Transverse Lower Abdominal Incision Research Articles

Massive Incisional Hernia of the Bowel and Urinary Bladder: A Case Report

Abdominal hernias are not rare in women, but incisional bladder herniation is uncommon. Incisional hernias are an iatrogenic condition caused by protrusion of the abdominal viscera through the abdominal fascia. Omentum and small intestines are by far the most common viscera involved, and the condition is diagnosed on clinical examination either visually or by palpation of an abdominal bulge. We describe a case of bladder and bowel herniation through a lower transverse abdominal incision (Pfannenstiel), which followed emergent operative intervention for ectopic pregnancy.

The feasibility of hand-assisted laparoscopic aortic bypass using a low transverse incision.

Hand-assisted laparoscopy can be used to perform aortoiliac reconstructive procedures. This study aimed to evaluate the safety and feasibility of a hand-assisted aortofemoral bypass in patients with occlusive disease using a low abdominal transverse incision to reduce postoperative respiratory problems. In 18 patients, a modified Pfannenstiel incision was performed. A hand-assist device was inserted, and the aorta was exposed using transperitoneal laparoscopy. Tunneling was performed under laparoscopic control. The anastomosis was always performed proximally to the inferior mesenteric artery. In three patients, the proximal anastomosis had to be performed laparoscopically. The indication for surgery was occlusive disease in 16 patients and a combination of an aneurysm and aortoiliac occlusion in 2 patients. Conversion was required in one patient (1/18). In 13 patients (13/18), the total operating time did not exceed 180 min, and 61% of the patients (11/18) could be discharged by postoperative day 5. None of the patients died perioperatively (0/18). Complications were observed in six patients (6/18). Only one of these patients had respiratory problems (1/18). The remaining five patients had local complications such as wound healing problems. The anastomosis was sutured laparoscopically in three patients (3/18). Hand-assisted laparoscopy can be performed safely using a low transverse abdominal incision. In our experience this laparoscopic access can reduce the incidence of postoperative respiratory problems and incision-related complications.

Laparoscopic Port-Site Recurrence Following Surgery for a Stage IB Squamous Cell Carcinoma of the Cervix with Negative Lymph Nodes

Background. Port-site metastases are commonly reported after laparoscopic surgery for ovarian cancer, but have also been reported in patients with cervical or endometrial cancer with positive lymph nodes. Recently, a case of port-site recurrence after laparoscopic surgery for a patient with node-negative early-stage adenocarcinoma of the cervix was reported. We report the first case of port-site metastasis in a patient with stage IB squamous cell carcinoma of the cervix with negative lymph nodes.Case. A 31-year-old woman had a laparoscopy for pelvic pain. Under anesthesia, she was noted to have a grossly abnormal-looking cervix and a biopsy revealed squamous cell carcinoma. She was referred to a gynecological oncologist and underwent radical hysterectomy and pelvic lymph node dissection through a transverse lower abdominal incision 6 weeks later. Nineteen months postoperatively, she presented with a soft tissue mass in a suprapubic laparoscopic trocar site.Conclusion. It is postulated that cells dislodged at the time of cervical manipulation and biopsy may have passed through the fallopian tubes and implanted in the laparoscopic port site due to the “chimney effect” caused by the pneumoperitoneum.

Postoperative morbidity in the morbidly obese parturient woman: Supraumbilical and low transverse abdominal approaches

Objective: Our purpose was to determine the differences in postoperative morbidity in obese women who had a supraumbilical or a Pfannenstiel incision at cesarean delivery. Study Design: A case-control retrospective review was conducted of all patients who were at >150% ideal body weight when undergoing cesarean delivery between 1989 and 1995 by means of either a supraumbilical or a Pfannenstiel incision. Patients were excluded if medical records were unavailable. A total of 15 women who had a supraumbilical incision and 54 who had a low transverse incision were included in the analysis. Antenatal complications were examined, as were age, weight, and training level of the surgeon. Postoperative complications were then compared. Results: The groups were similar in age and antepartum complications. However, mean weight and percentage of ideal body weight in the supraumbilical group were both higher ( P < .00001 and P < .0001, respectively), with the supraumbilical group 83 lb heavier on average. No significant differences were seen in any postoperative complication. Conclusion: Postoperative morbidity in morbidly obese women undergoing cesarean delivery does not differ between a supraumbilical approach and the low transverse abdominal incision. (Am J Obstet Gynecol 2000;182:1033-5.)

Free microvascular rectus abdominis muscle flap for soft tissue reconstruction of the lower leg and foot: results and donor site defect

The free rectus abdominis muscle flap is now a routine procedure for the reconstruction of soft tissue defects in the lower extremity. We present the follow-up of 21 out of 27 patients operated in our clinic between 1986 and 1994. The recipient leg always showed a stable soft-tissue coverage. Clinical or radiological signs of osteitis were not found. In many of the cases, where the transplantion was to the ankle region, the muscle bulk led to an alteration of the shape of the leg, without impairment of function. When harvested through a low transverse abdominal incision, the aesthetic results in the donor site are convincing. The functional donor site defect is negligible as long as only a segment of the muscle is used. Abdominal muscle tests showed good results when only a segment of the muscle was used. The patients reported no impairment in daily life. Abdominal wall weakness was present only when the entire muscle was harvested. There was one hernia after postoperative wound infection and secondary wound healing. In all other cases, the abdominal wall was stable. In the segmental use of the free rectus abdominis muscle flap, the good results obtained in our examination correlate to the high degree of patient satisfaction.

Donor-site morbidity of the segmental rectus abdominis muscle flap

The donor-site morbidity of the segmental rectus abdominis muscle flap was evaluated in 20 patients with an average follow-up time of 47 months. Our criteria were based on static and dynamic functional results including relaxation and hernia of the abdominal wall, aesthetic outcome and patient satisfaction. The dynamic functional tests of the abdominal wall showed good results corresponding to the reported minimal impairment of quality of life. There was one abdominal hernia after wound infection and secondary healing. There was no evidence of abdominal wall instability in any of the other patients. The aesthetic outcome was excellent when a transverse lower abdominal incision, asymmetrically elongated to the donor site, was used and moderate in the case of a paramedian vertical incision. Ninety-five per cent of the patients were completely satisfied or satisfied with the result at the donor site. In the segmental use of the free rectus abdominis flap a high degree of subjective patient satisfaction reflects the favourable outcome of our examinations. On the other hand there is a clinically significant functional donor-site defect of this flap. As this procedure is still widely used, and as its indication is closely linked to its absolute and relative donor-site defect, comparisons with the alternatives, e.g. the partial latissimus dorsi muscle flap, the extended gracilis muscle flap or the serratus anterior muscle flap will have to be made.

Laparoscopic burch colposuspension—New approaches

Endoscopic surgical developments have produced considerable benefits in reduction of postoperative morbidity and healthcare costs for the community. The Burch colposuspension via a transverse lower abdominal incision has achieved widespread acceptance in the management of stress incontinence. However, the potential benefits of laparoscopic Burch colposuspension include decreased perioperative and postoperative morbidity, shortened hospitalization, reduction of blood loss, and early return to normal activity. We present our initial 10 cases, 7 via the transperitoneal approach, and 3 using balloon distension of the retropubic space via an extraperitoneal approach. In all cases, the bladder neck and iliopectineal ligaments were clearly visualized laparoscopically. Sutures were placed between the paravaginal fascia and iliopectineal ligaments bilaterally, producing good bladder neck elevation. A suprapubic catheter was subsequently inserted. This initial group (N = 10), mean age 41 years (range 35-54 years) all had preoperative urodynamic studies confirming stress incontinence. A mean operating time of 3 hours 7 minutes (range 2-5 hrs) was achieved using the transperitoneal approach. However, switching to the balloon extraperitoneal method (N = 3), mean surgical time diminished to 65 minutes. All patients were managed with postoperative suprapubic catheterization with hospital discharge after 5.5 days (range 4-7 days) and minimal postoperative blood loss. All patients returned to normal activity within 18 days. Initial follow-up confirmed the absence of stress incontinence. Laparoscopic colposuspension would now appear to be the surgery of choice for stress incontinence.

Scar endometriosis: An unusual cause of lower abdominal pain in an adolescent

A 16-year-old primigravida presented with a 3-year history of right lower quadrant pain. Physical examination revealed a mass lateral to the edge of a low transverse abdominal incision from her cesarean section. Following surgical excision, histological examination revealed tissue consistent with endometriosis. The patient was discharged without complications with a diagnosis of scar endometriosis.

The Segmental Rectus Abdominis Free Flap for Ankle and Foot Reconstruction

The reconstruction of soft-tissue defects of the ankle and foot usually requires free-tissue transfer. Although certain local flaps have been described for the reconstruction of these injuries, their utility may be compromised by significant crush injury or the size and location of the defect. Part of the rectus abdominis muscle, the segmental rectus abdominis free flap, is ideally suited for this use because of the muscle's versatility, reliability, and negligible donor deformity when harvested through a low transverse abdominal incision. Seven patients reconstructed with this flap are presented, and the technique is discussed. All patients have been successfully reconstructed with preservation of the ankle and foot. At present, all patients are fully or partially weight-bearing. The segmental rectus abdominis free flap is recommended for the reconstruction of such wounds.

Successful Repair of an Unusual Hernia Associated With Traumatic Pubic Diastasis

A 70-year-old man had an unusual type of supravesical small bowel hernia associated with herniation of the bladder through a traumatic diastasis of the pubic symphysis. The diastasis was closed with prosthetic mesh through a preperitoneal approach. In patients in whom a scrotal hernia develops after a previous pelvic fracture, especially those with evidence of a pubic diastasis, an unusual type of hernia should be suspected. A preperitoneal surgical approach best reveals the anatomy and allows appropriate repair. The best procedure for prevention of such hernias is primary reduction of any substantial pubic diastasis, but operative intervention is not indicated in all patients.

Incisional Recurrence of Carcinoma

To the Editor.— A recent article by Greenlee et al (1981;246:69) on the incisional recurrence of cervical carcinoma prompted us to report a similar case in which the patient had progressive disease. Report of a Case.— A 43-year-old woman was admitted to our hospital because of a suprapubic mass in a lower abdominal transverse incision line. Approximately ten months previously, she had undergone a total abdominal hysterectomy for suspected uterine leiomyomata. The surgical specimen disclosed invasive squamous carcinoma of the cervix. Postoperatively, she received whole-pelvis radiotherapy that encompassed the surgical incision completely. One month before referral, she noticed a reddened and swollen area in her scar. Fine-needle aspiration cytological examination showed inflammation and dysplastic squamous cells. Admission chest roentgenogram was free of any metastases. Fine-needle aspiration cytological examination of the abdominal wall mass disclosed poorly differentiated squamous carcinoma. Subsequently the patient received cisplatin (50 mg/sq m) chemotherapy every three weeks.

11 - Caesarean Section and its Place in the Active Approach to Delivery

SUMMARY Providing certain precautions are taken, there is no reason why the general trend towards abdominal delivery in high-risk pregnancies, or when difficult vaginal delivery is anticipated, should not continue. As part of a planned delivery programme, caesarean section might also become more frequently indicated for social reasons and for convenience of medical staff. At the present time, the risks to the mother associated with anaesthesia, especially acid aspiration and caval compression, preclude the adoption of such a policy, but with advances in anaesthesiology, the employment of more purely obstetric anaesthetists, and the increasing use of epidural analgesia, these risks might be drastically reduced. Similarly, if the delivery of a premature infant can be avoided (by careful assessment of maturity), and liquor is aspirated from the infant’s oropharynx during delivery, risks to the fetus of abdominal delivery might be drastically reduced also. Post-operative maternal morbidity following elective caesarean section might be reduced if epidural analgesia were employed more often, if a transverse lower abdominal incision were used routinely, and if traditional ideas such as indwelling catheters during operation were abandoned. We have discussed in the first part on the Operation the fact that more women are requesting sterilisation after their second or third delivery. In other words, women are more concerned now with quality rather than quantity in childbirth. If maternal and fetal risks can be eliminated, elective abdominal delivery for the above reasons might come to be regarded as sensible, with sterilisation being performed at the second or third deliveries, and it may well be that during the next 40 years the allowing of a vaginal delivery or attempted vaginal delivery may need to be justified in each particular instance. Perhaps it is not altogether too provocative to suggest that vaginal delivery may yet become the exception rather than the rule

SURGICAL CORRECTION OF THE SEPTATE UTERUS

PIP: Metroplasty for septate uterus performed in 28 patients at Methodist Hospital in Houston is discussed. The preoperative fetal survival rate was 19.5%. Prior to laparotomy, D and C was performed in all patients. During the operation a lower abdominal transverse incision was used for abdominal exploration. The uterus was first divided from above downward in an anteroposterior direction until the endometrial cavity was entered. The incision was kept in the midline to minimize blood loss. Once the endometrial cavity was exposed, scissors were used to cut the septum bilaterally without excising it. Care was taken not to cut into the myometrium superiorly. The uterine walls were then reapproximated by simple interrupted no. 1 chromic catgut sutures that transversed serosa, myometrium, and endometrium. The first sutures were placed on the anterior and posterior aspects of the uterus just below the incision in the uterine wall. The remaining sutures were placed about .5 to 1 cm apart; none were tied until all sutures were in place. Closure was in a longitudinal anteroposterior direction along the same line as the incision. Approximation of the serosal surface was further enhanced by a running inverting 3-0 chromic catgut suture. In 16 patients, an IUD was placed in the uterine cavity before closure and left in place for 1 to 3 months. The frequency of associated endometriosis was 32.1%. Of the patients wishing to conceive, 73% became pregnant. The postoperative fetal survival rate was 87.5%. Delivery was by cesarean section.

Histology of the Divided Vas

Histologic studies were done after experimental vasectomy in the rat in order to investigate spontaneous reanastomosis of the vas after vasectomy; this condition was reported in a case where granulomas at the site of previous divisions were found containing epithelium which had canalized to restore continuity of the vas. In 12 rats through a transverse lower abdominal incision one vas was mobilized doubly ligated 2 cm distal to the epididymis and divided between the ties. Vasa were ligated with 5/0 black silk and 3/0 chromic catgut. After 5 months fixed testes and vasa from the vasectomized side compared with normal counterparts on the contralateral side were found to have swellings at the site of vasectomy (in 8). The swellings were thin-walled sacs which were continuous with the proximal end of the vas; spermatozoa were found in the lumen of both vas and sac. Methods to prevent joining of the sac with the distal vas must be improved.

Human Fallopian Tube Fluid. I. Protein Composition

A method for the collection of human tubal fluid and the determination of its protein content is described. 6 patients free of adnexal disease who were scheduled for elective abdominal hysterectomy or tubal ligation were selected for the study. Tubal fluid was collected by inserting a 16-gauge polyethylene tube into each oviduct about one-third of its length from the fimbrial end at laporatomy. The proximal end of fallopian tube was ligated at the uterine cornua. The fimbrial end was sutured snugly around the tubing. The ends of the polyethylene tubes were brought out through a low transverse abdominal incision. Each was attached to a needle which in turn was inserted into a vacuotube. A sterile dressing was applied to the wound covering the tubes and changed daily. The polyethylene tubes were removed on Postoperative Day 4 or 5. Tubal fluid was collected from 4 patients. In 2 cases the fluid was either too scant or discarded because of blood contamination. Total proteins were determined by the method of Lowry. The total proteins in the tubal fluid were 3.26 gm %. Major protein fractions consisted of albumen alpha 1 alpha 2 beta 1 beta 2 and gamma-globulins with approximately the same distribution as that in serum. Immunoelectrophoretic studies revealed the presence of some 15 serum type proteins. They included isoagglutinins and immunoglobulins with the exception of IgM which was found only in trace amounts in 1 sample. A specific beta-glycoprotein apparently produced by the fallopian tube and absent in blood was detected. This protein was immunologically identical with specific ovarian tissue antigen. It is suggeseted that further studies are required to determine precisely the functional role of such a large number of proteins in human tubal fluid.

TRANSVERSE LOWER ABDOMINAL INCISION IN OBSTETRICS AND GYNAECOLOGY.

Australian and New Zealand Journal of Obstetrics and GynaecologyVolume 5, Issue 2 p. 94-99 Transverse Lower Abdominal Incision in Obstetrics and Gynaecology Robert J. Gaal, Corresponding Author Robert J. Gaal Sydney*14 D.Y. Square, Dee Why, N.S.W.Search for more papers by this author Robert J. Gaal, Corresponding Author Robert J. Gaal Sydney*14 D.Y. Square, Dee Why, N.S.W.Search for more papers by this author First published: March 1965 https://doi.org/10.1111/j.1479-828X.1965.tb00297.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume5, Issue2March 1965Pages 94-99 RelatedInformation