Layers Of Abdominal Wall Research Articles

CT data analysis of catheter morphology and displacement in peritoneal dialysis: an exploratory study.

Catheter displacement is a common complication of peritoneal dialysis. The aim of this study was to explore the correlation between catheter morphology and displacement by analyzing CT data, providing a scientific basis for optimizing catheter morphology within abdominal wall layers. We retrospectively analyzed the clinical data of 94 patients. The parameters for analyzing catheter morphology were defined based on six key points identified from CT images. The covariates considered in the analysis included demographics, primary disease, body size, peritoneal dialysis method, and total weekly urea clearance index. During a mean follow-up period of 1056 ± 480 days, only the angle of the intramuscular part (IM angle) of the catheter significantly correlated with the time to first catheter displacement according to the multivariate analysis (hazard ratio [HR]: 1.039, 95% confidence interval [CI] 1.02-1.058, 0.01). When the cut-off value of IM angle was 39.4 , the area under receiver-operating characteristic (ROC) curve for predicting catheter displacement was 0.791 (95% CI 0.701-0.881, 0.01), with a sensitivity and specificity of 82.9% and 66.0%, respectively. Kaplan-Meier survival curves showed that the catheter survival rate was significantly higher in the group with an IM angle < 39.4 than in the group with an IM angle > 39.4 (log-rank =19.479, 0.01). None of the catheter morphology parameters were significantly correlated with technique survival in the multivariate analysis. There is a correlation between catheter morphology and catheter displacement. An IM angle > 39.4 is an independent risk factor for catheter displacement, while the position and angle of the subcutaneous part are not correlated with catheter displacement.

Multiple Cesarean Section Outcomes and Complications: A Retrospective Study in Jazan, Saudi Arabia.

Given the increase in the rate of cesarean sections (CSs) globally and in Saudi Arabia, this study was conducted to assess the maternal and perinatal complications after repeat cesarean sections in the studied population. This retrospective study was conducted by reviewing the records of all women who underwent CSs between January and July 2023 in three hospitals in the Jazan region of Saudi Arabia. Of the 268 women studied, 195 (72.7%) had a CS for the first or second time and 73 (27.3%) had two, three, or four previous CSs (repeat CS). The most common maternal intra-operative complications reported by the repeat CS group were intra-peritoneal adhesions (7.5%) and fused abdominal layers (7.1%) while the most common postoperative complications were the need for blood transfusion (22%) and UTIs (3%). The most common neonatal complications were a low Apgar score (19%), needing neonatal resuscitation (2.6%), and intensive care admission. In addition, 3.7% of mothers failed to initiate breastfeeding in the first 24 h. The frequent complications were intra-peritoneal adhesions, fused abdominal wall layers, blood transfusion, and postoperative infections which were overcome by the optimal hospital care. However, the frequent neonatal complications were a low Apgar score, needing neonatal resuscitation, and intensive care admission.

Development of a deep learning model for safe direct optical trocar insertion in minimally invasive surgery: an innovative method to prevent trocar injuries.

Direct optical trocar insertion is a common procedure in laparoscopic minimally invasive surgery. However, misinterpretations of the abdominal wall anatomy can lead to severe complications. Artificial intelligence has shown promise in surgical endoscopy, particularly in the employment of deep learning models for anatomical landmark identification. This study aimed to integrate a deep learning model with an alarm system algorithm for the precise detection of abdominal wall layers during trocar placement. Annotated bounding boxes and assigned classes were based on the six layers of the abdominal wall: subcutaneous, anterior rectus sheath, rectus muscle, posterior rectus sheath, peritoneum, and abdominal cavity. The cutting-edge YOLOv8 model was combined with a deep learning detector to train the dataset. The model was trained on still images and inferenced on laparoscopic videos to ensure real-time detection in the operating room. The alarm system was activated upon recognizing the peritoneum and abdominal cavity layers. We assessed the model's performance using mean average precision (mAP), precision, and recall metrics. A total of 3600 images were captured from 89 laparoscopic video cases. The proposed model was trained on 3000 images, validated with a set of 200 images, and tested on a separate set of 400 images. The results from the test set were 95.8% mAP, 89.8% precision, and 91.7% recall. The alarm system was validated and accepted by experienced surgeons at our institute. We demonstrated that deep learning has the potential to assist surgeons during direct optical trocar insertion. During trocar insertion, the proposed model promptly detects precise landmark references in real-time. The integration of this model with the alarm system enables timely reminders for surgeons to tilt the scope accordingly. Consequently, the implementation of the framework provides the potential to mitigate complications associated with direct optical trocar placement, thereby enhancing surgical safety and outcomes.

Surgical correction of omphalocele in local goat breed (Beetal) of Jhang, Punjab: A case study

Omphalocele is a rare congenital condition where closure defects in the abdominal wall at the umbilical ring lead to the protrusion of intestinal or other visceral organs, covered by a thin epithelial layer. The developmental mechanism of this condition is not fully understood, and various theories have been proposed to explain it. This study presents a case of omphalocele in a newborn female black goat kid, detailing its clinical presentation, surgical management, and postoperative care. The surgical procedure involved meticulous preparation of the surgical site, administration of local anesthesia, and careful repositioning of the intestines, liver, and a portion of the spleen. Excess skin and the amnion membrane were removed to facilitate safe repositioning, and the umbilical ring was excised to widen the opening. The abdominal wall layers were meticulously closed using appropriate suture materials. The kid’s postoperative recovery was uneventful, with normal vital signs, fecal passage, and feeding behavior observed. The study discusses omphalocele in comparison to other abdominal abnormalities and explores potential developmental mechanisms. The authors emphasize the importance of immediate surgical intervention despite varying prognoses associated with this condition. The study underscores the significance of surgical treatment for omphalocele cases in newborn goat kids, providing hope for affected animals and valuable insights for veterinary professionals. Although the exact prevalence of omphalocele remains uncertain due to unreported cases, this report demonstrates successful surgical correction and the potential for curing the condition if diagnosed and treated promptly. Further research is needed to fully understand the genetic and environmental factors contributing to omphalocele and its impact on livestock.

Efficacy of Local Anesthetic in Post-Operative Laparoscopic Cholecystectomy

Background: Pain management is medically pertinent for optimal care in surgical patients. Although development and advancement in understanding of the pathophysiology of pain, analgesic's pharmacology and the development of better effective techniques for postoperative pain control, patients still continue to experience considerable discomfort. Objectives: To compare the efficacy (in terms of pain) of local anesthetic in postoperative laparoscopic cholecystectomy compared to control group. Methods: A total of 60 patients undergoing laparoscopic cholecystectomy and of age 20-50 year were included. Group A included the cases in which at the end of laparoscopic surgery, prior to port withdrawal, a local anesthetic mixture, a short acting (Lidocaine 2%) plus a long acting (Bupivacaine 0.5%) was instilled through the port lumen between the abdominal wall layers while group B included the cases in which conventional analgesics (narcotics and NSAID) was given post - operatively. All the patients were assessed by the researcher himself up to 12 hours post-operatively and efficacy was noted by Visual Analogue Scale (VAS). This study was conducted in Department of surgery Quaid e Azam Medical College Bahawalpur. Duration of study was 1 year from August, 2018 to August, 2019. Results: Efficacy in control of pain of Group A (local anesthetic) was seen in 22(73.33%) while in Group B (control group) was seen in07 (23.33%) patients as shown in Table VI (p- value = 0.0001). Conclusion: The study concluded that the efficacy of local anesthetic in postoperative laparoscopic cholecystectomy is better as compared to control group.

OC-091 PREVENTION OF PARASTOMAL HERNIAS WITH 3D FUNNEL MESHES IN INTRAPERITONEAL ONLAY POSITION

Abstract Introduction In patients with permanently intended terminal ostomies, parastomal hernias (PSHs) occur on a frequent basis. Various strategies have been evaluated, but there is still a lack of evidence with regard to the best surgical technique for PSH- prevention Methods We conducted a retrospective analysis of prospectively collected data of 98 patients, who underwent elective permanent ostomy formation between 2009 and 2019 by means of prophylactic implantation of a specially designed three-dimensional funnel mesh in intraperitoneal onlay position. Results PSH developed in five (5.1%) of 92 patients available for follow-up (88 by CT-scan). No mesh-related complications were encountered and none of the implants had to be removed. Ostomy-related complications had to be noted in eight (8.2%) cases. Follow-up time was a median 38 (range 12–60) months. Conclusion The prophylactical implantation of a funnel mesh implant in IPOM technique during initial formation of a terminal enterostomy is safe, highly efficient and comparatively easy to perform. As opposed to what can be achieved with purely keyhole meshes regardless of their position in relation to the abdominal wall layers, the inner boundary areas of the ostomy itself can be well covered and protected from the surging viscera with the 3D design and there is no weak point at the lateral edge of the stoma as is typical for the sugarbaker access. A further improvement could be achieved by lengthening the tunnel by the manufacturer in order to counteract the shrinkage of the implant.

Impact of combined component separation technique and shoelace repair on big medline abdominal wall defect

BackgroundClosure of large anterior abdominal wall defects, regardless of their etiology, is challenging. There is no standardized information describing definitive management. Therefore, we conducted this study to illustrate our experience on large midline abdominal wall defect repair using an effective modified reconstructive technique. MethodsThis retrospective study was conducted at Al Naqib Hospital in Aden/Yemen between 2012 and 2019. Twenty-six patients with large midline abdominal wall defects of various etiologies underwent surgical repair using a combination of shoelace repair and the component separation technique. The procedure involved bilateral longitudinal division of the anterior rectus sheet and creation of a posterior layer by approximation of the medial edges of the divided rectus sheet (shoelace abdominoplasty) and anterior external oblique muscle aponeurosis separation (component separation technique) to approximate the lateral edges of the divided rectus sheet and move the rectus muscles toward the midline for constructing the anterior abdominal wall layer. The posterior and anterior layers and bilateral separated sheets were covered with a polypropylene mesh in all patients, except in those who underwent emergency damage control surgery. ResultsFour, one, and two patients developed seroma, skin necrosis and chronic pain, and post-surgical wound infection, respectively. No recurrent herniation was recorded during the median follow-up of 5 years. ConclusionThis technique is effective in restoring the integrity of the abdominal wall in large midline abdominal wall defects and has an acceptable aesthetic appearance. In our study, minimal complications were reported, and no cases of recurrent hernias were diagnosed during follow-up.

The first robotic STORRM: A case report

Abstract Parastomal hernias present a continued challenge to the general surgeon. There are a myriad of techniques available, with hernia recurrence rates varying between 10 to greater than 50%. Mesh reinforcement and underlay or sublay placement are associated with lower hernia recurrence rates. Many patients with parastomal hernia have associated comorbidities which increase their risk for perioperative wound complications. Robotic and minimally invasive techniques offer decreased rate of wound complications, but can be challenging to perform if the stoma needs to be relocated. For patients with complex parastomal hernias requiring abdominal wall reconstruction with transversus abdominis release and retromuscular mesh placement, it can be difficult to align the layers of the abdominal wall and create an aperture in the mesh to allow for a straight passage of the conduit and prevent subsequent angulation of the bowel. Stapled Transabdominal Ostomy Reinforcement with retromuscular mesh, or STORRM technique, has been previously described elsewhere as a technique whereby a circular EEA (End-to-End Anastomoses) stapler is used to create a straight tunnel through the mesh and abdominal wall layers, standardize sizing, fixate the mesh, and substitute traditional cruciate incisions with a stapled reinforcement of the aperture in the mesh/tissues.

OGBN V07 Laparoscopic repair of rare case of interparietal port-site incisional hernia with mesh in sub-lay; pre-peritoneal space

Abstract Background Interparietal hernias are defined as protrusions of intraabdominal contents within the layers of the abdominal wall. Primary interparietal hernias; like Spigelian's hernia are rare, 0.12% to 2% of all abdominal wall hernias. Recently, interparietal hernias are more encountered as incisional hernias. However, very few cases have been reported in literature of interparietal hernia at port site following laparoscopic surgery, keeping in mind that port site hernias incidence varies between 0.74% to 1.47% after laparoscopic surgical procedures. Here we are presenting a rare case of interparietal port site incisional hernia, its management and summarising the key steps for laparoscopic mesh in sub-lay (pre-peritoneal) plane with defect closure. Methods We present a case of 72-year-old gentleman, who had robotic prostatectomy in January 2020. He presented towards the end of that year with left lower abdominal ache and discomfort. On examination he had bout 2 cm palpable hernia in LLQ at the site of 11 mm port. CT scan confirms the hernia at port site where internal muscles had been damaged, but external oblique muscle remains intact. Hernia MDT discussion advised conservative management, given low probability of incarceration given the current hernia anatomy, and advised surgical intervention if hernia affecting daily activity and lifestyle. Clinical review after one year, patient describes more discomfort as dull pain that increases with his usual activity like gardening, walking or running, necessitating increasing analgesia for 2,3. The patient believes that this hernia is affecting his life. Repeat scan showed muscular defect within the left iliac fossa, between the left rectus abdominis medially and retracted transversus abdominis and internal oblique muscles laterally. The external oblique muscle and facia along with anterior rectus sheath are intact. After further discussion with patient regarding risks vs benefits, patient opted for surgical treatment with laparoscopic approach Results Patient in supine position. Pneumoperitoneum created using Veress needle at Palmer's point, 11mm optical-port in the right lumbar area. Laparoscopy confirmed bulging at the pre marked site of the hernia, another 2×5 mm ports. Bulging identified at hernia site. Anterior parietal peritoneum incised vertically along the midline and dissection carried out laterally to develop the pre-peritoneal space. Defect exposed and assessed. There was a horizontal rupture of the arcuate ligament across the posterior rectus sheath exposing a section of inferior epigastric vessels and rectus muscle. This rupture extends laterally to involve the transverse abdominus and internal obliques muscle total size defect of 6×3 cm. Defect closed with 1.0-Ehtilon that was introduced using Endo Close leaving the free end outside. The defect was closed continuously in two layers then the end was extracted and tied to free end trans-fascially under low abdominal pressure at the end of procedure. 20.3×15.2 Ventralight ST Mesh placed in the pre peritoneal plane after marking the centre with one 2.0-Prolene stitch that was used to anchor the mesh. Mesh was only fixed medially using AbsorbaTack to avoid post operative pain. Then the peritoneum was closed in the midline, covering the mesh using AbsorbaTack. Conclusions Interparietal hernias usually present with discomfort, pain or acutely due to incarceration or strangulation. Very little is reported regarding the presentation of interparietal port site hernia as few are reported in literature. This abstract describes a rare interparietal port site incisional hernia that is presented with pain and discomfort, affecting lifestyle. Furthermore, we describe an approach to repair the hernia without disturbing the intact anterior fascia, utilizing a combination of defect closure and synthetic prothesis placed in the pre peritoneal space, thus minimising the chance of future mesh complication. This case highlights not only the importance of closing port site more than 11 mm but more importantly the need to make sure that all abdominal wall layers are included to avoid interparietal hernia at port site.

НОВЫЙ МЕТОД ПЛАСТИКИ ПОСЛЕОПЕРАЦИОННЫХ ВЕНТРАЛЬНЫХ ГРЫЖ: СРАВНИТЕЛЬНОЕ ЭКСПЕРИМЕНТАЛЬНОЕ ИССЛЕДОВАНИЕ

The problem of incisional hernia has become widespread due to the increase in the amount of laparotomies in abdominal surgery. After laparotomy in 4-11% cases incisional hernias occurred, which makes the problem one of the most important in abdominal and plastic surgery. The research aim is to experimentally evaluate and compare the absolute strength, increase in strength and reaching tensile strength of abdominal wall tissues after surgical treatment of incisional hernia with two different methods: Sapezhko and modified Sapezhko, the latter involving placing the mesh in the double abdominal layer. Material and methods. At the first stage of the study, incisional hernia was modeled in 36 rats. Consequently, the animals were divided into two groups. The main group consisted of 18 rats and underwent the Sapezhko surgical treatment of incisional hernia. The control group of 18 remaining rats underwent modified Sapezhko surgical treatment. On days 10, 14 and 16 the animals were taken out of the experiment. Strength of native abdominal walls of 6 rats were examined. The strength of the parts of abdominal walls was measured on the universal testing machine. Results. The findings indicate that polypropylene mesh placed in the double layer of the abdominal wall induces tighter scar formation in comparison with scars in the double layer of abdominal wall without mesh. Conclusions. The results of experimental research show that newly developed method have statistically significant advantages on the absolute strength, increase in strength and reaching tensile of strength of abdominal wall tissues.

421P Ghost stoma – solving the dilemma of diversion after anterior resection: A single centre experience from India

Anastomotic leak is one of the most dreaded complication after anterior resection(AR) with leak rates ranging from 3 - 20 %. To avoid such leaks, many surgeons routinely perform diversion stoma after AR. However, stomas are associated with their own set of complications leading to decreased quality of life. Thus, to do prophylactic stoma or not is a matter of constant dilemma that most surgeons face. Ghost Stoma is a technique where in unnecessary prophylactic stoma can be avoided while ensuring that a diversion stoma can be created if need arises without the need of general anaesthesia. Surgical Technique: Ghost Stoma techniques done by pulling a loop of intestine up to parietal peritoneal layer of anterior abdominal wall with the help of silicone/ plastic tube at the time of anterior resection. If an anastomotic leak is detected in postoperative period, same loop of bowel can be pulled out and fashioned into stoma under local anaesthesia. Study Design: A retrospective analysis of all the cases who underwent this procedure between January 2015 to December 2019 was done. Total 68 patients underwent AR with ghost stoma at our institute during specified time period. Total 7 patients required creation of functional stoma post-operatively for suspected or confirmed leak and was done under local anesthesia in all patients. One patient had congestion of stoma due to rotation of mesentery and required refashioning of stoma under regional anesthesia. Rest of the patients had the plastic tube removed at around 2 weeks. However, none of the patients required re-laparotomy or peritoneal wash under general anaesthesia. None of the patients had any complication due to plastic tube like bowel rotation, obstruction, strangulation, adhesion, stricture or tube migration. Ghost Stoma is a very simple & safe procedure which can decrease the need of prophylactic diversion stoma in most cases of AR. It is technically easy, oncologically safe, decreases intraoperative time & also prevents patient from morbidity as well as psychological and financial burden of stoma. Using this technique unnecessary stoma could be avoided in >80 % patients of AR in this series.

The effects of age and sex on the elastic mechanical properties of human abdominal fascia

BackgroundThe abdominal hernias become more prevalent with age, that can adversely affect life quality. The mechanical properties of abdominal wall layers are supposed to play a significant role in developing of an abdominal hernia.The objective of this study was to determine the mechanical properties of the human abdominal layer – fascia and the effects of age and sex on it for choosing the proper brand of hernia mesh. Methods78 samples harvested from 19 fresh cadavers were subjected to uniaxial tension tests and divided into four groups according to age. Group A corresponds to age up to 60 years, Group B to age 61–70 years, Group C to age 71–80 years and Group D to 81–90 years. Median stress–stretch ratio curves with respect to age, sex and direction of loading were obtained. Median values of the maximum tensile stress, stretch at maximum stress and elastic modulus calculated at 5% strain were determined. FindingsThe abdominal fascia showed large variations between specimens depending on age and sex. The stiffness of the fascia increased with age. There is statistically significant differences between the median curves of male samples (P = 0.008) and female samples (P = 0.019) according to age in the L direction. Statistically significant differences between the values of maximum stress (P = 0.01) and elastic modulus (P = 0.003) from Group C in the L direction and maximum stress (P = 0.03) from Group D in the T direction was established. InterpretationThe female samples are stiffer than male samples especially after 80 years.

Transversus Abdominis Release Versus Anterior Component Separation in Ventral Abdominal Hernia - A Prospective Comparative Study

Ventral abdominal hernia (VAH) repair is considered a surgical challenge especially hernias with large defect size and loss of domain (1-3). The incidence of recurrence after VAH repair ranges from 18.1% in primary VAH to 30.6% in secondary VAH (incisional hernia) (4). The principle of any hernia repair is to achieve a tension free repair with re-enforcement by mesh to decrease the incidence of recurrence (5). Many techniques had been studied and evaluated to address the problem of complex VAH with large defects and loss domain (1,6). In 1973, Rives et al. described their technique of retro rectus space dissection for incisional hernia (IH) repair allowing medial mobilization of myofascial flap and sub-lay mesh insertion (7, 8). But this technique has limitation in cases of large VAH as it doesn’t allow major myofascial advancement due to lateral limitation of linea semilunaris (LS) (9). In 1990, Ramirez et al. at described their technique of open anterior component separation (ACS) (10). In this technique, the external oblique aponeurosis is separated from internal oblique lateral to LS to achieve more medial mobilization of myofascial flap (9). ACS was successfully utilized in cases of large VAH, but the technique had its drawbacks. ACS was found to be associated with high rates of wound complications (seroma, wound infection, and flap necrosis) due to excess subcutaneous dissection with the possibility of lateral abdominal wall hernia at area of external oblique incision. The recurrence rate after ACS ranges from 9-18% (4). In 2012, Novitsky et al. were the first to describe the technique of posterior component separation and transversus abdominis release (PCS-TAR). The technique involved retro rectus space dissection reaching the LS, then an incision is made at posterior rectus sheath to access the space between internal oblique and transversus abdominis muscles. Dissection is carried on in this space until reaching psoas muscle laterally. This technique has the advantage of allowing maximum medial myofascial mobilization without major subcutaneous dissection. In addition, the technique allows for sub-lay mesh placement (11). All these different component separation techniques aim to reestablish a functional abdominal wall through autologous tissue repair by separating between myofascial layers of anterior abdominal wall (AAW). This allows medial mobilization of myofascial flap to obliterate large size defects (12-14). Due to the relative novelty of these techniques, a knowledge gap still persists regarding which CS technique is suitable to different types of VAH. The aim of our study is to compare the outcomes of TAR with ACS as regard short term postoperative complication and recurrence rate.

BURST ABDOMEN: RELATED FACTORS AND POST-OPERATIVE CHALLENGE FOR SURGEONS

ABSTRACT Background: Burst abdomen is a post-operative dehiscence of the layers of abdominal wall including peritoneum with exposure of the intestines and is one of the most frustrating and difficult. Type of incision vertical or transverse, nature of surgery elective or emergency and postoperative complications affect the outcome of Laparotomy. Objective: To find and evaluate effective management of abdominal wound dehiscence in elective and emergency Laparotomy and how to prevent and overcome its complications. This post-operative complication encountered by surgeon is always a challenge. The main concern is because of risk of evisceration and need to intervene and there is always a possibility of recurrence of dehiscence. Patients and Methods: Our study was conducted in 310 patients who had undergone exploratory laparotomy at Punjab Institute of Medical Sciences, Jalandhar, Punjab, India . Out of 310 patients, 170 patients underwent emergency laparotomy and 140 were elective cases. They were managed either by midline vertical incision or transverse incision and outcome of results were analyzed for wound dehiscence. Result: Most significant variation associated with wound dehiscence was with hypoproteinemia, anemia, chronic cough and emergency procedures. Pre-operative and post-operative etiological factors such as chronic cough, anemia, hypoproteinemia, diabetes, obesity, use of Steroids, wound infection, abdominal distension, bowel leaks, electrolyte imbalances are significantly responsible for the outcome of patients. Moreover, the hospital stay was too long in burst abdomen and this adds to the economic burden on patient. 3 patients developed incisional hernia which was managed after 6-8 months by Mesh Hernioplasty. Conclusion: Midline Vertical incision is always the reason of choice in condition where quick access to intra-abdominal entry is required but transverse incision is a good access to intra-abdominal approach and the incidence of burst abdomen is less. Proper single or mass closure technique should be adopted and every effort should be made to minimize both pre-operative and post-operative risk factors.

Assessment of Anterior Abdominal Wall Layers Thickness under the influence of Age and Sex, Using Computed Tomography Imaging in Ibn-Sina Hospital, Khartoum, Sudan 2021

Background: The anterior abdominal wall is made up of skin, superficial fascia, deep fascia, muscles, extraperitoneal fascia, and parietal peritoneum. The radiological assessment of muscle and fat properties is fundamental in muscle diseases and obesity. A few studies in particular measured the thickness of anterior abdominal wall muscles and fatty layer.

Surgical Anatomy of Anterior Abdominal Wall: Know before you Incise

Incision and closure of the abdominal wall is among the most frequently performed surgical procedures. Anteriorabdominal wall is the first structure which a surgeon encounters in any abdominal surgery. Both in open surgeryand laparoscopic surgery, correct knowledge of layered structure of the anterior abdominal wall is a must to enterthe abdominal wall with maximum efficacy and safety. Hence knowledge of all structures which one encounterson entering abdominal wall layer by layer is essential for surgeon. Here we discuss in detail about anatomy ofabdominal wall and different types of incisions.

Shear wave elastography biases in abdominal wall layers characterization

Ventral incisional hernia repair is one of the most common surgical procedures. The characterization of the abdominal wall layer mechanical properties is the first step towards personalized treatment. This study investigates the capability of elastography to assess these properties using an in vivo and in vitro model of abdominal wall layers. Two experiment approaches are considered: shear wave elastography imaging and guided wave dispersion characterization, where the latter is used as a reference. Results show measurement biases in the shear wave elastography approach in such a layer structure configuration. Methods to overcome these biases are suggested to improve and to correct the elastography approach for abdominal wall layers and similar anatomical structures.

Robotic hernia repairII. English version : Robotic primary ventral and incisional hernia repair (rv‑TAPP and r‑Rives or r‑TARUP). Video report and results of aseries of 118patients.

Endoscopic management of umbilical and incisional hernias has adapted to the limitations of conventional laparoscopic instruments over the past 30 years. This includes the development of meshes for intraperitoneal placement (intraperitoneal onlay mesh, IPOM), with antiadhesive coatings; however, adhesions do occur in a significant proportion of these patients. Minimally invasive procedures result in fewer perioperative complications, but with a slightly higher recurrence rate. With the ergonomic resources of robotics, which offers angled instruments, it is now possible to implant meshes in a minimally invasively manner in different abdominal wall layers while achieving morphologic and functional reconstruction of the abdominal wall. This video article presents the treatment of ventral and incisional hernias with mesh implantation into the preperitoneal space (robot-assisted transabdominal preperitoneal ventral hernia repair, r‑ventral TAPP) as well as into the retrorectus space (r-Rives and robotic transabdominal retromuscular umbilical prosthetic repair, r‑TARUP, respectively). The results of a cohort study of 118 consecutive patients are presented and discussed with regard to the added value of the robotic technique in extraperitoneal mesh implantation and in the training of residents.Video onlineThe online version of this article (10.1007/s00104-021-01479-6) includes three videos and a fact sheet/OP checklist (Supplement Material 1).

The postpartum abdomen: psychology, surgery and quality of life.

The postpartum abdomen presents significant challenges to the surgeon. It is anatomically complex, with often substantial symptomatic divarication of the rectus abdominis, affecting all anterior abdominal wall layers. This may lead to profound functional sequelae, and often, of more importance to patients, a significant physical deformity. The complex interplay of functional/physical symptoms can result in reduced quality of life (QoL) as well as negative body image/self-esteem. Postpartum women may seek abdominoplasty to address the whole scope of these concerns. Whilst techniques have evolved achieving such goals operatively, the impact of such surgery on QoL/mental health has yet to be established. We perform a comprehensive review of potential options of validated patient-reported outcome measures (PROMs) for consideration of use in postpartum women seeking abdominoplasty; in addition to discussing current driving factors for seeking surgery and associated ethics. Pressure on postpartum women to return their abdominal wall contour to a pre-pregnant state is high. This poses important ethical considerations for surgeons. There are several well-established/validated PROMs used in body contouring in massive weight loss/bariatric population groups, including Body-Q and Body-QoL scales, but none yet specific to postpartum women. PROMs use to enable establishment of the true value of abdominoplasty in postpartum women, not just in terms of functional/physical restoration, but also in terms of delivering a positive impact on patients' mental health and QoL, are important. Further research is needed to determine if those already developed are appropriate or whether a postpartum-specific PROM would be beneficial.

Robotic hernia repair : Part II: Robotic primary ventral and incisional hernia repair (rv-TAPP and r-Rives or r-TARUP). Video report and results of a series of 118 patients

Die endoskopische Versorgung von Umbilikal- und Inzisionalhernien hat sich in den vergangenen 30 Jahren an die Limitationen der konventionellen laparoskopischen Instrumente angepasst. Dazu gehört die Entwicklung von Netzen für die intraperitoneale Lage (intraperitoneales Onlay-Mesh, IPOM) mit antiadhäsiven Beschichtungen; allerdings kommt es bei einem beträchtlichen Teil dieser Patienten doch zu Adhäsionen. Minimal-invasive Verfahren führen zu weniger perioperativen Komplikationen, bei einer etwas höheren Rezidivrate. Mit den ergonomischen Ressourcen der Robotik, die abgewinkelte Instrumente anbietet, besteht erstmals die Möglichkeit, Netze minimal-invasiv in unterschiedliche Bauchdeckenschichten zu implantieren und gleichzeitig eine morphologische und funktionelle Rekonstruktion der Bauchdecke zu erreichen. In diesem Videobeitrag wird die Versorgung von Ventral- und Inzisionalhernien mit Netzimplantation in den präperitonealen Raum (robotische ventrale transabdominelle präperitoneale Patchplastik, rv-TAPP) sowie in den retrorektalen Raum (r-Rives bzw. robotische transabdominelle retromuskuläre umbilikale Patchplastik [r-TARUP]) präsentiert. Es werden die Ergebnisse einer Kohortenstudie an 118 konsekutiven Patienten vorgestellt und im Hinblick auf den Mehrwert der robotischen Technik in der Extraperitonealisierung der Netze und in der Weiterbildung diskutiert.Video onlineDie Onlineversion dieses Beitrags (10.1007/s00104-021-01450-5) enthält drei Videos und ein Merkblatt/OP-Check-Liste (Supplement Material 1).