Paramedian Laparotomy Research Articles

Local and Systemic Micro-Rheological Changes during Intestinal Anastomosis Operation: A Metabolic Dependence in an Experimental Model.

Hemorheological factors may show arterio-venous differences. Alterations in acid-base and metabolic parameters may also influence these factors. However, little is known about changes in micro-rheological parameters during abdominal surgery, influencing splanchnic circulation. In anesthetized pigs, the external jugular vein, femoral artery and vein were cannulated unilaterally, and paramedian laparotomy was performed. In the anastomosis group, after resecting a bowel segment, end-to-end jejuno-jejunostomy was completed. Blood samples (from cannulas and by puncturing the portal vein) were taken before and after the intervention. Hematological, acid-base and blood gas parameters, metabolites, red blood cell (RBC) deformability and aggregation were determined. The highest hematocrit was found in portal blood, increasing further by the end of operation. A significant pH decrease was seen, and portal blood showed the highest lactate and creatinine concentration. The highest RBC aggregation values were found in arterial, the lowest in renal venous blood. The RBC aggregation increased with higher lactate concentration and lower pH. Osmotic gradient deformability declined, with the lowest values in portal and renal venous samples. In conclusion, micro-rheological parameters showed arterio-venous and porto-renal venous differences, influenced by oxygenation level, pH and lactate concentration. The intestinal anastomosis operation caused an immediate micro-rheological deterioration with portal venous dominancy in this experiment.

Changes in microcirculation of small intestine end-to-end anastomoses in an experimental model

IntroductionSufficient perfusion is essential for a safe intestinal anastomosis. Impaired microcirculation may lead to increased bacterial translocation and anastomosis insufficiency. Thus, it is important to estimate well the optimal distance of the anastomosis line from the last mesenterial vessel. However, it is still empiric. In this experiment the aim was to investigate the intestinal microcirculation at various distances from the anastomosis in a pig model. Materials and methodsOn 8 anesthetized pigs paramedian laparotomy and end-to-end jejuno-jejunostomy were performed. Using Cytocam-IDF camera, microcirculatory recordings were taken before surgery at the planned suture line, and 1 to 3 mesenterial vessel mural trunk distance from it, and at the same sites 15 and 120 min after anastomosis completion. After the microcirculation monitoring, anastomosed and intact bowel segments were removed to test tensile strength. ResultsThe proportion and the density of the perfused vessels decreased significantly after anastomosis completion. The perfusion rate increased gradually distal from the anastomosis, and after 120 min these values seemed to be normalized. Anastomosed bowels had significantly lower maximal tensile strength and higher slope of tensile strength curves than intact controls. ConclusionAlterations in microcirculation and tensile strength were observed. After completing the anastomosis, the improvement in perfusion increased gradually away from the wound edge. The IDF device was useful to monitor intestinal microcirculation providing data to estimate better the optimal distance of the anastomosis from the last order mesenteric vessel.

A CLINICAL STUDY OF ABDOMINAL WOUND DEHISCENCE

INTRODUCTION:-AWD (abdominal wound dehiscence) is a word that is widely used to describe the separation of different layers of an abdominal wound before it has healed completely. Acute laparotomy wound failure and burst abdomen are two more words that are used interchangeably. Wound dehiscence happens when a wound does not develop the necessary strength to withstand the demands exerted on it. Dehiscence happens when sutures are disrupted by external pressures, absorbable sutures dissolve too quickly, or tight sutures rip through tissues due to excessive strain. AWD has been a long-standing problem for which no surgical unit has offered a complete solution (i.e. none of the surgical units worldwide has reported 0 percent failure rate). However, numerous institutes around the world have been successful in achieving and maintaining failure rates considerably below 1%. These gures, on the other hand, do not deter researchers from continuing their efforts to solve the problem. In the last ten years, there have been a slew of publications attempting to explain how to solve this problem. The goal of this study is to assess the prevalence of abdominal wound dehiscence in relation to various risk factors, co-morbidities, and treatment options. The study aimed at nding out theAIM:- prevalence of abdominal wound dehiscence with respect to demographic factors, nature of preceding surgery and different risk factors and also to study the effective management of abdominal wound dehiscence. An Observational studyMETHODS:- on 60 patients comprising all patients admitted to Silchar medical College and Hospital a tertiary care center in Assam within the study period of 1st January 2021 to 31st July 2021 with diagnosed abdominal wound Dehiscence after undergoing surgical interventions. :-The majority of the patients in this study were between the ages of 41 and 50. Majority were male.RESULTS 81.67% were operated as emergency surgery. 66.67% have undergone procedures which are classied as contaminated. (80%) were operated with mid line incision. 58% patients with peritonitis due to hollow viscus perforation. 58.33% had hypoalbuminemia. Malnutrition, DM, HT, pulmonary diseases, anemia etc. are important risk factors for wound dehiscence. CONCLUSION:-Because of the poor blood supply at Linea Alba, individuals who had a midline laparotomy had a higher risk of wound dehiscence than those who had a paramedian laparotomy. Wound dehiscence is more likely in people with a BMI greater than 25, compared to those with a BMI less than 25. In this study wound dehiscence is mainly associated with complications like hypoproteinemia and pulmonary complications and anaemia.

Implantation du cathéter de dialyse péritonéale: technique et complications

The purpose of our study was to report catheter implantation technique for the treatment of peritoneal dialysis as well as the immediate complications of this surgical procedure. We conducted a retrospective study in the Department of Urology at the Hospital Center University Aristide Le Dantec. The study focused on the medical records of patients who had undergone catheter implantation for the treatment of peritoneal dialysis over the period January 2010-June 2016. Data from the medica records of 114 patients were collected. The average age of patients was 45.9 years; there was a female predominance (64%). Double-cuff Tenckhoff catheter was implanted in all patients. Surgery was performed in all patients on an outpatient basis under local anesthesia. The implantation was made by an urological surgeon in 34% of cases. Paramedian laparotomy was the only surgical technique used. Radiography of abdomen without preparation was systematically performed in all patients on the 1st postoperative day. Immediate surgical complications were reported in 17 patients (14.9%). The incorrect position of the catheter was the most common complication. The treatment of these complications was based on surgery in 12 patients. Catheter implantation for peritoneal dialysis by open surgery is simple and fast. It seems well adapted to countries with limited technical equipment.

Morgagni Hernia: How to approach!

BackgroundMorgagni Hernia (MH) is a retrosternal herniation through inherent diaphragmatic defect manifested by respiratory and/or gastrointestinal symptoms and is repaired through transabdominal or transthoracic approaches. MethodsThe study aimed to evaluate thoracic and abdominal approaches in terms of operative and postoperative sequalae. Herein, we included 18 patients with MH operated in the Cardiothoracic Surgery Department at Mansoura University Hospital, Mansoura, Egypt over a period of 7 years. They were divided into two groups. Group I operated via right thoracotomy and Group II operated via paramedian laparotomy. Each group included 9 patients. ResultsTwelve males and 6 females with right sided MH were included. The mean operative times in thoracotomy and laparotomy groups were 99.44 ± 13.33 and 85.0 ± 20.92 min respectively but without statistical significance P = 0.100. We recorded one recurrence in the thoracotomy group (group I) and one post-operative incisional hernia in the laparotomy group (group II). ConclusionsMH should be repaired upon diagnosis. The optimal surgical technique should be tailored to the patient characteristics. Still, the abdominal approach was linked to easier feasibility, less operative time and recurrence rates.

Influence of different positioning of a local pain catheter on postoperative pain after paramedian laparotomy-a blinded, randomized trial.

Continuous application of local anaesthetics reduces postoperative pain after different approaches for laparotomy. In this randomized, blinded trial, we investigated the effect of continuous application of local anaesthetics after paramedian laparotomy either with subfascial or subcutaneous catheter in addition to a standardized systemic analgesia. Patients with stage III/IV melanoma and indication for radical iliac lymph node dissection (RILND) were randomized to a continuous application of a local anaesthetic through either a subfascial or subcutaneous catheter. Participants and those assessing the outcomes were blinded. The main outcome criterion was the pain level on the first postoperative morning while exercising measured with a visual analogue scale. Minor criteria were the pain measured by the area-under-curve until the third postoperative day, the patient's satisfaction with analgesic treatment, the analgesic requirement, the overall complications and the day of discharge. Fifty-two patients were evaluated. Pain therapy was sufficient in both groups during the postoperative course while resting and during mobilization. There were no significant differences regarding the main and minor outcome criteria. Doses of additional analgesics did not differ between groups. No adverse events or side effects were observed. For patients who undergo paramedian laparotomy, none of the investigated techniques is superior to the other at a median pain level under visual analogue scale (VAS) 30mm on the first postoperative morning. DRKS00003632 (German Register of Clinical Trials).

Electronic Poster Presentations, Maternal Fetal Medicine

Electronic Poster Presentations, Maternal Fetal Medicine

Post-implantation mortality of in vitro produced embryos is associated with DNA methyltransferase 1 dysfunction in sheep placenta

Is DNA methyltransferase 1 (DNMT1) dysfunction involved in epigenetic deregulation of placentae from embryos obtained by assisted reproduction technologies (ARTs)? DNMT1 expression in growing placentae of in vitro produced (IVP) embryos is compromised and associated with pregnancy loss. DNMT1 maintains the methylation profile of genes during cell division. The methylation status of genes involved in placenta development is altered in embryos obtained in vitro. Disturbances in the epigenetic regulation of gene expression during placentogenesis could be involved in the frequent developmental arrest and loss of IVP embryos. Forty sheep were naturally mated (Group 1, CTR). IVP blastocysts (2-4 per ewe) were surgically transferred to the remaining 46 recipient sheep 6 days after oestrus (Group 2). Twenty-one recipients from Group 1 and 27 recipients from Group 2 were allowed to deliver in order to compare embryo survival in both groups at term (150 days). From the remaining recipients (n = 38), fetuses and placentae of both groups were recovered by paramedian laparotomy at Days 20, 22, 24, 26 and 28 of gestation. Immediately after collection, early placental tissues (chorion-allantois) were snap frozen in liquid nitrogen and DNMT1 expression and activity was evaluated. mRNA levels (for DNMT1, HDAC2, PCNA, DMAP1, MEST, IGF2, CDKN1C, H19) and the methylation status of H19 were also analyzed. Furthermore, embryo size and survival rate were measured. Our study shows that DNMT1 expression was reduced in early placentae from sheep IVP embryos. This reduction was associated with growth arrest and subsequent death of the sheep embryos. Conversely, normal levels of DNMT1 and its cofactors were observed in placentae from IVP embryos that survived this developmental bottleneck. Although DNA methylation machinery was severely compromised in IVP placentae only up to Day 24, the low DNMT1 enzymatic activity that persisted after this stage in IVP placentae was not lethal for the developing embryos. The studied genes represent only a small fraction of genes regulating DNA methylation. Further studies are needed to evaluate changes in the expression and methylation status of other genes that may lead to developmental arrest of IVP embryos. As this is the only study evaluating the functionality of DNMT1 machinery in placentae from ART embryos, studies on other species are needed to confirm if our observation may be applicable to all mammalian embryos produced in vitro. The knowledge about compromised activity of DNMT1 in placentae obtained from IVP embryos should stimulate detailed studies on the metabolic requirements of oocytes and embryos in order to adequately enrich the culture media.

Use of an inguinal approach adapted from equine surgery for cryptorchidectomy in dogs and cats: 26 cases (1999–2010)

OBJECTIVE-To determine whether a surgical technique used in cryptorchid horses can be used successfully to remove testicles retained in the inguinal region or abdominal cavity in dogs and cats. DESIGN-Retrospective case series. ANIMALS-22 dogs and 4 cats with cryptorchidism. PROCEDURES-In 1999 through 2010, 26 cryptorchid patients underwent surgery during which an incision was made over the inguinal ring and the undescended testicle was located for removal via identification of the vaginal process and the embryonic gubernaculum. Castration was performed once a testicle was located in the inguinal region or via removal of an intra-abdominally located testicle through the inguinal canal. RESULTS-4 dogs and 1 cat were bilaterally cryptorchid. Testicles were retained in the abdominal cavity in 18 dogs and in the inguinal region in 4 dogs; in all 4 cats, undescended testicles were located in the inguinal region. Twenty-one dogs and 4 cats were castrated without breaching the abdominal cavity; in one of those dogs, the inguinal ring was enlarged to permit extraction of a tumorous testicle. In 1 dog, the inguinal ring was enlarged into a paramedian laparotomy and viscera were manipulated to exteriorize an intra-abdominally located testicle because the gubernaculum had ruptured. Major intraoperative or long-term complications did not occur. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggested that as in horses, the surgical approach over the inguinal ring, wherein the vaginal process and the remnant of the gubernaculum are identified and used to locate an undescended testicle for removal, can be used successfully in dogs and cats.

Surgical management of cryptorchidism in the horse

ANY horse with no palpable scrotal testicles is potentially a cryptorchid, while a horse with only one palpable testicle is almost invariably a cryptorchid. In most cases, a horse with...

Laparoscopically Assisted Splenectomy Following Preoperative Splenic Artery Embolization Using Contour Emboli for Myelofibrosis with Massive Splenomegaly

Laparoscopically assisted splenectomy with an 8- to 10-cm left upper paramedian laparotomy was performed following preoperative splenic artery embolization using painless contour emboli (super absorbent polymer microsphere) with early successful results in two men (46 and 37 years old) with myelofibrosis accompanied by massive splenomegaly. Dissection around the lower part of the spleen and the hilum initially was performed intracorporeally with the usual laparoscopic view under 12 mm Hg pneumoperitoneum. The alternating changes of viewpoints between the direct view through an 8- to 10-cm incision and the usual laparoscopic view with or without application of a retraction method were effective for safe hilar devascularization. Preoperative splenic artery embolization at the distal site was effective for safe dissection around the enlarged spleen. The patients did not complain of pain before operation. Preoperative painless embolization and laparoscopically assisted splenectomy with small laparotomy promotes the feasibility and safety of minimally invasive splenectomy for myelofibrosis with massive splenomegaly.

EFFECT OF PENTAZOCINE ON RENAL BLOOD FLOW

Twenty dogs (weight 8-14 kg) were anaesthetized with sodium pentobarbitone 25 mg per kg body weight and anaesthesia was maintained with nitrous oxide in oxygen. Respiration was controlled with a volume-limited respirator (PaCO2 4.7 +/- 0.4 KPa). Renal blood flow was measured with a square wave electromagnetic flow meter inserted through a left paramedian laparotomy. Renal blood flow decreased transiently following an i.v. injection of pentazocine. The decreases were 81% +/- 10.8 and 77% +/- 3 of the control following the administration of pentazocine 1 mg and 2 mg per kg body weight respectively (P less than 0.01). Renal blood flow returned to control values 10-15 min after the injection of the drug.

Suprapubic paramedian laparotomy for equine abdominal cryptorchidism.

The history of techniques for abdominal equine cryptorchidectomy is briefly reviewed. The technique of suprapubic paramedian laparotomy as used since 1955 at the University of Liverpool veterinary field station is described in detail and an account given of the authors' experience with the technique in nearly 200 cases. It is concluded that the approach to the abdominal cavity is easy, that the testis itself is generally readily located and removed and that controlled repair of the incision is possible. Serious post-operative complications are rare and the danger of post-operative prolapse of bowel eliminated.