Abdominal Wall Mobility Research Articles

Association of Cough Peak Flow with Chest and Abdominal Wall Mobility in Older Adults

Association of Cough Peak Flow with Chest and Abdominal Wall Mobility in Older Adults

Relationship of Cough Strength to Respiratory Function, Physical Performance, and Physical Activity in Older Adults.

Age- and lifestyle-related changes in respiratory and physical function affect cough strength. However, in older adults, the main factors that relate to cough strength remain unclear. This study was a preliminary investigation of factors that contribute to cough strength and the relationships between cough strength and respiratory function, physical performance, physical activity, and sedentary behavior in community-dwelling older adults. By using accelerometers and other tools, we assessed cough peak flow (CPF), FVC, maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax), chest and abdominal wall mobility (breathing movement scale), physical performance (Timed Up and Go test and 30-s chair stand test), physical activity (steps, and locomotive and non-locomotive moderate-to-vigorous physical activity), and sedentary behavior (sedentary time) in 65 community-dwelling older adults (25 males and 40 females) without air-flow limitation. Twenty-six percent of the subjects (17/65) had reduced CPF (<240 L/min). The subjects with reduced CPF had significantly lower FVC, PImax, PEmax, chest and abdominal wall mobility, physical performance, and locomotive moderate-to-vigorous physical activity compared with those with non-reduced CPF. Significant correlations between CPF and variables of respiratory function (FVC, PImax, PEmax, and breathing movement scale) and physical performance were weak to moderate. FVC and PImax were independently associated with CPF during the multiple regression analysis adjusted for sex, age, and height. The receiver operating characteristic analysis showed that FVC and PImax had fair-to-good sensitivity for detecting reduced CPF. Analysis of our results indicated that FVC and PImax were related to CPF and provided preliminary evidence that supported strategies for preserving and improving cough strength in community-dwelling older adults.

Effect of chest and abdominal wall mobility and respiratory muscle strength on forced vital capacity in older adults

This study investigated by sex the effect of chest and abdominal wall mobility and respiratory muscle strength on forced vital capacity (FVC) in older adults. FVC, respiratory muscle strength, and chest and abdominal wall mobility were assessed in 154 community-dwelling older adults. As an index of the chest and abdominal wall mobility, chest (upper and lower chest) and total (upper chest, lower chest, and abdomen) scale values were measured using the breathing movement scale. Subjects with a restrictive spirometric pattern showed significantly lower chest and total scale values in both sexes, maximal inspiratory strength in women, and maximal expiratory strength in men. Chest and total scale values were significantly associated with FVC in the multiple regression analysis. The receiver operating characteristic analysis showed fair to good specificity of chest and total scale values for detecting a restrictive spirometric pattern. The results show that chest and abdominal wall mobility is closely associated with FVC in community-dwelling older adults without airflow limitation.

Reduced Chest and Abdominal Wall Mobility and Their Relationship to Lung Function, Respiratory Muscle Strength, and Exercise Tolerance in Subjects With COPD.

Advanced air-flow limitation in patients with COPD leads to a reduction in vital capacity, respiratory muscle strength, and exercise capacity. However, its impact on chest and abdominal wall mobility is unknown. This study aimed to ascertain the prevalence of patients with COPD with reduced chest and abdominal wall mobility and to investigate the effect of reduced chest and abdominal wall mobility on pulmonary function, respiratory muscle strength, and exercise capacity. In 51 elderly male subjects with COPD, chest and abdominal wall mobility, FVC, FEV1, FEV1/FVC, maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), and the 6-min walk distance (6MWD) were assessed. Chest and abdominal wall mobility were measured using the breathing movement scale (0-8) at the 3 regions (upper chest, lower chest, and abdomen). Reduced mobility was defined as a value lower than the lower limit of the normal scale. The unpaired t test, Mann-Whitney test, and multiple regression analysis were performed. The percentages of subjects with reduced mobility were 78% for the upper chest, 76% for the lower chest, and 53% for the abdomen. The subjects with reduced mobility had significantly low FVC, FEV1, and 6MWD in each region and significantly low FEV1/FVC, PImax, and PEmax in the abdominal region compared with those with nonreduced mobility. FVC and 6MWD were independently associated with the scale values in each region and with the abdominal scale value, respectively. The majority of subjects with COPD had reduced chest and abdominal wall mobility, which was independently associated with FVC. Even though abdominal wall mobility was relatively preserved compared with chest wall mobility, it was also independently associated with 6MWD.

Needlescopic Surgery Versus Single-port Laparoscopy for Inguinal Hernia.

Background and Objectives:In recent years, 2 modifications of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair—needlescopic (nTAPP) surgery and single-port (sTAPP) surgery—have greatly improved patient outcomes over traditional approaches. For a comparison of these 2 modifications, we sought to investigate and compare the extent of surgical trauma and postoperative consequences for the abdominal wall in these two procedures.Methods:In a retrospective study, 50 nTAPP and 35 sTAPP procedures occurring at a community hospital from November 1, 2009, through July 31, 2012 were reviewed. Intraoperative data, including length of the umbilical skin incision and operative time, were recorded. A follow-up evaluation included investigation of hernia recurrence, postoperative pain, abdominal wall mobility, cosmetic satisfaction, and period of sick leave.Results:The mean umbilical skin incision was 13 ± 4 mm in nTAPP vs 27 ± 3 mm in sTAPP (P < .001). The nTAPP procedure required less operating time than the sTAPP procedure (54.8 ± 16.9 minutes vs 85.9 ± 19.7 minutes; P < .001). The mean immediate postoperative pain score on the visual analog scale was 2.7 ± 2.1 in the nTAPP group and 4.4 ± 1.9 in the sTAPP group (P = .016). In addition, patients who underwent nTAPP had a shorter period of sick leave (11.2 ± 8.4 days vs 24.1 ± 20.1 days; P = .02). At the follow-up evaluation after approximately 30 months, abdominal wall mobility and cosmetic satisfaction were equally positive, with no hernia recurrence.Conclusion:In patients with uncomplicated inguinal hernia, the nTAPP procedure, with less surgical trauma and operating time, has distinct advantages in reduction of immediate postoperative pain and sick leave time.

Laparoscopic bridging vs. anatomic open reconstruction for midline abdominal hernia mesh repair [LABOR]: single-blinded, multicenter, randomized, controlled trial on long-term functional results

BackgroundRe-approximation of the rectal muscles along the midline is recommended by some groups as a rule for incisional and ventral hernia repairs. The introduction of laparoscopic repair has generated a debate because it is not aimed at restoring abdominal wall integrity but instead aims just to bridge the defect. Whether restoration of the abdominal integrity has a real impact on patient mobility is questionable, and the available literature provides no definitive answer. The present study aims to compare the functional results of laparoscopic bridging with those of re-approximation of the rectal muscle in the midline as a mesh repair for ventral and incisional abdominal defect through an “open” access. We hypothesized that, for the type of defect suitable for a laparoscopic bridging, the effect of an anatomical reconstruction is near negligible, thus not a fixed rule.Methods and designThe LABOR trial is a multicenter, prospective, two-arm, single-blinded, randomized trial. Patients of more than 60 years of age with a defect of less than 10 cm at its greatest diameter will be randomly submitted to open Rives or laparoscopic defect repair. All the participating patients will have a preoperative evaluation of their abdominal wall strength and mobility along with volumetry, respiratory function test, intraabdominal pressure and quality of life assessment.The primary outcome will be the difference in abdominal wall strength as measured by a double leg-lowering test performed at 12 months postoperatively. The secondary outcomes will be the rate of recurrence and changes in baseline abdominal mobility, respiratory function tests, intraabdominal pressure, CT volumetry and quality of life at 6 and 12 months postoperatively.DiscussionThe study will help to define the most suitable treatment for small-medium incisional and primary hernias in patients older than 60 years. Given a similar mid-term recurrence rate in both groups, if the trial shows no differences among treatments (acceptance of the null-hypothesis), then the choice of whether to submit a patient to one intervention will be made on the basis of cost and the surgeon’s experience.Trial registrationCurrent Controlled Trials ISRCTN93729016

Mini-incisional laparoscopic surgery (MILS) for inguinal hernia repair*

BACKGROUND: As meshes markedly reduce recurrence rates following surgery for inguinal hernia, surgical methods employing meshes have become increasingly popular among surgeons. Innovations in laparoscopic surgery have enabled the surgeon to minimize the size of trocar incisions. This type of laparoscopy is therefore referred to as minimal incisional laparoscopic surgery (MILS). METHODS: All inguinal hernia patients who reported at our department during the last two years were included in a prospective observational study. In order to assess the feasibility of the MILS technique as well as its benefits for the patient, we investigated and compared the following intra- and postoperative parameters of two laparoscopic TAPP (transabdominal pre-peritoneal) techniques (MILS-TAPP versus conventional-TAPP): operating times, perioperative complications, postoperative and chronic pain, abdominal wall mobility, and recurrence rates. RESULTS: Of 462 patients aged 18 to 94 years (mean, 46 years), 559 inguinal hernias in 481 patients (86.1%) were treated by laparoscopic approach. The Lichtenstein technique was used to treat 65 hernias (11.6%). The mean operating time was 60 minutes for the conventional TAPP technique (n = 217) and 56 minutes for the MILS technique (n = 264). Postoperative abdominal wall mobility scored by Janda's method was significantly superior in the MILS group (4.6) than in the conventional laparoscopic group (3.7). Postoperative pain on the VAS scale was rated 1.3 in the MILS group versus 2.6 in the conventional TAPP group. Three (1.4%) recurrences occurred after the conventional TAPP technique, whereas no hernia recurrence occurred when a self-adhesive mesh was used. CONCLUSIONS: Minimization of trauma secondary to the trocar incision was able to reduce postoperative pain and improve abdominal wall mobility. The self-adhesive mesh may be inserted by the practiced laparoscopic surgeon with no delay, and optimizes incorporation in the groin by laminar mesh adhesion in the preperitoneal cavity.

Detection of recurrent hernia and intraabdominal adhesions following incisional hernia repair: a functional cine MRI-study

To non-invasively identify incisional hernia repair implanted synthetic meshes with MRI, and also focusing on the evaluation of postsurgical complications such as adhesions. A total of 43 patients underwent either laparoscopic intraperitoneal onlay-mesh or open abdominal wall repair using preperitoneal layers. The patients were examined using a true-fast-imaging-with-steady-state-precession (trueFISP)-sequence in transverse/sagittal orientation with a section-by-section dynamic depiction of induced visceral slide. A 9-segment-abdominal-map was used to document the adhesion location/type. The MR-images were analysed regarding hernia relapse, layer-morphology, rectus-abdominis muscle-condition, and abdominal wall mobility. In 12 patients pre- and postsurgery-MRI was performed. Time range between surgery and examination was 6-36 months. In all laparoscopy-patients the meshes were identified. For open surgery the mesh was not visualized in 20, but was seen in 6 cases. A total of 11 cases showed a recurrent hernia. Seventy intraabdominal adhesions were detected. Fifteen patients had restricted mobility. 20 patients showed an rectus-abdominis-muscle-asymmetry. Comparing pre- and post-op-MRI, 6 out of 8 patients with open repair showed thick scar-plaques. Three patients with open repair had new adhesion-formations postoperatively. Functional cine MRI is suitable for follow-up studies in patients after hernia repair to detect and evaluate the implanted meshes. Typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed as well.

Modified mesh for hernia repair that is adapted to the physiology of the abdominal wall.

To develop a new mesh for hernia repair that is adapted to the physiological forces. Animal experiment. Surgical Department of the RWTH-Aachen. Wistar rats Textile analysis, tensile strength, bending stiffness, histology and morphometry. After textile analysis of commercially available meshes in clinical use we defined the physiological forces and constructed a new mesh (Soft Hernia Mesh, SHM) based on a combination of non-absorbable polypropylene and absorbable polyglactin 910. The amount of non-absorbable material could be reduced to < 30% compared with Marlex while still guaranteeing the necessary pulling force of 16 N/cm. Improvements of the hosiery structure improved the symmetrical distribution of the retaining forces in all directions. Compared with the considerable restriction of the abdominal wall mobility by Prolene (polypropylene) and Mersilene (polyester) meshes there was no increase in the bending stiffness after the implantation of the new mesh. Histological examination showed a pronounced reduction of the inflammatory reaction in the tissues, and the collagen bundles were orientated merely around the mesh filaments instead of forming a scar plate that completely embedded the mesh. Different meshes caused specific histological reactions with changes of their mechanical properties after implantation in rodents. A new mesh with a reduced amount of polypropylene showed both less inflammation and less restriction in the mobility of the abdominal wall though it exceeded the required tensile strength of 16 N/cm.

PVDF as a new polymer for the construction of surgical meshes

Abdominal hernia repair is the most frequently performed operation in surgery. Mostly due to lowered recurrence rates mesh repairs in hernia surgery have become an integral component despite increasing mesh-related complications. Current available mesh prosthesis are made of polypropylene (PP), polyethylene-terephtalat or polytetrafluorethylene, though all of them reveal some disadvantages. The introduction of new materials seems to be advisable. Caused by supposed advantageous textile properties and tissue response two mesh modifications made of polyvinylidene fluoride (PVDF) for abdominal hernia repair were developed. In the present study the PVDF meshes were compared to a common heavy weight PP-mesh (Prolene®) in regard to functional consequences and morphological tissue response. After implantation in rats as inlay for 3, 14, 21, 42 and 90 days abdominal wall mobility was recorded by three-dimensional photogrammetry. Tensile strength of the suture zone and the mesh itself were determined. Explanted tissue samples have been investigated for their histological reaction in regard to the inflammatory infiltrate, vascularisation, connective and fat tissue ingrowth. Number of granulocytes, macrophages, fibroblasts, lymphocytes and foreign giant body cells have been evaluated to reflect quality of tissue response. The cellular response was grasped by measurement of DNA strand breaks and apoptosis (TUNEL), proliferation (Ki67) and cell stress (HSP70). Analyzing the results confirmed that construction of hernia meshes made of PVDF could be an advantageous alternative to the commonly used materials due to an improved biostability, lowered bending stiffness and a minimum tissue response.

Polymers in hernia repair–common polyester vs. polypropylene surgical meshes

Within the last years meshes have become essential for the repair ofabdominal wall hernias. While the type of mesh obviously influencesthe clinical result, the selection of the best suitablemesh-modification should have favourable effects onto the rate ofcomplications. Available surgical meshes mainly differ in the typeand amount of the basic polymers. The most common meshes are madeeither out of monofilament polypropylene (PP) or multifilamentpolyester (PET). In the following contribution we studied thefunctional and histological results of standard and commerciallyavailable surgical meshes: a standard heavyweight, large pore-sizedPP-mesh (Prolene®), a heavyweight, large pore-sized PET-mesh(Parietex®, coated with bovine collagen) and a low weightsmall pore-sized PET-mesh (Mersilene®) in a standardised ratmodel. The meshes are studied by three dimensional stereography,tensiometry, light-(LM) and transmission electron microscopy (TEM),as well as morphometry over implantation intervals of 3, 7, 14, 21and 90 days. The results proved marked differences between thetested meshes in regard to textile properties, the mechanicalfunction (tensile strength, abdominal wall mobility), as well as thehistologically proved tissue reaction. Both heavyweight meshes (PPand PET) revealed an enormous and most similar strength whereas thelow weight PET-mesh primarily showed a considerable increase offlexibility. Despite their different structures and their diversehistological response all tested meshes led to a similar andsignificant reduction of the abdominal wall flexibility. However, thelocal tissue response of the interface mesh/recipient tissuesrevealed a significant reduction of the acute inflammatory activity anda significant decrease of connective tissue formation in the case ofthe low weight PET-mesh Mersilene® compared to both heavyweightmesh-modifications. Mersilene® showed an excellent andrelatively inert tissue reaction of the interface compared toProlene® and Parietex®. Modifications of the mesh-structure(e.g. larger pores) should improve the functional results, inparticular, abdominal wall flexibility. However, the use of PET inhernia surgery is at least questionable in respect to the obligatelong-term degradation of this polymer.

Expression of heat shock protein 70 (HSP70) at the interface of polymer-implants in vivo.

Synthetic polymer meshes are widely applied in the modern surgical approach for repairing abdominal wall defects. The implanted material is often observed leading to post-operative complications such as deficient abdominal wall mobility and adhesion formation with the abdominal cavity and/or abdominal organs. However, the functioning of the implant is primarily affected by the wound healing process guided by inflammatory events occurring at the tissue-material interface. This could presumably be influenced by the physicochemical properties of the polymer. With regard to it, the cellular and molecular processes involved in the successful restoration of the abdominal wall function are poorly understood. The present in vivo study, therefore, exemplary investigated in a rat model, the commercially available polymer-meshes Prolene (polypropylene, PP), Mersilene (polyester, PE) and Vicryl (polyglactin 910), as well as new mesh variants consisting either of PP (EB) or a combination of PP and polyglactin 910 (A plus or Vypro). The implanted material was evaluated by light and electron microscopy, immunohistochemistry as well as morphometry over an implantation period of 90 days. The data show that polymers induce heat shock protein (HSP)70, and its expression at the interface correlates inversely with the activity of the inflammatory reaction in vivo. Further, an ascent in HSP70 expression parallels the increasing implantation period and evolving foreign-body granulomas. Accordingly, a major role for HSP70 in modulating the local acceptance of polymers and as an additional marker for in vivo testing of polymers is suggestive.

Functional and morphological evaluation of different polypropylene-mesh modifications for abdominal wall repair

Modern surgical hernia repair depends increasingly on synthetic meshes for the reconstruction of the abdominal wall. Despite the undisputed advantages of the polypropylene (PP) meshes currently available (Marlex ®, Prolene ®), reports of complications after implantation are increasing. Although, serious complications such as perforation and fistula formation are rare, minor and local complaints such as seromas, misfeelings and a decreased abdominal wall mobility are observed in about one-half of the patients. In regard to the exaggerated strength of the currently available mesh modifications a reduction of the material should improve the integration of the meshes into the artificial abdominal wall. In the present study, the commercially available basic mesh Prolene ® has been compared to two newly constructed PP-mesh modifications with reduced amounts of PP. The modifications have gradually been adopted to the physiological requirements of abdominal wall stability and mobility by reducing the amount of PP to 64% (E-BLUE) and 24% (variant A) of the Prolene ® mesh (developed by ETHICON ®, Norderstedt, Germany). All PP-mesh variants have been implanted in a rat model and studied by 3D-photogrammetry, tensiometry, light- and electron microscopy, as well as morphometry over implantation intervals of 3, 7, 14, 21 and 90 days. The data show that current constructions of PP-meshes are oversized and definitely restrict abdominal wall mobility in the present model. Sufficient stability of the artificial abdominal wall is even guaranteed by PP-mesh modifications with a reduction of PP-quantity to about 25% of the Prolene ® mesh. The degree of fibrosis directly correlated with abdominal wall restriction, whereas the formation of connective tissue in the interface PP-fibre/host-issue depends on the amount and activity of the inflammatory reaction. The quantity and quality of inflammation, again, directly relies to the amount of PP and to the surface area in contact with the recipient tissues. Altogether, the present study suggests that a modification of the PP-meshes could be helpful to prevent major and minor complications of surgical PP-meshes.

Abdominal wall compliance after Marlex� mesh implantation for incisional hernia repair

In view of the poor results of suturing techniques, incisional hernias are often best repaired with biomaterials. Their use brings the recurrence rate to below 10%, but patients sometimes complain of discomfort and restricted abdominal mobility. We report our experience with 41 patients after implantation of a Marlex®-mesh in a preperitoneal, retromuscular position (mean follow-up period 16.7 months). The effect of implanted meshes on abdominal wall mobility was measured noninvasively with the aid of three dimensional stereography and compared with a non-operated healthy control group (n = 21). The commonest early postoperative complication was seroma in 32% of cases, usually relieved by aspiration. Infection and hematoma were less frequent at 4.9% and 12.2% respectively. Three patients developed a recurrent hernia. During follow-up 7.3% experienced pain during heavy activities, 29.3% during daily activities and 4.9% at rest. Three dimensional stereography showed a highly significant (p < 0.001) decrease in abdominal wall mobility following mesh implantation, compared to a non-operated control group. Improved composition of the mesh material involving a smaller proportion of polypropylene and greater elasticity, should be considered for the future, in order to reduce patient discomfort.

Application of three-dimensional stereography to assess abdominal wall mobility

Functional impairment of the abdominal wall can cause serious discomfort in patients, even during daily activity. We introduce a new method to describe and calculate abdominal wall mobility and its disturbances. The abdominal wall compliance can be measured non-invasively by three-dimensional stereography. Three-dimensional stereography is an optical method for measuring the topography of surfaces. The deformation of a light grid projected onto the abdominal wall is documented by video. After automatic digitisation of the pictures the computer calculates changes of the surface area. The abdominal wall mobility can then be measured by comparing the abdominal surface changes in minimum and maximum excursions. Measurement of defined geometric bodies proved the accuracy of our method with a variation under 5%. We found an abdominal wall mobility in normal persons (n=21) of 5.4 cm ± 1.9 for height difference, 2.6 1/100 cm ± 1.4 for the minimum curvature difference, 6.2 1/100 cm ± 1.8 for the maximum curvature (p<0.01), 110 cm ± 74 for the adjusted radius at minimum excursion and 41 cm ± 14 at maximum excursion (p<0.01). This method allows us to calculate abdominal wall compliance and its restriction. Comparison of pre- and postoperative data could help us to assess the success of operations concerning the abdominal wall.