Abdominal Wall Incision Research Articles

Is the NICE procedure the great equalizer for patients with high BMI undergoing resection for diverticulitis?

By 2030, projections indicate that nearly half of USS adults will be obese, with 29 states exceeding a 50% obesity rate. High Body Mass Index (BMI) presents particular challenges in treating diverticulitis, including worsened symptoms and increased risk of surgical complications. The Robotic Natural orifice Intracorporeal Anastomosis with Transrectal Extraction (NICE) procedure has been developed for colorectal surgeries to tackle these challenges. This study evaluates the efficacy of the Robotic NICE procedure in achieving comparable surgical outcomes in patients with both high and normal BMI. This retrospective cohort study assessed the outcomes of robotic-assisted colectomy utilizing the NICE technique in patients with diverticulitis, dividing them into two groups based on BMI: high BMI (≥ 30 kg/m^2) and non-high BMI (< 30 kg/m^2). Among the 194 patients analyzed, the incidence of complicated diverticulitis was significantly higher in the high BMI group (60.5%) compared to the non-high BMI group (39%; p = 0.003).The high BMI group had higher ASA scores, indicating sicker patients. The high BMI group also had a significantly higher rate of unplanned operations within 30 days (7.9% vs. 1.7%, p = 0.034). However, no significant differences were observed in the length of hospital stay, time to first flatus, or ICU admission rates between the two groups. Binary logistic regression highlighted the length of stay as a significant predictor of postoperative complications (Odds Ratio: 1.9686, 95% CI: 1.372-2.825, p < 0.001). Other factors, including age, operative time, and gender, did not significantly predict complications. The findings suggest that the Robotic NICE procedure can mitigate some of the challenges typically associated with conventional minimally invasive surgery in which abdominal wall incision is made, providing consistent outcomes regardless of BMI. Further research is needed to explore long-term benefits, aiming to establish this approach as a standard for managing diverticulitis in our patient population.

Ultrasound-Guided Quadratus Lumborum Block Using Bupivacaine versus Bupivacaine – Dexamethasone as Postoperative Analgesia in Laparoscopic Cholecystectomy

Abstract Background The QLB is an effective analgesic technique for various abdominal wall incisions. The QLB covers T7 to L2 dermatomes by the spread of LA drugs either into the paravertebral space or in the thoracolumbar plane, through iliohypogastric and ilioinguinal nerves, A and C fiber nociceptors, mechanoreceptors and high-density network of lumbar sympathetic fibers. Objective To assess the analgesic sparing effect of adding Dexamethasone to Bupivacaine in Quadratus lumborum block in patients undergoing Laparoscopic cholecystectomy under general anesthesia. Patients and Methods Sixty patients scheduled for elective Laparoscopic cholecystectomy surgeries under general anesthesia were included in this study, they were divided into two groups. Group A (perineural dexamethasone and bupivacaine group) [n = 30] Those cases will receive 2ml volume of dexamethasone (8mg) combined with 18 ml of bupivacaine of 0.25% concentration. Group B (perineural bupivacaine group) [n = 30] Those cases will receive perineural 18 ml bupivacaine (0.25%) combined with 2 ml normal saline. Results At the end of this study we found that The addition of dexamethasone to bupivacaine in QLB in Laparoscopic cholecystectomy surgeries provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to bupivacaine alone group. Conclusion The addition of dexamethasone to Bupivacaine in lateral QLB in Laparoscopic cholecystectomy surgery provides a prolonged duration of postoperative analgesia, with reduced analgesic requirements, a better quality of analgesia in terms of NRS compared to bupivacaine alone group.

A descriptive analysis of skin-only closure and Bogota bag techniques for achieving complete fascial closure in damage control abdominal surgery

BackgroundTemporary abdominal closure (TAC) techniques are essential in managing open abdomen cases, particularly in damage control surgery. Skin-only closure (SC) and Bogota bag closure (BBC) are commonly used methods for TAC, but their comparative effectiveness in achieving primary fascial closure (PFC) remains unclear. The objective of this study was to evaluate the rates of PFC between patients undergoing SC and BBC techniques for TAC in peritonitis or abdominal trauma cases at a tertiary care hospital.MethodsA retrospective cross-sectional study was conducted at the Surgical A Unit of Hayatabad Medical Complex, Peshawar, from January 2022 to July 2023. Approval was obtained from the institutional review board, and patient consent was secured for data use. Patients undergoing temporary abdominal closure using either skin-only or Bogota bag techniques were included. Exclusions comprised patients younger than 15 or older than 75 years, those with multiple abdominal wall incisions, and those with prior abdominal surgeries. Data analysis utilized SPSS version 25. The study aimed to assess outcomes following damage control surgery, focusing on primary fascial closure rates and associated factors. Closure techniques (skin-only and Bogota bag) were chosen based on institutional protocols and clinical context. Indications for damage control surgery (DCS) included traumatic and non-traumatic emergencies. Intra-abdominal pressure (IAP) was measured using standardized methods. Patients were divided into SC and BBC groups for comparison. Criteria for reoperation and primary fascial closure were established, with timing and technique determined based on clinical assessment and multidisciplinary team collaboration. The decision to leave patients open during the index operation followed damage control surgery principles.ResultsA total of 193 patients were included in this study, with 59.0% undergoing skin-only closure (SC) and 41.0% receiving Bogota bag closure (BBC). Patients exhibited similar demographic characteristics across cohorts, with a majority being male (73.1%) and experiencing acute abdomen of non-traumatic origin (58.0%). Among the reasons for leaving the abdomen open, severe intra-abdominal sepsis affected 51.3% of patients, while 42.0% experienced hemodynamic instability. Patients who received SC had significantly higher rates of primary fascial closure (PFC) compared to BBC (85.1% vs. 65.8%, p = 0.04), with lower rates of fascial dehiscence (1.7% vs. 7.6%, p = 0.052) and wound infections (p = 0.010). Multivariate regression analysis showed SC was associated with a higher likelihood of achieving PFC compared to BBC (adjusted OR = 1.7, 95% CI: 1.3–3.8, p < 0.05).ConclusionIn patients with peritonitis or abdominal trauma, SC demonstrated higher rates of PFC compared to BBC for TAC in our study population. However, further studies are warranted to validate these results and explore the long-term outcomes associated with different TAC techniques.

Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial

BackgroundThe recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed.MethodsWe propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery.DiscussionThis trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates.Trial registrationUMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205

Efficacy of Trans Abdominis Plane (TAP) Block for Post-caesarean Delivery Analgesia: A Prospective Randomized Controlled Study

Background: Caesarean delivery is a major surgical procedure after which substantial post-operative pain and discomfort can be anticipated. A substantial component of pain experienced by patients is derived from abdominal wall incision. Currently multimodal analgesia technique involving abdominal field block with parenteral analgesia are becoming popular for these patients. Transversus abdominal plane (TAP) blockcan relieve pain associated with abdominal incision. We carried out this study to evaluate the efficacy of TAP block in providing post operativepain relief and the cumulative requirement of analgesic over first 48 hour in patients who underwent LSCS under spinal anaesthesia.Methods: This prospective randomized controlled study was carried out with 60 patients posted for electivecaesarean section, two groups with 30 patients each. Both groups were compared to see the effectiveness of Trans Abdominis Plane (TAP) Block as a method for post-operative multimodal analgesia technique using VAS score. Total number of rescue analgesia required upto 48hrs and total dose of rescue analgesia given in both the groups was also compared.Results: The mean VAS score at rest andon movement was decreased significantly after Trans Abdominis Plane (TAP) Block. The total dose and number of rescue analgesia was also decreased significantly.Conclusions: TAP block as a component of multimodal analgesia after caesarean section was effective in providing analgesia with delayed time for 1st rescue analgesia and reduction in total analgesic requirement in 1st 48 hr.

DESCRIPTION OF POST SECTIO CAESAREA PATIENTS WITH CONVENTIONAL METHODS AND ERACS METHODS

hysterotomy) through an incision in the front abdominal wall. The problem that often arises in post Section Caesarea patients is pain that is still felt 2-3 days after Sectio Caesarea so that it makes the mother reluctant to move her body. The purpose of this research is to describe the pain level of post section caesarea patients by conventional method and ERACS method in Melati Room at Immanuel Way Halim Bandar Lampung Hospital.The design of this research is descriptive research. The population of this study were conventional post-cesarean section patients and in patients with the ERACS method. The number of samples was 48 patients, 36 conventional post section caesarea patients and 12 post-caesarean patient with the ERACS method. This reseach used accidental sampling.

External oblique intercostal block in open nephrectomy patients - A zenith in analgesia for anterolateral upper abdominal surgeries: A case series

Open nephrectomy is a common surgery usually performed for malignant and non-malignant renal pathologies. The external oblique intercostal block (EOIB) blocks the anterior and lateral cutaneous nerves from T6 to T10 and provides somatic analgesia. We present a case series of the use of EOIB in patients undergoing open nephrectomy by subcostal incision. Ten patients were given EOIB, which included patients undergoing simple nephrectomy for non-functioning kidneys and radical nephrectomy for renal mass. The patients had satisfactory numerical rating scale scores, mostly &lt;4 for 24 h. Post-operative opioid consumption was minimal. The external oblique fascial plain block is a novel thoracic block that provides reliable upper thoracoabdominal somatic analgesia. It can certainly be considered a suitable option in surgeries such as nephrectomies that involve an upper lateral abdominal wall incision.

Penerapan Terapi Relaksasi Benson Untuk Mengurangi Nyeri Pada Klien Post Sectio Caesarea Dengan Indikasi Letak Lintang Di Ruang Anggrek RSUD Dr.T.C Hillers Maumere

Background: Sectio caesarea is an artificial birth in which the fetus is born through an incision in the front abdominal wall and uterine wall provided that the uterus is intact and the fetus weighs above 500 grams (Ramandanty, 2019). Sectio Caesarea is a surgical procedure by opening the abdominal wall and uterine wall to give birth to a fetus with a fetal weight of more than 500 grams and a fetal age of &gt; 28 weeks and is carried out by means of surgery on the abdominal wall (laparotomy) and uterus (hysterectomy) with the aim of removing one or more babies. Sectio Caesarea delivery is carried out to prevent the death of the fetus and mother due to complications that will occur in vaginal delivery. Relaxation techniques are the most appropriate techniques for reducing pain, one of which is Benson Relaxation which is a development of the deep breathing relaxation method by involving the patient's confidence factor which can create a calm environment so that it can help patients achieve a higher state of health and well-being. Research Objective: to analyze the effect of the Benson relaxation technique on post caesarean section patients in the Orchid (Nifas) room at RSUD dr. T.C Hillers Maumere. Research Method: The research method used was a descriptive method with a case study/nursing care approach, with 2 patients who experienced post-cesarean section pain. Results: The results found after applying the Benson relaxation technique in both patients gave a positive response and the level of post caesarean section pain decreased. Conclusion: Benson relaxation therapy is effective in reducing pain.

A case of urachal abscess resection via colpotomy in a cow.

This study describes a novel surgical method to remove urinary bladder-related urachal abscesses in a cow. Traditional methods, such as the midline or paramedian approach in calves and the preinguinal approach, can be challenging in adult cattle, especially for lesions situated near the pelvic cavity. In this case, a 4-year-old cow had a urachal abscess attached to the bladder apex, making it difficult to approach via abdominal wall incision. Colpotomy and pulling the abscess through a vaginal wall incision allowed for complete exteriorization of the lesion and comfortable accessibility of the abscess and the resection site. This report suggests that colpotomy is an effective new route in adult cattle for accessing urachal abscesses not accessible via traditional surgical approaches.

Uterine giant cell tumor of soft tissue: A case report.

Giant cell tumor of soft tissue (GCT-ST) is a rare primary soft tissue tumor. GCT-ST mainly occurs in the trunk and extremities. There is no standard treatment for GCT-ST. This paper reports a rare case of primary uterine GCT-ST. A 48-year-old female patient underwent a transabdominal subhysterectomy for uterine leiomyoma. Postoperative pathological examination showed GCT-ST with unclear tissue boundary (10.0 × 6.0 × 5.0 cm). A small amount of GCT-ST tissue could be seen on the local edge of the leiomyoma. Residual tumor tissue was found around the uterine cavity. The patient reported persistent lower abdominal distension pain 3 months after the operation. Pelvic and abdominal imaging showed a huge tumor and multiple pelvic and abdominal organ metastasis. No pulmonary metastasis was found. Exploratory surgery revealed widespread metastases in the abdominal and peritoneal cavities, involving both ovaries, right tubal serous membrane, appendix serous membrane, bladder, pelvic peritoneum, and abdominal wall incision. After surgery, the patient had 6 cycles of docetaxel and carboplatin but stopped treatments due to economic reasons. The patient died 3 months later because of multiple organs failure. GCT-ST is generally benign but has unpredictable behavior. A massive recurrence with wide invasion is possible after subtotal resection.

The roboticNICE procedure outperforms conventional laparoscopic extracorporeal-assisted colorectal resection: results of a matched cohort analysis.

We introduced the robotic NICE procedure for left-sided colorectal resection in 2018 in which the entire procedure is performed without loss of pneumoperitoneum and without an abdominal wall incision by performing natural orifice-assisted transrectal extraction of the specimen and intracorporeal anastomosis. We compare the results of the NICE procedure versus conventional laparoscopic resection, which was our standard approach prior to 2018. A matched pair case-control study compared patients following the NICE procedure versus those who underwent laparoscopic left-sided colorectal resection with conventional extracorporeal-assisted technique. Cases were performed at an Academic Medical Center and recorded in a prospective database to analyze perioperative outcomes. From a total cohort of 352 patients, 83 were matched in each group. When comparing the NICE procedure vs. the Extracorporeal-Assisted laparoscopic group, there were no significant differences in age (58.5 vs. 59.3years old), sex (47 vs. 42 Female), body mass index (27.4 vs. 27.5kg/m2), ASA, diagnosis, or type of surgery. Operative time (198.8 vs. 197.7min), blood loss (56.0 vs. 53.3ml), intraoperative complications (0.0% vs. 0.0%), and conversion rates (0.0% vs. 0.0%) were similar in both groups. The NICE procedure was associated with significantly earlier return of bowel function (40.7 vs. 23.6h), shorter length of stay (3.1 vs. 2.2days), and lower total opioid use (94.6 vs. 70.5 morphine milligram equivalents). Overall, there were no differences in postoperative abscess formation, complications, readmission, or reoperation rates. When compared to conventional laparoscopic resection, the NICE procedure is associated with short-term benefits including earlier recovery and less opioid use without increased operative time or increased risk of complications. Multicenter studies are recommended to validate benefits and limitations of this technique.

The Outcomes of Using Scalpel and Electrosurgery Methods for Anterior Abdominal Wall Incision During Cesarean Section

Background: There are different ways to make a surgical incision. The most widely used ones are the use of scalpel and electrosurgery. Each of these methods has advantages and disadvantages that affect its use. Objectives: This study aimed to compare scalpel and electrosurgery methods in cutting the anterior abdominal wall during Cesarean section. Methods: This double-blind clinical trial manner was conducted by permuted block randomization. The participants were placed in two groups. In the scalpel group, incisions were made with a scalpel, and in the electrosurgery group, incisions were made with an electrosurgical pencil. This clinical trial was conducted on 86 pregnant women who were candidates for Cesarean section with spinal anesthesia. The inclusion criteria were an age range of 18 - 45 years, gestational age of 37 - 41 weeks, Pfannenstiel skin incision, and willingness to participate. The exclusion criteria were emergency Cesarean section, vertical skin incisions, incomplete medical files, chronic skin diseases, allergy to antibiotics, consuming anticoagulants, cardiovascular and pulmonary problems, and underlying diseases. Results: There was no significant difference between the two groups in terms of intraoperative bleeding, newborn Apgar score, postoperative pain, and wound complications. However, the duration of surgery (P = 0.012), incision time (P = 0.049), and hemodynamic status showed a significant difference (P &lt; 0.05). Conclusions: The use of electrosurgery to make a surgical incision does not pose a risk to the patient if safety points are followed.

V-026 LAPAROSCOPIC TAPP REPAIR: IS IT REALLY FEASIBLE IN A RE-RECURRENT HERNIA?

Abstract Aim Describe a step by step laparoscopic transabdominal preperitoneal (TAPP) repair of a re-recurrent incisional lumbar hernia. Material &amp; Methods This is the case of a 72-year-old man who had a previous traumatic right lumbar hernia initially approached by laparoscopic intra-peritoneal onlay mesh repair (IPOM) and its recurrence approached by open onlay mesh repair. CT-scan revealed a lumbar hernia on the right with a neck size of 40 mm. The hernia sac measured 65 mm and contained part of the right colon inside, without signs of incarceration nor dilated intestinal loops. According to the European Hernia Society classification for incisional abdominal wall hernias, the patient had a lateral hernia (L4 W2). Results Lateral incisional hernias are limited by the inguinal region inferiorly, the costal margin superiorly, the lateral margin of the rectal sheath medially and the lumbar region laterally. Due to their low incidence and the resulting lack of expertise in the treatment of this abdominal wall defect, surgical treatment poses a challenge- Conclusion The repair of a recurrent hernia is a daunting task, even more so of a re-recurrent one. By choosing to perform a TAPP repair, we were able to prove a laparoscopic re-do repair is feasible even faced with weakened tissues and distorted anatomy.

OC-030 COMPARISON OF OUTCOMES OF THE EXTENDED-VIEW TOTALLY EXTRAPERITONEAL RIVES-STOPPA (ETEP-RS) AND THE INTRAPERITONEAL ONLAY MESH WITH DEFECT CLOSURE (IPOM-PLUS) FOR W1-W2 MIDLINE INCISIONAL HERNIA REPAIR

Abstract Aim This study aimed to compare the outcomes of the eTEP-RS and IPOM-plus procedures in W1 and W2 midline incisional abdominal wall hernia (IAWH) repairs performed by the same surgeon. Material and Methods Prospectively collected data of laparoscopic abdominal wall repairs performed on 61 patients with eTEP between November 2018 and April 2022 and on 67 patients with IPOM-plus between January 2016 and April 2022 were retrospectively analyzed. A total of 74 out of 128 patients, 30 in the eTEP-RS group and 44 in the IPOM-plus group, who underwent W1-W2 midline incisional hernia repair were included in the study. The mean follow-up was 24 months in the eTEP-RS group and 45 months in the IPOM-plus group. Results There was no statistically significant difference between the groups regarding age, sex, BMI, ASA score, or active smoking. The mean mesh area (MMA) and mesh/defect (M/D) ratio were higher in the eTEP-RS group (p &amp;lt;0.001 and p =0.004). In the eTEP-RS group, the hospital length of stay (LOS) (1.48 days vs. 2.58 days, p &amp;lt;0.001) and pain on the first and 10th postoperative days were significantly lower (p &amp;lt;0.001), while the operative time was significantly longer (p &amp;lt;0.001). There was no significant difference in terms of intraoperative complications (p =0.56), seroma formation (p =0.83), or recurrence (p =0.83). Conclusions The eTEP-RS technique has advantages over the IPOM-plus approach, such as a shorter LOS and less early postoperative pain with W1-W2 midline IAWH repair. However, the eTEP technique has a longer operative time.

OC-096 Short-Term Results of Transversus Abdominis Release in Patients under Immunosuppression

Abstract Aim Immunosuppressive medication might increase the likelihood of wound morbidity, with possible higher rate of surgical site infections (SSIs). We aim to identify short-term outcomes and hospital stay after incisional hernia repair with transversus abdominis release (TAR) in patients with versus without immunosuppression. Material &amp; Methods All patients undergoing open incisional abdominal wall hernia repair with uni-or bilateral TAR from January 2021 through November 2022 were identified using a prospectively maintained database. Minimum follow-up was 30 days. Outcomes included 30-day SSIs, seroma rate, hospital stay, and early recurrence. Results Twenty-seven patients with immunosuppressive medication were identified and 75 without (mean age 59.0 ± 13.9 vs. 65.1 ± 11.4, 74.1% vs. 46.7% male, respectively). Median hernia width was 7.7 ± 5.1 cm vs. 7.9 ± 4.3 cm respectively. At 30 days follow-up, SSI rate was 1/27 (3.7%) in the group under immunosuppression and 5/75 (6.7%) in the group without (p = 0.575). Seroma rate was 3/27 (11.1%) vs. 12/75 (16.0%), respectively (p = 0.539). Mean hospital stay was 6.0 ± 3.6 days in the immunosuppression group vs 8.1 ± 6.7 days in the group without (p = 0.052). No early recurrences were detected in either group. Conclusion Immunosuppression does not significantly increase the risk of short-term complications in incisional hernia repair with transversus abdominis release. There is a trend towards a shorter hospital stay in patients under immunosuppression, possibly related to a reduced inflammatory response.

P-041 3-YEAR RETROSPECTIVE ANALYSIS OF USE OF ONLAY PROPHYLACTIC MESH IN MIDLINE LAPAROTOMY FOR GASTRIC CANCER

Abstract Background Incisional hernias are a frequent complication of abdominal wall incisions, ranging from 12.8% to 69% in long-time series. Recent literature supports the use of prophylactic mesh placement to avoid long-term incisional hernias. Gastric surgery in our center is performed via midline laparotomy and prophylactic mesh placement is carried out as a usual practice. The objective of our study is to evaluate long-term results of prophylactic mesh in midline laparotomies for gastric cancer. Methods Observational retrospective analysis of all patients undergoing gastric cancer sugery via midline incision with use of a polypropliene autoadhesive prophylactic mesh, between the years 2019–2021. Outcome measures included demographics, comorbidities, wound complications, reinterventions, neoplastic recurrences and incisional hernias (diagnosed by CT scan). Results A cohort of 55 patients (80% male). Mean age 68.1 years old (41–86), BMI 25,75 kg/m2 (18.73–33). All patients operated for gastric cancer, abdominal wall closure with small bite technique (monofilament absorbable 2/0 suture) and autoadhesive onlay mesh. 72.7% distal subtotal gastrectomies. 89% elective surgery. Mean albumin in preoperative analytic 40.5 g/L. Postoperative complications: 72% Clavien-Dindo grade II, mean CCI 29 (including 4 reinterventions and 1 exitus). Mean follow-up 24.9 months: 8 (14.5%) neoplastic recurrences, 4 (7.3%) exitus for cancer progression and 3 (5.4%) incisional hernias diagnosed by CT Scan (none of them reoperated). No meshes have been removed. In a comparative study no risk factors for incisional hernia have been found. Conclusions In our setting, the use of polypropylene autoadhesive prophylactic meshes in midline incision for gastric cancer is safe and durable.

Dl-3-n-butylphthalide improves intestinal microcirculation disorders in septic rats by regulating the PI3K/AKT signaling pathway and autophagy.

Sepsis has complex pathophysiological mechanisms that bring new challenges in the treatment of sepsis at a time when the intestinal microcirculation in sepsis is receiving increasing attention. Dl-3-n-butylphthalide (NBP), which is a drug that can improve multiorgan ischemic diseases, is also worth examining to improve the intestinal microcirculation in sepsis. In this study, male Sprague-Dawley rats were divided into the sham group (n=6), CLP group (n=6), NBP group (n=6) and NBP+LY294002 group (n=6). The rat model of severe sepsis was established by cecal ligation and puncture (CLP). Abdominal wall incisions and sutures were performed in the first group, and CLP was performed in the latter three groups. Normal saline/NBP/NBP+LY294002 solution was injected intraperitoneally 2h or 1h before modeling. Hemodynamic data (blood pressure and heart rate) were recorded at 0, 2, 4 and 6h. Sidestream dark field (SDF) imaging and the Medsoft System were used to observe the intestinal microcirculation of rats and obtain data at 0, 2, 4, and 6h. Six hours after the model was established, the serum levels of TNF-α and IL-6 were measured to evaluate the level of systemic inflammation. Pathological damage to the small intestine was evaluated by electron microscopy and histological analysis. The expression levels of P-PI3K, PI3K, P-AKT, AKT, LC3 and p62 in the small intestine were analyzed by Western blotting. The expressions of P-PI3K, P-AKT, LC3 and P62 in small intestine were detected by immunohistochemical staining. NBP improved intestinal microcirculation disturbances in septic rats, alleviated the systemic inflammatory response, reduced the destruction of the small intestinal mucosa and the disruption of microvascular endothelial cells, and alleviated autophagy in vascular endothelial cells. NBP increased the ratio of P-PI3K/total PI3K, P-AKT/total AKT, and P62/β-actin and decreased the ratio of LC3 II/LC3 I. NBP ameliorated intestinal microcirculation disturbances and the destruction of small intestinal vascular endothelial cells in septic rats by activating the PI3K/Akt signaling pathway and regulating autophagy.

TRANSVERSUS ABDOMINIS PLANE(TAP) BLOCK AS A PART OF MULTIMODAL ANALGESIA AFTER CAESAREAN SECTION DELIVERY

Background: Patients after Caesarean Section go through post operative pain. Most of this pain is experienced after the abdominal wall incision. Transversus abdominis plan (TAP) block as part of multimodal analgesia is a novel approach for patients delivered by caesarean section (CS). This technique (TAP block) lends itself particularly well to resource-poor settings as it does not require a nerve stimulator. The aim of this study was to evaluate the efcacy of transversus abdominis plane (TAP) block when it is used as part of multimodal analgesia on obstetric patients after Caesarean Section. Methods: Institution based prospective cohort study design was conducted on patients, who have Caesarean Section from January to March, 2023. All patients operated under spinal anaesthesia for caesarean delivery were included. Patients divided into TAP block (n=20) and controls (n=20). The TAP block group was given bilateral 20 ml of 0.25% bupivacaine at the end of surgery. Postoperative pain was assessed within the rst 24 hours i.e. at 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours using 100 mm long visual analogue scale (VAS), total analgesic consumption and time for the rst analgesic request. Result: There was reduction of VAS scores within the rst 24 hours after caesarean section in TAP block group compared with the control group. VAS scores as median(IQR) at 2 hours 0.00(0.00-11.50) vs 39.00(7.75-60.50), p=0.001, at 4 hours 0.00(0.00–12.75) vs 17.50(13.25-24.00), p=0.000, at 6 hours 9.00(1.50-12.00) vs 22.00(14.75-45.00), p=0.000, at 12hours 13.00(11.00-16.00) vs 42.00(10.00-52.00), p=0.003, at 24 hours 10.00(8.0012.00) vs 15.50(11.25-26.00), p=0.013 respectively. The total analgesic Tramadol consumption within 24 hours was reduced in TAP block group, and time for the rst analgesic request was signicantly prolonged (286.00 vs 76.25, p=0.000) minutes. Conclusion: Bilateral TAP block provides lower postoperative severity of pain, reduced total postoperative Tramadol analgesics consumption and prolonged time for the rst analgesic request after caesarean section under spinal anaesthesia when it is used as multimodal analgesia. We recommend TAP block should be included as part of multimodal analgesia in the postoperative period for women after Caesarean Section delivery

Review of incisional hernias

The 10 to 15% of patients get incisional hernias following any type of abdominal wall incision, with midline wounds carrying a larger risk (3 to 20%). Infection at the surgery site, obesity, smoking, malnutrition, and poor surgical technique are risk factors. Clinical signs include an abdominal bulge at or near a prior incision, which, in non-obese individuals, is frequently identified by palpating the split borders of the fascial defect. CT imaging is particularly useful for complicated ventral hernias, which are characterized by enormous size or considerable loss of dominance. For the purpose of detecting any contents within the hernia sac and deciding whether preoperative abdominal expansion is necessary to lower the risk of postoperative abdominal compartment syndrome, preoperative CT imaging is crucial. When clinically necessary, surgeons should think about making an incision outside the midline and employ the proper fascia closure procedures to lower the likelihood of an incisional hernia. Although the implantation of preventative mesh during the closure of abdominal incisions is being studied, routine usage is not advised owing to probable long-term problems. Incisional hernias can be treated surgically or expectantly, and the patient should be informed of both options.

Biological prosthesis, platelet enriched plasma and bone marrow stem cells in complicated incisional hernia reconstruction in emergency surgery: a prospective case control study

Numerous innovations have been aided by abdominal wall surgical repair. Abdominal wall surgery was drastically altered by synthetic materials. Tissue engineering was unquestionably first applied to biomaterials. The purpose of the present study is to compare different repeating approaches with rising tissue engineering complexity in repairing complex incisional hernia in emergency setting. Patients with complicated incisional hernia were prospectively included in the study and divided into 4 groups: DR (Direct Repair) group underwent direct reconstruction of the abdominal wall, BR (Biological mesh Repair) group underwent reconstruction of the abdominal wall with biological mesh (retro-muscular), BPR [Biological mesh and Platelet Enriched Plasma (PEP), gel] group underwent reconstruction of the abdominal wall with Biological mesh (retro-muscular) and PEP, BPSR (biological mesh, PEP gel and Bone Marrow Stem Cells) group underwent reconstruction of the abdominal wall with biological mesh (retromuscular), PEP and Bone Marrow Stem cells (BMSc). Forty patients were enrolled. Patients in the DR group experienced a higher rate of severe complication (p&lt;0.05). Recurrence rates were 60% for DR patients, 20% for BM patients and 10% for the BM+PEP group (p&lt;0.05). Median follow-up period was 64.6, 55.7 and 55.8 months (p&lt;0.05). 7- and 30-days abdominal wall thickness is progressively increased by different techniques: BP, BP+PEP and BP+PEP+BMSc (p&lt;0.05). No mortality was registered. Tissue engineering techniques in abdominal wall reconstruction showed promising results. They seem to reduce the recurrence rate without increasing complication one in complicated incisional abdominal wall hernia. Although many aspects are yet to be determined and standardized, it seems extremely important to continue research and experimentation in this field.