Correction Of Abdominal Wall Defects Research Articles

Laparoscopy-assisted percutaneous correction of abdominal wall defects in the umbilical region in a cadaveric model of bovine fetus.

Abdominal wall defects in calves are commonly diagnosed and treated via laparotomy. This technique has witnessed several advancements in the management of these disorders. This study aimed to create a study model and evaluate the feasibility of video-assisted percutaneous correction of abdominal wall defects in bovine fetuses (corpses) compared with the conventional technique. Sixteen bovine fetuses from pregnant cows slaughtered in slaughterhouses were included in this study. The fetuses were categorized into the control group (CG, n = 8), which was subjected to umbilical abdominorrhaphy via laparotomy, and the video-surgical group (VG, n = 8), which received video-assisted percutaneous sutures with two lateral accesses on the right flank. An abdominal wall defect was created in the VG group to generate a study model, which was corrected using the laparoscopic technique. The procedures were performed in two steps. The first step consisted of creating an abdominal wall defect in the umbilical region by laparoscopic approach in an iatrogenic manner (Step 1: E1). The second stage consisted of conventional abdominorrhaphy of the umbilical region wall defect in the CG group and video-assisted percutaneous suturing of the edges of the iatrogenic abdominal wall defect in the VG group, until reversal of the laparoscopic accesses (Step 2: E2). Step 1 showed no statistically significant difference between the two groups. However, a significant statistical difference (p < 0.0001) was observed between the two groups in step 2. The surgical time of step 2 was longer in the CG group (33.10 ± 0.43 minutes) than that in the VG group (10.13 ± 0.68 minutes, p < 0.0001), and the total surgical time was also longer in the CG group (38.48 ± 0.35 minutes) than that in the VG group (15.86 ± 0.67 minutes). The proposed laparoscopic technique allowed the creation of a study model for video-assisted percutaneous suturing with two portals and reduced the surgical time compared with the conventional technique. However, this method needs to be studied further in live animals.

Symptomatic reponible umbilical hernia in the rabbit

A case of umbilical hernia in a 7-month-old female rabbit was presented to the Surgery Clinic of the Veterinary Faculty, University of Sarajevo. The owner noticed inappetence and lethargy four days before arrival at the clinic. Clinical parameters on physical examination were within the physiological range. Bruxism and lethargy were noted as signs of discomfort due to gas accumulation in colon. A reponible, nonpainful mass in the umbilical scar area was palpated but intestinal peristalsis was not altered. General anesthesia was induced by intramuscular administration of ketamine with medetomidine and maintained with isoflurane. Surgical treatment of hernia included the peritoneal sac dissection and amputation, repositioning of small intestines, and correction of abdominal wall defect. Intraoperative multimodal analgesia approach was used to reduce inhalant anesthesia requirements and to prevent pain-related and stress-related complications. In this case report we described a surgical and veterinary treatment of the reponible umbilical hernia in a rabbit.

Floating gallbladder in exomphalos minor an exceptional condition that should be considered, a case report.

BackgroundThe exomphalos minor or small omphalocele is a defect of the abdominal wall smaller than 5 cm, located in the umbilical cord. It presents a sac containing intra-abdominal organs, mainly the small intestine. The main surgical objective is to repair the defected wall, preserving the intra-abdominal structures inside the sac. A floating gallbladder is unusual in this pathology; however, it must be removed when that occurs due to the risk of torsion, inflammation, and volvulus.Presentation of caseWe present the case of a 7-day-old patient who comes to the emergency room with an abdominal mass. The physical examination shows minor exomphalos with local signs of inflammation. Genetic, chromosomal, and imaging studies are solicited. The abdominal ultrasonography report shows the absence of the gallbladder in the liver. The patient requires surgical correction of abdominal wall defect. The gallbladder is found inside the sac of defect that does not have a hepatic fixation; a cholecystectomy is performed. The patient presents a satisfactory postoperative evolution and is discharged.ConclusionsThe exomphalos minor is a malformation of the abdominal wall. It needs surgical treatment; this must be done carefully, preserving the intra-abdominal organs inside the sac as much as possible. The gallbladder without hepatic fixation, elongated meso, or suspended by its pedicle is unusual in pediatric age, and they present a higher risk of torsion, inflammation, and necrosis. For this reason, cholecystectomy is indicated. A minor exomphalos has a better prognosis when the defect is small. It is not associated with malformations or associated structural alterations.

Lipoabdominoplasty in correction of abdominal wall defects

The aim — to increase the treatment efficacy for patients with cosmetic defects of the anterior abdominal wall by introducing new simultaneous operations techniques in combination with lipoabdominoplasty.Materials and methods. The original procedure was used in 42 patients (the main group). The comparison group included 40 patients. The average age of patients in the main group was 38.2 ± 2.8 years, and 41.1 ± 2.3 years in the comparison group. 35 (83.3 %) of the patients in the main group were either obese or overweight (average BMI 34.2 ± 1.9), the maximal patient’s body weight was 113 kg. In the comparison group, the average BMI was 35.1 ± 1.7, the maximal patient’s body weight was 117 kg. The term of postoperative observation was 12 months.Results and discussion. The average duration of surgical intervention was 129 ± 15 min in the comparison group and 170.2 ± 6.5 minutes in the main group, which was caused by the additional liposuction procedure. The average volumes of liposuction were 1253.6 ± 36.2 ml and ranged 250 — 2750 ml. Volumes over 1000 ml were observed in 30 patients (71.4 %). 6 complications (13.3 %) developed in the main group and in 12 patients from the comparison group (30.0 %).Conclusions. The lower level of postoperative complications in patients with 13.3 % with a potentially high risk compared with traditional abdominoplasty — 30.0 % (p &lt; 0.05), is an important argument in favour of lipoabdominoplasty. When evaluating the result after 12 months, the advantage of an excellent result in the main group was found to be 71.2 %, as opposed to 37.5 % in the comparison group.

Pseudoexstrophy associated with penile duplication and hypospadias: A case report and literature review

Bladder exstrophy is a rare developmental anomaly. Four principle variants of bladder exstrophy have been described and they themselves are rarer than the bladder exstrophy. Authors describe the management of a case of pseudoexstrophy type of variant in a 9 month old male child with penile duplication with torsion and coronal hypospadias. The rectal fascial defect was repaired without osteotomy as the distance between two pubic bones was <4 cm (3.1 cm). Genital reconstruction with excision of duplicate atrophic penile shaft and repair of coronal hypospadias with detorsion of the functional penile shaft could be accomplished. The patient had good outcome in terms of cosmesis and urinary stream. Total of 18 cases of the pseudoexstrophy have been described till date. Pseudoexstrophy of bladder is a very rare condition and can simultaneously present with other defects like omphalocele, anorectal malformations, pouch colon, multiple or solitary urogenital anomalies. The principles of correction though remain same with correction of abdominal wall defect with or without osteotomy depending upon severity of pubic diastasis. Other anomalies can undergo treatment as per standard protocol.

Effects of nitrofurazone on correction of abdominal wall defect treated with polypropylene mesh involved by fibrous tissue

To evaluate the effects of nitrofurazone on the correction of abdominal wall defect treated with polypropylene mesh involved by fibrous tissue in rats. A defect in the abdominal wall was created and corrected with polypropylene mesh in 20 rats. They were randomly distributed into four groups: control, fibrous mesh, nitrofurazone and nitrofurazone dip in the mesh. Euthanasia was performed in 21 post-operative days. The healing process was analyzed regarding the meshes and macroscopic and microscopic aspects. All animals had adhesions. However, no statistically significant difference (p>0.05) when compared between groups. Similarly microscopic analysis, in which there was no statistical significance level for the evaluated parameters such as mono and polymorphonuclear lymphocytes, granuloma, fibrosis, necrosis and collagen proliferation. There was no significant effect on the abdominal wall defect repair with polypropylene mesh surrounded by fibrous tissue when dipped in nitrofurazone 2%.

Effect of copaiba oil on correction of abdominal wall defect treated with the use of polypropylene/polyglecaprone mesh

To evaluate the effects of copaiba oil on the correction of abdominal defect treated with the use of polypropylene/polyglecaprone mesh in rats. A defect in the abdominal wall was created and corrected with polypropylene/polyglecaprone mesh in 36 rats. They were randomly distributed into three groups: control, copaiba by oral administration (gavage) and copaiba oil dip in the mesh. Euthanasia was performed after seven, 14 and 21 post-operative days. The healing process was analyzed regarding the meshes and macroscopic and microscopic aspects. All animals had abdominal adhesions, which were smaller in the copaiba (gavage) group (p<0.05). In microscopy, all animals had an acute inflammation stage and the inflammatory response was best characterized by foreign body-type granulomas around the mesh fragments, which was not found in the mesh fragments within the copaiba dip group. There was a greater area of necrosis and fibrosis in the copaiba dip group compared to the control group (p<0.05). The copaiba (gavage) group had a greater quantity of collagen fibers compared to the control group. Copaiba oil administered by gavage decreased the amount of abdominal adhesions, besides accelerating the process of collagen fibers formation, without damages within the early stages of healing. However, when used by dip directly on the mesh, it had corrosive effects compromising the healing process of the abdominal wall.

Monitoring intravesical pressure during gastroschisis closure. Does it help to decide between delayed primary or staged closure?

Introduction and objective: Correction of gastroschisis may be accomplished by either primary or staged closure or even delayed primary closure after the use of a preformed silo. However, there is neither a consensus on the best approach nor established criteria to favor one method over the other. The aim of this paper was to investigate the role of intravesical pressure (IVP) as a tool to prevent abdominal compartment syndrome in newborns undergoing correction of abdominal wall defects. Methods: We retrospectively analyzed 45 newborns with gastroschisis in whom trans-operative intravesical pressure was used to choose between primary or staged closure. A threshold of 20 cm H2O was used and the outcomes between the two methods were compared. Results: In 24 children delayed primary closure was achieved while the remaining 21 underwent staged reduction and closure. There was no difference in the frequency of complications, time to begin oral feeding, length of parenteral nutrition or length of hospital stay between the children of the two groups. The incidence of temporary oliguria or anuria, averaged 33% and it was similar in both groups of children. Conclusion: The data here presented suggests that monitoring intraoperative IVP during correction of gastroschisis may help to select children in whom staged closure is necessary, keeping their complication rate and overall outcome similar to that of children undergoing delayed primary closure. Further prospective studies should investigate more deeply the correlation between type of closure and the development of a compartment syndrome.

Comparative study between polypropylene and polypropylene/poliglecaprone meshes used in the correction of abdominal wall defect in rats

To evaluate the healing process of a defect in the ventral abdominal wall of rats, comparing the polypropylene and polypropylene/poliglecaprone meshes on the 30(th) and 60(th) postoperative day. Thirty two Wistar rats were submitted to a ventral abdominal wall defect, with integrity of the parietal peritoneum. In the repair, were used polypropylene (group A) and polypropylene/poliglecaprone (group B) meshes. The groups were subdivided into four subgroups of eight animals euthanized on the 30(th) (A30 and B30) and 60(th) postoperative day (A60 and B60). Fragments of the abdominal wall of the animals were submitted to macroscopic, tensiometric and histological evaluations. The tensiometry on subgroup A30 showed a mean average break point of 0.78 MPa and in A60, 0.66 Mpa. In subgroup B30 it was 0.84 MPa and in B60, 1.27 Mpa. The score of the inflammatory process showed subacute phase on A30 and B30 sub-groups and chronic inflammatory process in subgroups A30 and 60B. The tensile strength was higher on the wall repaired by polypropylene/poliglecaprone mesh in the 60(th) post-operative day. Histology showed higher concentration of fibrosis on the surface of the polypropylene mesh with a tendency to encapsulation. In polypropylene/poliglecaprone subgroups the histology showed higher concentration of fibrosis on the surface of mesh filaments.

O uso de telas Parietex® e Surgisis® na correção de defeitos produzidos na parede abdominal de coelhos

In general surgery, the repair of abdominal wall hernias has a prominent place, and the indications and uses of meshes have increased due to better results. To compare the repair of induced abdominal wall defects with Parietex and Surgisis meshes, in direct contact with abdominal viscera (intraperitoneal mesh). For the experiments, were used 16 female young adult rabbits. Two full thickness triangular defects of 2 cm base by 2.5 cm high were created, lateral to the linea alba, one at each side. They were repaired with rectangular meshes of 3 cm base by 3.5 cm high, on the right side with Parietex mesh (polyester/collagen-polyethylenglycol-glycerol), and on the left side with Surgisis mesh (lyophilized porcine small bowel submucosa). The evaluation included clinical-surgical findings as well as histological and immunohistochemical parameters. Eight rabbits were subjected to euthanasia after 30 days, and the eight after 60 days. Both meshes induced skin erosions, despite the varying levels of mesh undermining evaluated, no incisional hernia occurred. There were peritoneal adhesions to the surface of both types of meshes after 30 days and in a lower extent and intensity after 60 days. Meshes' shrinking correspond to 1/3 of the original size and Parietex caused less inflammatory process at the histologic evaluation. Deposition of collagen type I presented no significant difference between the meshes, but deposition of collagen type III was more intense after 60 days, in both groups. Regarding collagen's rearrangement, the production of MMP8 was higher on Parietex after 30 days, and MMP13 enzyme was increased after 60 days, in both meshes (significant only for Parietex). Both meshes were efficient in the correction of abdominal wall defects, and with similar results, but Parietex presented less inflammatory process and greater amount of matrix-metalloproteinases MMP8 and MMP13 than Surgisis.

The incidence and morbidity of adhesions after treatment of neonates with gastroschisis and omphalocele: a 30-year review

Background/Purpose Adhesive small bowel obstruction (SBO) is a feared complication after correction of abdominal wall defects in neonates. Knowledge of its incidence and potential risk factors in a well-documented group with strict follow-up is needed to guide preventive measures. Methods Records of 170 neonates with abdominal wall defects, 59 gastroschisis (GS) and 111 omphalocele (OC), were reviewed focusing on SBO. Risk of SBO was calculated, and potential risk factors were analyzed. Long-term complaints possibly associated with adhesions were assessed through questionnaire. Results One hundred forty-seven neonates were operated on, 12 were treated nonoperatively, and 11 patients died shortly after birth. Defects were primarily closed in 128, 7 neonates needed prosthetic mesh, and 12 had a silastic sac inserted. Twenty-six (18%) neonates had SBO, 14 (25%) of 55 with GS, and 12 (13%) of 92 with OC ( P = .06). Of the 26 with SBO, 26 (88%) needed laparotomy. Four patients died because of SBO. Most episodes (85%) were in the first year. Sepsis and fascia dehiscence were predicting risk factors for SBO. Abdominal pain and constipation were frequent long-term complaints not significantly associated with SBO. Conclusions Adhesive SBO is a frequent and serious complication in the first year after treatment of congenital abdominal wall defects. Sepsis and fascial dehiscence are predictive factors.

Developmental pattern of maximal transdiaphragmatic pressure in infants during crying.

Diaphragm strength was measured as maximal transdiaphragmatic pressure (Pdi) during airway occlusion in 38 infants aged 11.6 +/- 0.5 (S.E.) months postconception (mpc), range 8-21 mpc. All infants were asymptomatic at the time of study and required no mechanical ventilatory assistance. Ten infants had previous surgical correction of abdominal wall defects (gastroschisis/omphalocele); 10 infants had previous surgical correction of congenital diaphragmatic hernia; and 18 infants had no thoracic or abdominal surgery. The mean maximal Pdi for all infants was 72 +/- 3 cmH2O. There were no significant differences between the three groups. All infants with a maximal Pdi of less than 60 cmH2O were aged less than 10 mpc. After 13 mpc there was no significant increase in maximal Pdi. Between the ages 8-13 mpc there was a significant positive correlation between maximal Pdi and age postconception (r = 0.87, P less than 0.0005), reflecting a developmental pattern of increasing maximal transdiaphragmatic pressure in infants during crying.

1721 DEVELOPMENTAL PATTERN OF DIAPHRAGM STRENGTH IN INFANCY

Diaphragm strength was measured as maximal transdiaphragmatic pressure (Pdi) during airway occlusion in 33 infants aged 11.3 ± 0.6 (SE) months post-conception (mpc), range 8-21 mpc. All infants were asymptomatic at the time of study and required no ventilatory support. 9 infants had previous surgical correction of abdominal wall defects (gastroschisis/omphalocele), 9 infants had previous surgical correction of congenital diaphragmatic hernia, and 15 infants had no thoracic or abdominal surgery. The mean maximal Pdi for all infants was 69.7 ± 3.5 cm H2O. There were no significant differences between the 3 groups (P = 0.20). In the entire group, there was a significant correlation between maximal Pdi and age {Pdi (cm H20) = Age (mpc) x 3.4 + 30.9; r = 0.598; P = 0.0005}. In contrast, maximal Pdi in 3 ventilator dependent infants was less than 30 cm H2O. Subsequently, Pdi increased to above 40 cm H2O in these 3 infants following the ability to wean from mechanical ventilatory assistance. We conclude that diaphragm strength increases during the first year of life. Since respiratory failure may be viewed as inadequate ventilatory muscle power to overcome increased work of breathing, young infants may be at increased risk for respiratory failure relative to older infants due to decreased diaphragm strength.