Abdominal Wall Thickness Research Articles

Evaluation of barbed suture for celiorrhaphy and subcutaneous closure in bitches with pyometra submitted to ovariohysterectomy.

ABSTRACTPurposeTo evaluate the use of barbed sutures over the surgical time, the leukogram, the tissue thickness in which the sutures were employed (ultrasonography), the costs, and the possible complications in bitches with pyometra submitted to ovariohysterectomy (OH).MethodsConvectional 2.0 polyglyconate suture was used in the control group (CG n = 10) and 2.0 barbed polyglyconate suture in the barbed group (BG n = 10) to perform celiorrhaphy (simple continuous pattern) and subcutaneous closure (continuous intradermal pattern). Data were assessed using paired (leukogram between 24 and 48 h within the same group) and unpaired (leukogram, surgical time, tissue thickness, and costs) Student’s t-test. The Fisher exact test was used to assess the occurrence of seroma between groups (p < 0.05). Results are shown as mean ± standard error of mean.ResultsThe time spent to perform the celiorrhaphy (195.30 ± 17.37 s vs. 204 ± 16.00 s), subcutaneous closure (174.0 ± 15.86 s vs. 198.0 ± 15.62 s), and the total surgical time (24.30 ± 1.44 min vs. 23.00 ± 1.30 min) did not differ between BG and CG, respectively (p > 0.05). Leukogram at 48 h post-surgery did not differ between groups (p = 0.20). No differences were observed in the subcutaneous and the abdominal wall thickness (cm) assessed by ultrasonography at 48 h in BG (0.31 ± 0.04, 0.80 ± 0.05) and CG (0.34 ± 0.03, 0.72 ± 0.06), respectively. Similarly, 15 days post-surgery the same structures did not differ between BG (0.26 ± 0.02, 0.74 ± 0.08) and CG (0.26 ± 0.03, 0.64 ± 0.05) (p > 0.05). In one bitch from each group, a mild seroma was observed on one side of the surgical wound 48 h after surgery (p = 1.00). The procedures in which barbed sutures were used had an average additional cost of R$ 200.00 ± 11.66 (p < 0.0001).ConclusionsBarbed suture has proven to be efficient and safe for abdominal and subcutaneous closure. However, considering its current high cost in addition thatthe surgical time of bitches with pyometra undergone OH was not reduced, no advantages were observed with theuse of barbed sutures for this type of surgery.

Abdominal Wall Thickness is a Predictor for Surgical Site Infections in Patients Undergoing Colorectal Operations.

Surgical site infections (SSIs) are an established complication following colorectal operations, with rates up to 30% reported in the literature. Obesity is a known risk factor for SSI; however, body mass index (BMI), body fat percentage, waist-hip ratio, or abdominal circumference are imperfect measures. The purpose of our study was to determine whether abdominal wall thickness (AWT) is predictive of SSI. We queried our American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database for patients (age ≥18years) undergoing a colectomy at the University of Kentucky (UK) from January 1, 2013 to December 31, 2018. The exclusion criteria included patients with open abdomens or the lack of preoperative computed tomography (CT) within 3months of their operation. AWT was measured at the level of the anterior superior iliac spine (ASIS) on abdominal CT. SSI was defined by superficial SSI, deep SSI, and wound dehiscence. Of 1261 patients enrolled, 52.2% were female, with an average age of 57.4years. More patients had laparoscopic operations (51%), and the median length of stay was 7days. Our study demonstrated an SSI rate of 9.4% and a 30-day readmission rate of 11%. The overall mean AWT was 2.6cm (range .1-13.1), and patients with the highest AWT quintile were more likely to develop an SSI than the lowest quintile (12% vs. 5%). After controlling for risk factors and confounders, the odds of an SSI were 3.6 times higher for patients with the highest AWT than patients with the lowest AWT. Among colorectal surgery patients, AWT is an independent risk factor predictive for SSI.

Non-invasive indirect monitoring of intra-abdominal pressure using microwave reflectometry: system design and proof-of-concept clinical trial.

Monitoring intra-abdominal pressure (IAP) has become a standard in intensive care units. Correlation between the abdominal wall’s thickness (AWTh) and IAP has been reported previously. The abdominal wall can be modeled as a compound of parallel dielectric slabs; changes in their width have a direct effect on the reflection coefficient of the abdominal wall at microwave frequencies. This work describes the design of a reflectometry system and its proof-of-concept trial on five patients during laparoscopic surgery. The system complies with IEEE Std. C95.1-2005 concerning exposure of humans to microwave electromagnetic fields in controlled environments. The results putatively show an inverse correlation between IAP and the reflection coefficient, and a strong dependence on the body mass index. A better understanding of the dynamics in the changes of the AWTh (during intra-abdominal hypertension) will allow further development of a microwave-based technique for the continuous non-invasive indirect monitoring of IAP in critical patients.

Abdominal Wall Thickness Versus BMI as a Predictor of Complications After Abdominally Based Free Flaps to Treat Mastectomy Defects

INTRODUCTION: Although body mass index (BMI) > 30 kg/m2 is often considered a relative or absolute contraindication for abdominally -based free flaps, there is very little evidence in the literature that BMI correlates with complication rate. The purpose of this study was to determine whether BMI or abdominal wall thickness correlated with postoperative complication rate. METHODS: A retrospective chart review was conducted on 151 patients who underwent abdominally based free flap reconstruction after mastectomy at our institution. Preoperative axial computed tomography scans were used to measure the distance from the skin surface to the abdominal wall at the umbilicus and at the lower abdomen (8 cm inferior to the umbilicus). The medical records of all 151 patients were then scanned for demographic data, medical history, BMI, surgical records, and post-operative complications. Mean BMI, mean abdominal wall thickness at the umbilicus, and mean lower abdominal wall thickness (LAWT) were then compared between patients who did and did not develop overall, abdominal donor site, and breast recipient site complications. The mean LAWT was also compared between patients who had and had not experienced different subtypes of abdominal and breast complications (unpaired t test). Patients were then stratified into four groups based on LAWT, and complication rates were then compared between all four groups (chi-square test). RESULTS: Average BMI did not differ significantly between patients who did or did not experience any complication, abdominal complications, or breast complications. Mean abdominal wall thickness at the umbilicus was significantly higher in patients with overall complications (P = 0.005) and abdominal complications (P = 0.003) but did not differ significantly between those who did and did not experience breast complications. Average LAWT was significantly higher in patients who experienced all three types of complications (P = 0.001, 0.0001, 0.02, respectively), and so this point was chosen as the major comparison point. Patients with abdominal complications requiring re-operation (P = 0.001), abdominal wound healing complications (P < 0.0001), and breast wound healing complications (0.004) had a higher average LAWT compared with those without these respective complications, but there was no significant difference between those who did and did not experience abdominal infectious complications, breast complications requiring reoperation, breast fat necrosis, or breast infectious complications. After stratification of complication rates based on LAWT groups, the rates of overall abdominal complications and abdominal wound healing complications significantly increased as LAWT increased (P = 0.01, 0.03, respectively). Breast wound healing complications were also higher in the high LAWT groups, although this did not reach statistical significance (P = 0.2). CONCLUSIONS: Abdominal wall thickness is a much better predictor of complications after abdominally based free flaps compared with BMI.

VP47.03: Can fetal abdominal wall thickness predict intrapartum complications amongst mothers with pre‐gestational type 2 diabetes? A cohort study

VP47.03: Can fetal abdominal wall thickness predict intrapartum complications amongst mothers with pre‐gestational type 2 diabetes? A cohort study

Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation.

Although changes in lateral abdominal wall musculature after posterior component separation with transversus abdominis release have been investigated, the effects of endoscopic subcutaneous anterior component separation (ES-ACS) on postoperative muscle anatomy have not been evaluated. The purpose of this study was to evaluate changes in the lateral abdominal muscles after ES-ACS. Computed tomography (CT) images of patients who underwent ES-ACS were retrospectively evaluated. Lateral abdominal wall thickness and external oblique displacement were measured at the level of fixed retroperitoneal structures. Measurements on the ES-ACS side were compared with those on the contralateral undivided side or with preoperative images in patients with bilateral procedures. Fifteen patients met the criteria for study inclusion. Most patients (n = 13, 86.7%) underwent unilateral ES-ACS. The most commonly performed procedure was laparoscopic intraperitoneal onlay mesh-plus hernia repair (n = 12, 80.0%; the remaining patients underwent open repair). The Mean defect width was 8.4cm (range 6-15cm). There was no difference in the thickness of the lateral abdominal musculature between ES-ACS and undivided sides. There was a significant lateral displacement of the external oblique muscle from the lateral edge of the rectus abdominis on the ES-ACS side (mean distance 3.7cm; p = 0.0006). No midline hernia recurrences, iatrogenic linea semilunaris hernias, or lateral eventrations were observed during a mean follow-up period of 2.6years (range 0.5-7.4years). ES-ACS resulted in no atrophy of the lateral abdominal muscles in long-term CT follow-up. The procedure is a safe and effective adjunct to complex hernia repair in selected patients.

Fetal anterior abdominal wall thickness between gestational diabetes and normal pregnant women

ObjectivesTo compare fetal anterior abdominal wall thickness (AAWT) between women with and without GDM during third trimester and to determine accuracy of AAWT to predict large for gestational age (LGA) infants. Materials and methodsA total of 250 pregnant women, including 125 women with GDM and 125 women without GDM, were enrolled. Tansabdominal ultrasonographic examinations were performed at 28–30, 32–34 and 36–38 weeks. In addition to standard fetal biometries, AAWT was measured. Patient characteristics and ultrasonographic measurements were compared between groups. Sensitivity and specificity of AAWT for identifying LGA were evaluated. ResultsWhile standard fetal biometries were comparable, mean fetal AAWT in GDM women were significantly higher than those without GDM at 28–30 weeks (2.8 ± 0.8 vs. 2.6 ± 0.6, p = 0.006) and 32–34 weeks (4.0 ± 0.9 vs. 3.5 ± 0.8, p = 0.042). LGA infants had significantly higher fetal AAWT at each time point only in GDM women. Using cut off values of AAWT of ≥2.0, 3.0, and 4.0 mm at 28–30, 32–34, and 36–38 weeks, sensitivity for LGA diagnosis in GDM women were 94.4%, 93.9%, and 89.3%, respectively. The use of abdominal circumference (AC) at >90th percentile showed lower sensitivity but higher specificity, regardless of GDM status. Combination of both measurements increased sensitivity to approximately 90% or higher in every time point, especially among GDM women. ConclusionSignificant increase in fetal AAWT was observed in GDM women at 28–30 and 32–34 weeks. Fetal AAWT significantly increased among LGA infants and had higher sensitivity than AC in identifying LGA during third trimester. In GDM women at 28–30 weeks, AAWT ≥2.0 mm and AC >90th percentile had 97.2% sensitivity for LGA diagnosis.

Influence of Prenatal Aerobic Exercise on Fetal Morphometry.

The purpose of this study was to determine the effects of supervised prenatal aerobic exercise on fetal morphometrics at 36weeks of gestation. This study used data from a, 24-week, two-arm randomized controlled trial: aerobic exercise (EX) and stretching/breathing comparison group (CON). Singleton pregnancies (< 16weeks pregnant) and women aged 18 to 40years, BMI between 18.5 and 34.99kg/m2, and no preexisting chronic health conditions were eligible. The EX group participated in 150min of moderate-intensity weekly exercise while CON group participated in low-intensity stretching/breathing. Fetal morphometric outcomes included estimated fetal weight (EFW), ponderal index (PI), abdominal circumference (AC), anterior abdominal wall thickness (AAWT), fat mass, percent body fat, fat-free mass, assessed at 36weeks gestation. Partial spearman rank correlations were performed, adjusting for 3rd trimester weight gain. Of the 128 pregnant women randomized, 83 (EX [n = 46] and CON [n = 37]) were eligible for analyses. Intention-to-treat analysis showed no differences in EFW (rhos = - 0.13; p = 0.28), PI (rhos = 0.03; p = 0.81), AC (rhos = - 0.22; p = 0.09), AAWT (rhos = - 0.11; p = 0.40), fat mass (rhos = - 0.16; p = 0.23), percent body fat (rhos = - 0.10; p = 0.43), and fat-free mass (rhos = - 0.22; p = 0.08), after adjusting for 3rd trimester weight gain. Similar results were observed in the per protocol analyses. For Practice Moderate-intensity aerobic exercise during pregnancy was not associated with select fetal morphometrics at 36weeks gestation. Potential differences in offspring morphometrics may only appear in the postnatal period, as previously documented. Further research into offspring tissue composition after birth is encouraged, specifically studies investigating differences in cellular signaling pathways related to adipose and skeletal muscle tissue development.

Relationships Between Body Mass Normalized Abdominal Wall Thickness And Self-reported Activity And Global Health

The anterolateral abdominal wall, rectus abdominis (RA), external oblique (EO), and internal oblique (IO), contributes to lumbopelvic-hip strength; and its role in injured populations such as low back pain has been well explored. However, it is important to establish the association between a body mass normalized measure of muscle size with overall physical activity in a healthy population due to their utility as a frequently used control group and for the potential of this measurement technique in aging, resistance training, and abdominal fat assessment. PURPOSE: To determine relationships between muscle thickness (at rest and during contraction) of RA, EO, IO and patient-reported outcome measures on physical activity and health. METHODS: Eight active participants with no history of low back or lower extremity injury (23.1±5.4yrs, 171.1±11.3cm, 70.6±15.1kg, 4F) completed a single imaging session of RA, EO, and IO. Before imaging, participants completed the PROMIS Global Health (GH), PROMIS Physical Function (PF), and International Physical Activity Questionnaire Short Form (IPAQ). Ultrasound images were collected at rest while supine, hook-lying and during contraction with participants instructed to perform an abdominal crunch for RA, and crunches toward either knee for EO and IO. Thickness measures were normalized to body mass (kg). Pearson’s r correlation coefficients were used to determine relationships. RESULTS: Six of the 8 participants scored high on the IPAQ (≥3000 METmin/week) and the rest were moderate (≥600 METmin/week). The average hrs/day participants spent sitting was 4.6±2.3hrs. The PROMIS GH (37.5±4.7) and PROMIS PF (98.9±2.4) both confirmed overall health and activity levels. Right side EO at rest (r=.74, p=.04) and during contraction (r=.84, p=.01) were strongly related to hours spent sitting per day. CONCLUSIONS: Normalized EO muscle thickness was found to increase, at rest and during contraction, as healthy, active individuals sat longer. Although this was the only significant correlation, this controversial finding may be explained due to the relative 17.4% decrease in EO activity on the right side, compared to the left. The connection between the abdominal wall and self-reported physical activity is important to distinguish, especially with a body mass normalization technique.

Liver Shear Wave Speed and Other Quantitative Ultrasound Measures of Liver Parenchyma: Prospective Evaluation in Healthy Children and Adults.

OBJECTIVE. The purpose of this study was to use 2D ultrasound shear wave elastography (SWE) to define expected ranges for liver shear wave speed and shear wave dispersion in children and adults without a known history of liver disease. The study also sought to define liver attenuation in adults. SUBJECTS AND METHODS. This was an institutional review board-approved prospective study of 128 children (younger than 18 years old) and 32 adults without liver disease who underwent 2D SWE of the liver with a Canon Aplio i800 ultrasound system (i8CX1 transducer). Ten shear wave speed and shear wave dispersion measurements were obtained. In adults, five attenuation measurements were also obtained. Pearson correlation and t tests were used to define relationships between shear wave speed and dispersion values and predictor variables. Multivariable logistic regression with forward selection was used to generate models. RESULTS. Median age was 5.04 years old for the pediatric participants and 48.92 years old for the adult participants. Mean median shear wave speed and shear wave dispersion were 1.29 ± 0.13 m/s and 11.43 ± 1.75 (m/s)/kHz, respectively, for the pediatric participants and 1.32 ± 0.13 m/s and 10.24 ± 1.65 (m/s)/kHz, respectively, for the adults. Mean median attenuation in adults was 0.52 ± 0.11 dB/cm/MHz. On multivariable modeling, height was the only significant predictor of shear wave speed in children (0.0012 m/s per cm, p < 0.0001) and abdominal wall thickness was the only predictor of shear wave speed in adults (0.12 m/s per cm, p = 0.0008). CONCLUSION. Liver shear wave speed and shear wave dispersion data for children and adults without liver disease provides data against which results from patients with liver disease can be compared. Liver shear wave speed increases during childhood associated with increases in height and shear wave speed increases in adulthood with increasing abdominal wall thickness.

Gender abdominal features, determining depth of incisional wound in abdominal surgeries

Aim. To determine the mean values of the anterior abdominal wall thickness and abdominal cavity depth for men and women with different types of constitution and reveal the mechanisms, allowing the surgeon to predict these parameters in the preoperative period.&#x0D; Materials and methods. One hundred twenty male and female computer tomograms of the abdominal cavity were studied.&#x0D; Results. The anterior abdominal wall thickness and abdominal cavity depth values for men and women with different types of constitution at different levels of measurement were determined. The depth of laparotomy wound was found to be dependent on the distance between the anterior upper iliac spines.&#x0D; Conclusions. The gender features of the anterior abdominal wall thickness and abdominal cavity depth were revealed. There were determined the coefficients, permitting to predict the depth of laparotomy wound in the preoperative period.

First Evidence of Realized Selection Response on Fillet Yield in Rainbow Trout Oncorhynchus mykiss, Using Sib Selection or Based on Correlated Ultrasound Measurements.

Fillet yield, the proportion of edible fillet relative to body weight, is a major trait to improve in fish sold processed, as it has a direct impact on profitability and can simultaneously decrease the environmental impact of producing a given amount of fillet. However, it is difficult to improve by selective breeding, because it cannot be measured on live breeding candidates, its phenotypic variation is low, and, as a ratio, it is not normally distributed and a same change in fillet yield can be the result of different changes in fillet weight and body weight. Residual headless gutted carcass weight (rHGCW) is heritable and highly genetically correlated to Fillet% in rainbow trout, and can be predicted by the ratio of abdominal wall thickness to depth of the peritoneal cavity (E8/E23), measured on live fish by ultrasound tomography. We selected broodstock based on rHGCW, measured on sibs of the selection candidates, on ultrasound measurements (E8/E23) measured on the selection candidates, or a combination of both. Seven broodstock groups were selected: fish with 15% highest (rHGCW+) or lowest (rHGCW−) EBV for rHGCW, with 15% highest (E8/E23+) or lowest (E8/E23−) EBV for E8/E23, with both rHGCW+ and E8/E23+ (Both+) or rHGCW− and E8/E23− (Both−), or with close to zero EBVs for both traits (Mid). Seven corresponding groups of offspring were produced and reared communally. At harvest size (1.5 kg mean weight), 1,561 trout were slaughtered, measured for the traits of interest, and pedigreed with DNA fingerprinting. Offspring from groups Both+, rHGCW+ and E8/E23+ had a higher EBV for rHGCW than the control group, while down-selected groups had a lower EBV. Looking at the phenotypic mean for Fillet% (correlated response), up-selected fish had more fillet than down-selected fish. The highest difference was between Both+ (69.36%) and Both− (68.20%), a 1.16% units difference in fillet percentage. The change in Fillet% was explained by an opposite change in Viscera%, while Head% remained stable. Selection using sib information on rHGCW was on average more efficient than selection using the candidates’ own E8/E23 phenotypes, and downward selection (decreasing Fillet%) was more efficient than upward selection.

Increasing abdominal wall thickness predicts complications in abdominally based breast reconstruction: A review of 106 consecutive patients

Body mass index (BMI) has long been the proxy for patient selection in obese patients presenting for abdominally based breast reconstruction. BMI, however, fails to accurately reflect the distribution of abdominal adipose tissue. This study aims to quantify the effect of abdominal wall thickness on the incidence of post-operative complications and contrast abdominal wall thickness and BMI as predictors of post-operative morbidity. We performed a retrospective review of 106 consecutive patients who underwent abdominally based breast reconstruction. Abdominal wall thickness was quantified using preoperative CT angiograms. Primary outcomes included delayed wound healing (abdomen and/or breast), flap fat necrosis, return to OR in 30 days, infection, and flap loss. Patients experiencing delayed abdominal wound healing (n=38), delayed breast wound healing (n=27), and flap fat necrosis (n=24) had significantly thicker abdominal wall measurements (p<0.0015). Of the 24 patients with palpable fat necrosis, 11 required excision. Increasing abdominal wall thickness significantly increased the odds of delayed abdominal wound healing (p=0.0005), delayed breast wound healing (p=0.0009), flap fat necrosis (p=0.0028), and infection (p=0.0198). Compared to BMI, abdominal wall thickness proved to be a more accurate predictor of delayed breast wound healing, any delayed wound healing, flap fat necrosis, and infection. Our data indicate that as abdominal wall thickness increases, so does the risk of postoperative morbidity. Abdominal wall thickness outperformed BMI as a predictor of postoperative morbidity in several areas. This suggests that objective data obtained from preoperative CT scans may allow more accurate, individualized perioperative risk assessment.

Optimized electrical bioimpedance measurements of abdominal wall on a porcine model for the continuous non-invasive assessment of intra-abdominal pressure.

This work describes the optimization of electrical bioimpedance measurements for indirect intra-abdominal pressure (IAP) assessment. The experimental run was performed on a female Sus scrofa domesticus (domestic pig). Different values of IAP were induced by inflation of the abdominal cavity, using a trocar placed near the umbilicus over the linea alba. The whole experiment was run within 1h of the subject being sacrificed. The abdominal wall thickness was measured at an IAP of 5mmHg. An exponential trend linking between the bioimpedance values at 99.8kHz and the IAP was found. Non-optimized electrode placement presented a strongly reduced sensitivity to IAP changes above 7mmHg. Upon optimization and placing the electrodes with a separation of about 3.6 times the measured abdominal wall thickness, the sensitivity for high IAP drastically increased, allowing continuous non-invasive monitoring of IAP, confirming the optimization method proposed in this work.

P.222 Impact of discretionary and non-discretionary factors on driving the high growth of anti-depressant prescribing in primary care in england

The aim of the study was to investigate the relationship of BMI and abdominal wall thickness (AWT) with the diameter of the dominant deep inferior epigastric artery perforator (DIEP) as well as DIEA branching pattern in preoperatively performed computed tomography angiography (CTA).We conducted a retrospective study including all patients undergoing DIEP flap breast reconstruction with available CTAs from November 2013 to April 2018 in our department. The caliber-strongest DIEP was detected after passage of the rectus fascia as well as the superficial inferior epigastric artery (SIEA) and correlated with the AWT 5 cm above and below the umbilicus, lateral at the level of the umbilicus and at the level of the anterior superior iliac spine (ASIS), and with BMI.Seventy-seven patients met the inclusion criteria (age: 47.3 ± 8.9 years). We observed a significant relationship (p < 0.05) between DIEP (mean ∅ = 2.98 mm) and BMI (r = 0.353), the AWT supra- and infraumbilical (r ≥ 0.32), and the AWT lateral at the level of the umbilicus and ASIS (r ≥ 0.25). In addition, there was a highly significant correlation (p < 0.01) between SIEA and BMI (r = 0.389) and between the AWT lateral at the level of ASIS (r ≥ 0.41).We demonstrated a correlation of the diameter of the dominant DIEP with both BMI and AWT. Focusing on the diameter, in patients with a high AWT at the level of the ASIS, the SIEA, if present, may represent an alternative therapeutic option.

Body mass index and abdominal wall thickness correlate with perforator caliber in free abdominal tissue transfer for breast reconstruction

IntroductionThe aim of the study was to investigate the relationship of BMI and abdominal wall thickness (AWT) with the diameter of the dominant deep inferior epigastric artery perforator (DIEP) as well as DIEA branching pattern in preoperatively performed computed tomography angiography (CTA). Patients and methodsWe conducted a retrospective study including all patients undergoing DIEP flap breast reconstruction with available CTAs from November 2013 to April 2018 in our department. The caliber-strongest DIEP was detected after passage of the rectus fascia as well as the superficial inferior epigastric artery (SIEA) and correlated with the AWT 5 cm above and below the umbilicus, lateral at the level of the umbilicus and at the level of the anterior superior iliac spine (ASIS), and with BMI. ResultsSeventy-seven patients met the inclusion criteria (age: 47.3 ± 8.9 years). We observed a significant relationship (p < 0.05) between DIEP (mean ∅ = 2.98 mm) and BMI (r = 0.353), the AWT supra- and infraumbilical (r ≥ 0.32), and the AWT lateral at the level of the umbilicus and ASIS (r ≥ 0.25). In addition, there was a highly significant correlation (p < 0.01) between SIEA and BMI (r = 0.389) and between the AWT lateral at the level of ASIS (r ≥ 0.41). ConclusionWe demonstrated a correlation of the diameter of the dominant DIEP with both BMI and AWT. Focusing on the diameter, in patients with a high AWT at the level of the ASIS, the SIEA, if present, may represent an alternative therapeutic option.

Power Morcellation with Contained Tissue Extraction – A Retrospective Chart Review

Study Objective To evaluate the clinical performance of power morcellation (PM) with contained tissue extraction (CTE) (PneumoLiner, Advanced Surgical Concepts, Limited, Wicklow, Ireland) for presumed benign indications for minimally invasive gynecological surgery (MIGS). Design Multi-center, retrospective, IRB-approved chart review conducted by a version-controlled protocol. The primary endpoint was operative time and was measured from skin incision to skin closure. Secondary endpoints included complications related to the surgical procedure, morcellator, or tissue containment device; integrity of the tissue containment device following post-operative inspection; specimen histopathology; 30-day hospital readmission; and device deficiencies. Data were pooled and descriptive statistics were used for per-protocol analysis. Setting Three tertiary care institutions in the United States Patients or Participants 211 cases including females ≥ 18 years of age indicated for MIGS (robotic or laparoscopic) using PM and CTE were included in this study. Cases were excluded if patients were peri- or post-menopausal, had a known malignancy, were candidates for en bloc tissue removal, had undiagnosed uterine bleeding, had suspected allergies to polyurethane, or had abdominal wall thickness > 10cm. Interventions N/A Measurements and Main Results Mean age and body mass index was 41.2±6.7 years and 30.9±7.1 kg/m2 respectively. Common surgical indications included: uterine fibroids 70% (148), abnormal uterine bleeding 63% (133), and endometriosis 19% (40). Mean operative time was 82±36.7 minutes. Post-operative complications were reported in 2.4% (5) of patients, including umbilical port site (3) and urinary tract infections (2); all were related to the surgical procedure. Integrity of the tissue containment device was maintained in 100% (211) of cases. Histopathology confirmed malignancy in 0.5% (1) of patients. There were no hospital readmissions or device deficiencies. Conclusion Power morcellation with contained tissue extraction is feasible in patients with presumed benign indications for minimally invasive gynecologic surgery.

Abdominal Wall Thickness Is a Predictor for Postoperative Infections in Colorectal Patients

Abdominal Wall Thickness Is a Predictor for Postoperative Infections in Colorectal Patients

3D black-blood 3T-MRI for the diagnosis of abdominal large vessel vasculitis.

To assess the value of a T1-3D black-blood turbo spin echo (TSE) sequence for the diagnosis of abdominal large vessel vasculitis (LVV). The study included 20 patients with abdominal LVV and 17 controls, who underwent a 3T-MRI scan using a modified T1-3D volumetric isotropic TSE acquisition and a segmented T1-3D turbo field echo sequence (T1-mVISTA/T1-eTHRIVE). Two radiologists independently analyzed the aorta for concentric contrast enhancement, concentric wall thickening, image quality, and flow artifact intensity (CCE/CWT/IQ/FAI; 4-point scales). The mean aortic wall thickness (MAWT) in post-contrast T1-mVISTA was compared between patients and controls. IQ of T1-mVISTA was rated good to excellent in 91.5% of 282 evaluated vessel segments with no or minor FAI present in 85.5%. The inter-observer reproducibility for the identification of CCE/CWT on T1-mVISTA was 0.92 and 0.93 (p < 0.001). The distribution of segmental inflammation in T1-mVISTA significantly correlated with T1-eTHRIVE (CCE, κ= 0.768; CWT, κ = 0.715; p < 0.001), resulting in a sensitivity, specificity, and positive predictive value of 100%, 81.3%, and 83.3%. The MAWT significantly differed between patients and controls (3.29 ± 0.81 vs. 2.24 ± 0.45mm; p < 0.001). T1-mVISTA enables the evaluation of the MAWT and allows the detection of abdominal LVV. • 3D T1w-mVISTA accurately depicted the large abdominal vessels. • 3D T1w-mVISTA enables accurate measurements of the abdominal aortic wall thickness. • 3D T1w-mVISTA is useful for the detection of abdominal LVV.

A Comparison of Totally Laparoscopic Pylorus Preserving Gastrectomy and Laparoscopy-Assisted Pylorus Preserving Gastrectomy for Early Gastric Cancer.

PurposePylorus-preserving gastrectomy (PPG) is known to have both nutritional and functional advantages over distal gastrectomy for the treatment of early gastric cancer. Although laparoscopic surgery is a popular choice, intracorporeal anastomosis is a newly developed technique that is gaining popularity. This study aimed to determine any differences in the oncological, surgical, and functional outcomes of intracorporeal and extracorporeal anastomosis after PPG.MethodsA retrospective analysis was performed on 90 patients for cT1N0 gastric cancer who underwent laparoscopic pylorus preserving gastrectomy from January 2015 to June 2017 at the OOO, Korea; 38 patients underwent intracorporeal (TLPPG) and 52 underwent extracorporeal (LAPPG) anastomosis. The postoperative oncological, surgical, and functional outcomes were compared between the two groups. In order to compare the outcomes in obese patients, the postoperative and functional outcomes in patients with a BMI of ≥25, and in those with abdominal wall thickness measuring ≥28 mm, were evaluated.ResultsThe TLPPG group showed a significantly reduced wound size (4 cm (3~4) vs 5 cm (5~6), p<0.001) and had fewer wound complaints than the LAPPG group (0.0% vs 15.4%, p=0.01). Postoperative complications were not significantly different between the two groups. In the BMI ≥25 subgroup, the first flatus time after operation was shorter in the TLPPG group (2.9±0.5 vs 3.5±0.8 days, p=0.04).ConclusionThe study demonstrates that both TLPPG and LAPPG are safe and feasible, and that there is a potential benefit for obese patients.