 8-ply small intestinal submucosa (SIS) and review the literature regarding inflammatory reactions with this material in genitourinary reconstruction. Between August 2002 and June 2003, 6 of 10 patients treated for stress urinary incontinence with 8-ply SIS had postoperative inflammatory reactions. Patients underwent a thorough evaluation, including history, physical examination and urodynamic studies, before surgical intervention. All patients presented with induration and erythema at the abdominal incision site(s) and pain 10 to 39 days postoperatively. Pelvic examinations were negative. In 3 patients the inflammatory reaction resolved with minimal or no intervention. Incision and drainage of a sterile abscess were required in 1 patient. Despite 7 days of prophylactic postoperative antibiotics and anti-inflammatory drugs, 2 patients had delayed inflammatory reactions. One patient had resolution with conservative treatment, while the other had an abscess that spontaneously drained. With short-term followup (mean 7 months, range 4 to 10), 8 patients are dry, 1 is improved and 1 is incontinent. While the results with the 8-ply SIS tension-free sling in the short term are encouraging, the additional morbidity is alarming and caution is warranted. It is essential that patients be made aware of potential risks and possible delayed presentation of morbidity with the use of this material. The human to 8-ply SIS interaction needs further investigation to ensure that long-term safety and efficacy will not be jeopardized. Until then we will continue to use other sling materials.

Whirlpool therapy on postoperative pain and surgical wound healing: an exploration

Postoperatively, patients who have major abdominal surgery, experience pain because of increased tension on muscles and tissues at the abdominal incision site. Also, pain is due to trapped anesthesia gases in the intestines. These postoperative events can cause increased anxiety and stress resulting in poor pain management and altered tissue regeneration. An intervention, such as whirlpool therapy, can enhance relaxation and promote pain relief and normal wound healing. The purpose of this study was to examine the effects of whirlpool therapy on pain and surgical wound healing in adults having major abdominal surgery. Sixty-three subjects (43 female and 20 male), ages 25–60, participated in a quasi-experimental study of repeated measures of pain and surgical wound assessments over a 3-day period. Statistical tests for repeated measures revealed that the experimental group response to verbal pain was not significant. However, it did reveal that observable pain behaviors using the Pain Rating Scale (PRS) were significant for three consecutive days. Also, statistical tests for repeated measures of wound healing revealed less signs of surgical wound inflammation in the experimental group over a 3-day period. It was concluded that the intervention of whirlpool therapy promoted some degree of comfort and positive signs of wound healing.