Linea Alba Research Articles

The Impact of Hypopressive Abdominal Exercise on Linea Alba Morphology in Women Who Are Postpartum: A Short-Term Cross-Sectional Study.

The purpose of this study was to determine the acute effect of an abdominal hypopressive exercise (AHE) on linea alba morphology among women who are primiparous and to compare this effect with that of other common abdominal exercise modalities. A cross-sectional study of 46 women 3months after first delivery was conducted. B-mode ultrasound imaging of the interrectus distance (IRD) and linea alba distortion was performed 2cm below (I-point) and above (S-point) the umbilicus and at the mid-point between the umbilicus and xiphoid process (X-point). Images were recorded at rest and during an AHE performed in a supine position, a semi curl-up (SCU), an abdominal drawing-in maneuver (ADIM), and a SCU performed after an initial ADIM (ADIM+SCU). The SCU exercise narrowed the IRD at the X- and S-points. Compared with SCU, AHE and ADIM widened the IRD at the S- and X-points. No significant differences were found when comparing the IRD at rest, during AHE and during ADIM, but AHE tended to narrow I-point IRD more than ADIM but to widen S-point IRD more than ADIM+SCU. No participant showed linea alba distortion during the AHE or ADIM. When compared, SCU increased the occurrence of distortion with respect to AHE and ADIM. The isolated hypopressive posture did not change the IRD or linea alba distortion. Among women who were postpartum, AHE seemed to narrow IRD below the umbilicus compared with ADIM without either of these 2 modalities generating linea alba distortion, as SCU or ADIM+SCU does. Thus, although no significant differences were found when comparing the IRD at rest and during AHE, the AHE could improve the tensile response of the linea alba without increasing the IRD. This is believed to be the first study to describe linea alba changes during AHE in women who are postpartum. AHE and ADIM seem to show different effects on infraumbilical IRD. The lack of distortion suggests that linea alba may undergo tensile loading at all levels.

Investigation of anaesthetic potentials of various extracts of Annona muricata (sour sop) in Wister albino rat and dog

ObjectivesLocal and general anaesthetics currently used in clinical practice are not absolutely safe and efficacious. Hence two or more drugs are used for induction and maintenance of general anaesthesia. MethodsIn view of this, local and general anaesthetic potentials of Annona muricata extracts were investigated prospectively in laboratory using rat and dog. A total of 15 animals comprising 6 rats (3 males; 3 females) and 9 dogs (5 males; 4 females) were used. Secondary metabolites in root bark, leaf, stem bark and seed of Annona muricata were qualitatively and quantitatively determined. Methanol and water extracts were tested for induction and maintenance of surgical anaesthesia in rat and dog. The dose of the extracts (1250 mg/kg body weight of rat) that produced deep anaesthesia in rats was translated to 150, 170 and 150 mg/kg of root bark methanol extract (RBME), stem bark water extract (SBWE) and seed water extract (SWE), respectively. Each extract was administered to female and male dog for induction and maintenance of anaesthesia. Laparatomy was carried out via linea alba, and the length of small intestine (220 cm) and large intestine (32 cm) were measured using measuring ruler. ResultsPhenols and tannins were significantly lower (p < 0.05) as compared to saponins, flavonoids, alkaloids and glycosides. The median lethal dose (LD50) of methanol extract was < 5000 mg/kg in female and > 5000 mg/kg in male rats, respectively. Sedation, anaesthesia, male mounting and death were observed within 4 days of extract administration in the female rats, However, 12.5 mg/kg showed significant (p < 0.05) local anaesthesia on the test surgical sites. The male administered 170 mg/kg of SBWE showed salivation, significantly decreased respiratory rate, and loss of palpebral reflex, excretion, urination that characterized plane III; stage III of anaesthesia (deep anaesthesia) which lasted for 67 min. ConclusionsAqueous extract of Annona muricata have very potent local and general anaesthetic effects for a period of over 1 h. The observed effects may be due to presence of secondary metabolites.

Evaluación de las consecuencias físicas y psicosociales de la diástasis de rectos abdominales y su interferencia en la salud: un estudio mixto

IntroductionDiastasis rectus abdominis (DRA) is defined as the separation of the rectus abdominis along the linea alba. This condition can occur in both sexes, being frequent in women during pregnancy and pospartum. There is little evidence on the consequences of DRA on the quality of life of women. ObjectiveThe analysis of the perception of the symptoms of and its repercussion on a physical, psychological and social level in women affected by this condition. Patients and methodsObservational study through a semi-structured online survey, composed of 30 closed questions and 2 open ones. The inclusion criteria were adult Spanish-speaking women who had given birth and who presented abdominal diástasis. The data were analyzed quantitatively and the qualitative information was obtained through a content analysis of the open questions. Results319 women with DRA were included. The results showed a negative effect of DRA on quality of life, functional capacities, and urogynecological and digestive health. Likewise, a negative impact was evidenced at an emotional level, on body image and poor self-perceived health. ConclusionDRA has a negative impact on women's health. Women with DRA present an impairment of the quality of life and functional capacities, an alteration in body image, feelings of abandonment by health institutions, shame, sadness, powerlessness, lack of self-esteem, resignation and social pressure.

A Novel Modification of Subcutaneous Onlay Endoscopic Repair of Midline Ventral Hernias With Diastasis Recti: An Indian Experience.

IntroductionA ventral hernia is a common problem in the population. Many patients with umbilical/epigastric hernia often present with diastasis recti (DR) too. Diastasis recti is the thinning of the linea alba with an abnormal increase in the distance between the recti without a concomitant fascial defect. The presence of diastasis recti complicates the repair of the existing umbilical/epigastric hernia. Repair of only the umbilical/epigastric hernia in the presence of DR results in incomplete repair and predisposes to recurrence. There are various options available for the repair of umbilical hernia with diastasis recti. Open hernia repairs often have unsatisfactory cosmetic outcomes and, furthermore, involve complications frequently associated with large incisions such as surgical site occurrences (SSO), pain, dermal flap necrosis, and delayed postoperative recovery, to name a few. The era of minimal access surgery leaves us with a vast array of creative solutions to the same. Laparoscopic onlay repair has been given various names in literature, e.g., minimally invasive linea alba reconstruction (MILAR), pre-aponeurotic endoscopic repair (REPA), endoscopic linea alba reconstruction (ELAR), subcutaneous onlay laparoscopic approach (SCOLA), and totally endoscopic assisted linea alba reconstruction (TESLAR), with similar principles for all the procedures. The average rate of seroma formation in these procedures varies from 5% to 40%. SCOLA has been used in our study, with an added modification of the operating port and limiting the extent of lateral dissection with the aid of spinal needles, resulting in restrained dissection and creation of smaller lipocutaneous flaps, leading to reduced incidence of seroma formation.MethodsPatients with symptomatic primary ventral hernia with concomitant diastasis recti were enrolled in the participating center from the period of May 2020 to December 2021. Thirty patients were enrolled for this prospective study. The patients underwent subcutaneous laparoscopic onlay repair of midline ventral hernia with diastasis recti, with plication of the defect and onlay placement of a polypropylene mesh.ResultsSix point sixty-six percent (6.66%) of the patients developed seroma and SSO. The incidence is congruent with the results available in current literature. None of the patients had necrosis of umbilical skin. There were no recurrences at the three months follow-up.ConclusionOur modification of SCOLA is an ergonomically favorable procedure and has comparable outcomes to other approaches, with minimal complications.

Review and Follow up of Open Pre-rectus Mesh Repair in the Management of Midline Incisional Hernias

Repair of incisional hernia with prosthetic mesh provides tension free closure of the abdominal wall with improved results. Different methods of fixation of mesh have been described with varying results. Mesh fixation to the fascia is the most important part of a hernia repair. Anterior rectus sheaths are tough aponeurotic structures and so are ideal for mesh fixation. This study reports the long-term results of placement of prosthetic mesh in pre-rectus position and fixation to anterior rectus sheaths along with linea alba by open technique, for incisional hernias occurring in the midline. The primary end point was hernia recurrence. Patients and Methods: A total of 126 consecutive patients with incisional hernias occurring in the midline were operated from July 2009 to October2020. After dissection of the plane between rectus muscles and anterior rectus sheath, a polypropylene mesh of suitable size was placed in front of the rectus muscles and fixed to the posterior surfaces of anterior rectus sheaths and the linea alba. In 2013, cases were reviewed and the study continued. The patients were followed on phone or by personal visits up to March 2021. Results: The average period of follow up was 60 months. There were five recurrences. Wound infection was noted in 16 patients with complete healing in all cases with antibiotics and dressings. There were 4 cases of seroma, 5 cases of skin edge necrosis and two cases of suture sinus. There was no mortality, mesh infection or extrusion. Conclusion: Open ‘pre-rectus’ technique for repair of midline incisional hernias is effective with a low recurrence rate.

Management of midline ventral hernias in a surgical department of sub-Saharan Africa: A retrospective cohort study

IntroductionThe linea alba is the second most frequent site of abdominal wall hernias after the inguinal region. Prosthetic approach, often recommended, comes up against the low socio-economic level and the availability of these materials in developing countries. Our objective is to evaluate the indications and results of midline ventral hernia surgery. MethodsThis was a retrospective cross-sectional study over 36 months including all adult patients (over 15 years old) treated for primary or recurrent midline ventral hernias. The parameters studied were: age, sex, risk factors, type of hernia according to the classification of the European Hernia Society (EHS), clinical presentation, hernial ring size, surgical technique and results (recurrence, chronic pain). ResultsWe included 65 patients. The mean age was 40.5 years ± 16.4. There was a female predominance (56.3%, n = 36) with a sex ratio of 0.77. According to the EHS classification, type M3 (umbilical) was more common (67.2%), followed by type M2 (epigastric) in 25% and M4 (infra-umbilical) in 1.6%. According to the clinical presentation, 85.6% (n = 55) were uncomplicated, 10.9% (n = 7) were strangulated in and 3.1% (n = 2) incarcerated. A primary suture was performed in 93.8% (n = 61) and a mesh repair in 6.15% (n = 4). With a mean follow-up of 8.2 ± 11.9 months, we noted a recurrence in 6.1% (n = 4) and chronic pain in 6.1% (n = 4). ConclusionThere is a need to individualize or contextualize the guidelines. In our context where meshes are not always available, pure tissue repairs keep their place in the treatment.

Diastasis recti abdominis (DRA): review of risk factors, diagnostic methods, conservative and surgical treatment

Diastasis recti abdominis (DRA) is an acquired condition defined as a thinning, widening and protruding of the linea alba following an increase in intra-abdominal pressure. The aim of this review is to provide insight in the pathophysiology, risk factors, diagnostic methods and treatment modalities of DRA. DRA occurs in both women and in men, however, it is extraordinarily common and even expected condition affecting over half of women during pregnancy and one third 12 months after childbirth. There is no consensus of risk factors for DRA. Proposed risk factors include multiparity, maternal age and high age, caesarean section, macrosomia, multiple pregnancy, ethnicity, heavy lifting, body mass index (BMI) and diabetes. To diagnose the presence of DRA and its severity the interrecti distance (IRD) is measured. Palpation, caliper, ultrasound, computed tomography (CT) and magnetic resonance (MR) are applied to measure IRD and exclude concurrent hernias. DRA is mostly treated conservatively by physiotherapists. However, physiotherapy is unlikely to prevent or completely treat DRA. Over four fifth of patients are unsatisfied with the results of training programmes and opted for surgical intervention. Thereby the main purpose of physical training is to restore function, not to reduce the DRA. Physiotherapy may be an alternative for those who cannot undergo surgery. In case if severe cosmetic and functional impairment patients are referred for surgery. Patients with severe symptoms benefit more from surgery. Surgery is challenging since guidelines almost do not exist. Plication and mesh reinforcement are recommended by most authors, however whether it should be open or laparoscopic remains debatable.

Prevalence and predictors of bruxism in two university clinic patient populations with dental implants: A cross-sectional analysis

ABSTRACT Objective To analyze the prevalence, predictors, and prosthetic complications of bruxing patients with dental implants in two tertiary clinics in Istanbul, Turkey. Methods Patients with at least one dental implant and with a fixed prosthesis were examined for the evidence of probable bruxism. Factors that could be related to bruxism were analyzed in relation to patient-specific variables. Technical and mechanical complications were investigated. Results A total of 1688 patients were analyzed. The overall rate of probable bruxism was 19.72%. Besides self-reported bruxism (p < 0.022), antidepressant use (p < 0.002), frequent headaches (p < 0.014), and observation of linea alba (p < 0.028) were the predictors for probable bruxism. Technical and mechanical complications were frequent in the probable bruxers (p < 0.05). Conclusion Overall prevalence of bruxism was 19.72%, and bruxism was associated with general and gender-specific predictors.

The Relationship Between the Shape of the Spine and the Width of Linea Alba in Children Aged 6-9 Years. Case-Control Study.

IntroductionCivilization development coupled with contemporary lifestyle leads to a systematic increase in postural disorders. An analysis of factors that may provoke postural disorders indicates that such a stimulus may be the diastasis of the rectus abdominis muscles. Moreover, abnormal activity of the rectus abdominis muscles may affect balance disorders through reduced spinal stabilization and disturbed body statics. There is an increase in body posture abnormalities between the ages of 6 and 9 related to new school duties.Purpose of the StudyThe purpose of the study was to evaluate the relationship between the shape of the spine and the width of the linea alba in children aged 6–9 years.Material and MethodThe study was designed to evaluate parameters determining the shape of the spine, and the width of the linea alba in healthy children aged 6–9 years. The study participants were divided into two groups based on the width of the linea alba. The study group with the width of the linea alba >10 mm and the control group with the width of the linea alba ≤ 10 mm. The study group were included 37 children and the control group 24 children. The examination of the linea alba width was performed by a radiology specialist using a linear transducer and SAOTE- My Lab Classc-type ultrasound at rest and during contraction of the rectus abdominis muscles. Parameters describing the shape of the spine were measured using the Diers Formetric 4D system: trunk inclination, trunk imbalance, pelvis tilt, pelvic torsion, kyphotic apex, lordotic apex, kyphotic angle, lordotic angle, rotation angle, trunk torsion, lateral deviation. The obtained results were statistically analyzed using a Paired t test for comparison of differences between the results in the study and control groups and Pearson's test to assess the correlation between the width of the linea alba and parameters describing spinal alignment.ResultsIn both groups, the parameters describing the shape of the spine did not differ from the norms accepted as typical for the age norm. The only statistically significant difference between the study and control group concerned the trunk inclination, which was negative in the study group, signifying a shift of the entire spine axis backwards beyond the vertical.ConclusionsThere is a correlation between the shape of spine and the width of the linea alba in terms of selected parameters determining the body posture in the sagittal plane, which concern: the position of the lumbar lordotic apex, trunk inclination and the depth of the lumbar lordotic angle. The width of the linea alba is not explicitly related to abnormalities of pelvic and spinal alignment in the frontal and transverse planes.

Postoperative pain assessment with concurrent administration of intraperitoneal tramadol and incisional lidocaine following ovariohysterectomy in dogs

This study aimed to assess postoperative pain with concurrent administration of intraperitoneal tramadol and incisional lidocaine following ovariohysterectomy in dogs. A group of twenty mixed breed female dogs, aged 1–2 years, weighing 19.5 ± 0.8 kg were used. Initially, dogs were sedated with intramuscular administration of acepromazine 1%. Anaesthesia was induced with diazepam (0.5 mg/kg) and ketamine (10 mg/kg) and maintained with 1.5% Isoflurane. Ketoprofen (2 mg/kg) was administered intravenously immediately before surgery. Five minutes before midline incision, saline (0.2 ml/kg) was administered to the muscles and subcutaneous space around the incision in the tramadol-saline (TS) group. Also, in the tramadol-lidocaine (TL) group, lidocaine 2% with epinephrine (1.5 mg/Kg) was administered. Ovariohysterectomy was performed and before closing the linea alba, tramadol (4 mg/kg) was splashed on the abdominal viscera in both groups. Cortisol, vital signs and pain scoring systems were evaluated at different time points. Heart rate, respiratory rate and rectal temperature changes were not significant between groups. Cortisol level showed a significant difference between groups at 1, 3 and 6 hours after surgery (p≤0.05). Both UMPS and CMPS-SF pain scores in the TL group were significantly lower than the TS group at 30 minutes, 1, 3 and 6 hours after surgery (p≤0.05) and also at 12 hours after surgery (p≤0.05). It seems that intraperitoneal administration of tramadol (4 mg/kg) along with administration of incisional lidocaine with epinephrine (1.5 mg/kg) is recommended following ovariohysterectomy in dogs.

Open Versus Laparoscopic Surgical Management of Rectus Diastasis: Systematic Review and Pooled Analysis of Complications and Recurrence Rates.

Rectus diastasis (RD) is defined as widening of the linea alba and laxity of the abdominal muscles. It can be treated via a wide array of both conservative and surgical modalities. Due to the quickly evolving nature of this field coupled with the multiple novel surgical modalities described recently, there is a need for an updated review of surgical techniques and a quantitative analysis of complications and recurrence rates. A systematic review of PUBMED and EMBASE databases was preformed to retrieve all clinical studies describing surgical management of RD. Pooled analyses were preformed to assess recurrence and complication rates after both open and laparoscopic RD repairs (after controlling for herniorrhaphy). A total of 56 papers were included in this review. In patients who underwent both an RD and a herniorrhaphy, there was no significant difference in recurrence rates between open (0.86%) and laparoscopic repairs (1.6%) (p > 0.05). Similarly, in patients who underwent RD repair without a herniorrhaphy, there was no significant difference in recurrence rates between open (0.89%) and laparoscopic repairs (0%) (p > 0.05). The most common complications reported were seroma, skin dehiscence, hematoma/post-operative bleeding, and infection. After controlling for a herniorrhaphy, there were no significant difference in total complication rates between open and laparoscopic RD repair. The total complication rates in patients who underwent an open RD repair with a herniorrhaphy were 13.3% compared to 14.5% in patients who underwent laparoscopic repairs (p > 0.05). Similarly, the total complication rates in patients who underwent RD repair without a herniorrhaphy were 11.8% in patients who underwent open repairs compared to 16.2% in their counterparts who underwent laparoscopic repairs (p > 0.05). Both open and laparoscopic approaches are safe and effective in repairing RD in patients with and without concurrent herniorrhaphy. Future research should report patient reported outcomes to better differentiate between different surgical approaches.

Pathways of the preperitoneal plane: from the "fatty triangle" in Rives to the "fatty trident" in extended retromuscular abdominal wall reconstruction. A tribute toProf. Schumpelick.

Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence in retromuscular preperitoneal dissections. Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated. The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum not covered by the preperitoneal fatty trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair. The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow three specific pathways to find our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.

New Insights Into the Development of the Anterior Abdominal Wall.

PurposeAmong the few studies that have examined the development of the anterior abdominal wall, several are based on incomplete “series”, substituted in many cases by non-human specimens.Material and MethodsIn total, 19 human embryos corresponding to Carnegie stages 15–23, 36 fetuses with estimated gestational ages ranging from 9 weeks to term, and eight neonates were included in this study. All specimens belong to the collection of the Department of Anatomy and Embryology at the Complutense University of Madrid.ResultsThe muscles of the anterior abdominal wall appear in the dorsal region at stages 15 and 16 (33–37 days). At stages 17 and 18 (41–44 days), this muscular mass grows ventrally and splits into two sheets: the external abdominal oblique muscle and the common mass of the internal abdominal oblique, and the transversus abdominis muscles, all of which end ventrally in the primitive condensation of the rectus abdominis. In embryos at stages 19 and 20 (48 days), the anterior abdominal wall continues to show an umbilical hernia in the amniotic cavity. However, a narrow neck is apparent for the first time and there is a wider anterior abdominal wall below the hernia made up of dense mesenchyme tissue without layers and showing the primordia of the umbilical canal. In embryos at stages 21, 22, and 23 (51–57 days), the abdominal muscles and aponeuroses cross the midline (linea alba) covering the rectus abdominis and pyramidalis muscles while the umbilical hernia has shrunk. In fetuses during the 9th and 10th weeks, the umbilical hernia becomes encircled by the rectus abdominis muscle, its aponeurosis, and the three layers of lateral abdominal muscles, which are more developed and covered by Camper's and Scarpa's fasciae. The inguinal canal has a course and relationships like those described in adults, with Hesselbach's ligament.

Analysis of pH and Electrolytes in Blood and Electrolytes in Ruminal Fluid, including Kidney Function Tests, in Sheep Undergoing General Anaesthesia for Laparotomy.

Simple SummaryCaesarean section is a common surgery performed in sheep, wherefore the animal is often placed in the supine position, which can lead to compromised lung function caused by pressure from the rumen and the full uterus. The forestomach system in ruminants contains fluids and electrolytes, which can function as a great reservoir for the blood equilibrium. The ruminal fluid as well as kidney function in sheep undergoing surgical procedures has so far been little examined in research. Therefore, the aim of this study was to evaluate the influence of the type of anaesthesia as well as pregnancy status on these parameters. Based on our results, we can state that inhalational anaesthesia with added oxygen improves the oxygen saturation and partial pressure of oxygen in the blood of sheep in the supine position. Kidney function can be maintained with a minimal electrolyte infusion regime and changes in electrolytes in ruminal fluid could be observed.Background: Performing Sectio Caesarea in sheep under general anaesthesia is a common procedure in veterinary practice. The abdominal cavity can be accessed via linea alba, for which the ewe is positioned in the supine position, whereby rumen and uterus can compromise lung function. Although the rumen represents an important reservoir for fluid and electrolytes, and kidney function during anaesthesia is essential, these parameters have not been focused on in research. Therefore, the objective of this study is to contribute data on blood parameters, ruminal fluid, and kidney function tests during laparotomy. Methods: Laparotomy was performed in 14 ewes, whereof five animals were pregnant ewes (PE) and nine non-pregnant ewes (NPE). A total of seven animals received isoflurane in addition to oxygen (inhalational anaesthesia (InhA)) and seven ewes were anaesthetised with xylazine and ketamine (total intravenous anaesthesia (TIVA)); all ewes received lumbosacral anaesthesia. Blood, urine, and ruminal fluid were sampled every hour over a three-hour period. Results: On comparing InhA to TIVA, higher values were detected for TIVA in haemoglobin, paced cell volume, sodium, phosphate, glucose concentration in the blood, and phosphate in ruminal fluid. Lower values were detected for TIVA in partial pressure of oxygen, oxygen saturation, and creatinine clearance. On comparing PE to NPE, higher values were detected in PE in magnesium and ruminal calcium. Lower values in PE were detected in chloride, base excess in the blood, and ruminal phosphate. Over time, an increase in partial pressure of carbon dioxide, glucose in the blood, glucose in urine, and a decrease in protein and albumin could be observed. Conclusion: Surgery in sheep in the supine position should be performed with additional oxygen to maintain physiological pO2 and sO2 values. Kidney function could be maintained with a minimal electrolyte infusion regime. Additional glucose is not necessary, even in pregnant ewes. Further research should be conducted on parameters in ruminal fluid.

When transversus abdominis release (TAR) is not enough during the repair of large midline incisional hernias: the double peritoneal flap to the rescue.

Transversus abdominis release (TAR) is becoming an increasingly popular approach to incisional hernia repair. As the technique has been applied to more complex hernias, it appears insufficient for repairing large defects due to the impossibility to achieve a tension-free reapproximation of the peritoneum and/or the linea alba, then a bridged repair with interposed omentum, reabsorbable or coated prosthesis frequently leaving the mesh in contact with the subcutaneous space, has been proposed. To overcome these setbacks, we have developed the double peritoneal flap-TAR (DPF-TAR) technique, which entails placement of a retromuscular mesh completely isolated from either peritoneal cavity and subcutaneous space by joining both peritoneal sac halves into a double-bridged design. Of 19 patients, 17 (89%) were available for the study. Median transverse diameter of the hernia was 13,3cm (10-17), and 10 (53%) cases had a complete failure of the linea alba. Five (26%) patients developed a surgical site occurrence (SSO). With a median follow-up of 11 (4-28) months, one (5,8%) recurrence and four (23,5%) wound bulging were diagnosed. We suggest that DPF-TAR approach can provide an effective repair using native tissues to isolate the retromuscular mesh, with acceptable failure and SSOs rates. By avoiding the need for a steep learning curve, this method may constitute a handy complement to the surgeon's armory for difficult reconstructions of the abdominal wall.

Virtual simulation of the biomechanics of the abdominal wall with different stoma locations

An ostomy is a surgical procedure by which an artificial opening in the abdominal wall, known as a stoma, is created. We assess the effects of stoma location on the abdominal wall mechanics. We perform three-dimensional finite element simulations on an anatomy model which was generated on the basis of medical images. Our simulation methodology is entirely based on open source software. We consider seventeen different locations for the stoma incision (trephine) and we simulate the mechanical response of the abdominal wall when an intraabdominal pressure as high as 20 kPa is applied. We focus on factors related to the risk of parastomal hernia development such as the deformation experienced by the abdominal wall, the stress levels supported by its tissues and the corresponding level of trephine enlargement. No significant dependence was found between stoma location and the levels of abdominal wall deformations or stress supported by tissues, except for the case with a stoma located on the linea alba. Trephine perimeter and area respectively increased by as much as 44% and 85%. The level of trephine deformation depends on stoma location with considerably higher trephine enlargements found in stomas laterally located with respect to the rectus abdominis muscle.

Intussusception resemble to rectal prolapse and its surgical management in cats: Report of two cases

Two cats were presented to Teaching Veterinary Clinical Complex, Mannuthy with a complaint of rectal prolapse from the past two days. The presented animals were weak and emaciated. A small sausage shaped structure could be palpated on abdominal palpation, and the animal exhibited pain on palpation. Due to the oedema of the prolapsed mass, it could not be reduced to a normal position. The ultrasonographic examination of the abdomen produced a target sign suggestive that the condition was intussusception. I decided to correct the condition surgically. Opened the abdominal cavity through the Linea alba and exteriorized the affected portion from the remaining segments. Manually reduced the affected portion under general anaesthesia. Closed the abdominal cavity and skin incision as per the standard manner. Animals were exhibited successful recovery.

Prevalence of oral mucosal lesions in children in Xiangyun of Yunnan, China: a cross-sectional study

BackgroundThis population-based cross-sectional study aimed to evaluate the prevalence of oral mucosal lesions (OMLs) in children in a rural area in China as epidemiological data on these conditions from such areas are insufficient.MethodsA total of 3145 children in Xiangyun of Yunnan were enrolled. A socio-economic questionnaire and a field survey of OMLs were administered. We gathered information on factors (sex, age, caregiver, parental education, and last-month household income) that might be associated with OMLs in these children.ResultsOMLs in children in Xiangyun of Yunnan had a prevalence of 1.8% (95% CI; 1.3–2.3%). The most prevalent OML was oral ulcer (n = 11; 18.3%), followed by linea alba (n = 10; 16.7%), whereas the least prevalent OMLs were frenal tag (n = 1; 1.7%) and herpes labialis (n = 1; 1.7%). On unadjusted or adjusted regression, school-aged children had about 50% lower risk of OMLs than preschoolers.ConclusionsThese findings indicate that the prevalence of OMLs in Xiangyun of Yunnan is lower than previously reported. Additionally, the age might be associated with the occurrence of OMLs in children in Xiangyun of Yunnan, China.

Truncal function after abdominal wall reconstruction via transversus abdominis muscle release (TAR) for large incisional hernias: a prospective case–control study

Data about abdominal wall function in patients with incisional hernias (IH) are limited. Abdominal Wall Reconstruction (AWR) could be beneficial for the improvement of this function. The goal of the study was to evaluate if the abdominal wall function was restored after transversus abdominis muscle release (TAR). We performed a prospective case-control study of 59 patients with IH equal or larger than 10cm in their width undergoing AWR via TAR with mesh reinforcement and complete linea alba restoration. With two simple physical tests-Trunk Raising (TR) and Double Leg Lowering (DLL), we clinically assessed, preoperatively, 1month and 1year postoperatively the functionality of the abdominal wall (flexion). Patients were compared with a control group (n = 57) with an intact abdominal wall undergoing visceral surgery through a midline laparotomy. There were no differences between the groups in terms of sex and mean age. In the study group, TR demonstrated an increase from 1.93 preoperatively to 2.44 at 1month and 4.27, respectively, at 1year postoperatively (p &lt; 0.001). DLL was improved from 2.067 to 4.37 at 1year postoperatively (p = 0.016). In the control group, surgery resulted in a decrease of truncal flexion. At 1year postoperatively, the abdominal wall function for study group patients was almost identical with that the functionality of the control group featuring an intact abdominal wall (TR 4.26 vs 4.33 p = 0.532; DLL 4.42 vs 4.21 p = 0.193). AWR via TAR for large IH specifically improved long-term abdominal wall muscular function.

Occurrence of Diastasis of the Rectus Abdominis Muscles in Patients with Medial Pectus Excavatum.

Background:Since 1994, we have used soft silicone blocks sculpted intraoperatively to correct pectus excavatum in male patients. This technique involves a horizontal access incision in the region of the lower edge of the sternum. During the dissection to expose the sternum, we observed a constant diastasis of the rectus abdominis muscle and changes of the anatomy at its superior insertion. There is no report on this association.Methods:Male patients with untreated medial pectus excavatum with indication for silicone block correction were enrolled. Age, weight, height, and the presence of other associated conditions were noted. Ultrasound examination was performed. During the surgery, the width of the linea alba was evaluated and the anatomical positioning of the insertion of rectus abdominis muscle was noted.Results:From 2017 to 2019, 10 patients were submitted to surgery. The mean age was 27 years. All patients presented diastasis at the preoperative physical examination. Imaging examination reports showed diastasis of the rectus abdominis muscle: seven partial epigastric separations and three total separations, two of which were associated with umbilical hernia. The intraoperative findings showed the line alba with a minimum of 23 mm and a maximum of 45 mm width at 4 cm from the xiphoid process edge. The muscle borders presented a curved lateral deviation up to the insertion in the costal arches with a distance ranging from 35 mm to 60 mm.Conclusions:This study confirms the anatomical alterations of the superior portion of the rectus abdominis muscle. The authors discuss the surgical consequences and suggest that the semiology of rectus abdominis muscle is an important preoperative action in pectus excavatum patients.