Pressure In Abdominal Cavity Research Articles

V-033 MINIMAL INCISION REPAIR OF RECTUS ABDOMINIS MUSCLE DIASTASIS (MIRRAD) AS DAY CASE SURGERY: A PILOT STUDY

Abstract Rectus abdominis muscle diastasis (RAD) is a common condition where the rectus muscles are separated by an abnormal distance causing widening of the linea-alba. This condition usually occurs due to increased abdominal cavity pressure. The most common causes are pregnancy and truncal obesity. There is also an increased risk of hernia in the linea-alba. Some of the patients with RAD can increase the stability with the abdominal wall muscle-training program, while others do not benefit from this type of exercise. There is no consensus yet regarding the preferred surgical treatment. The need for a minimal invasive surgical procedure as a day case surgery in RAD in selected cases is obvious. The aim of this study is to evaluate the safety and effectiveness of MIRRAD as a day case surgery. All patients are planned as elective day case surgery. Through a small skin incision on one side of the umbilicus, the subcutaneous fat is undermined and dissected from the external aponeurosis 7–9 cm above and 5 cm below the umbilicus to expose the diastasis. The umbilicus is de-attached from the external fascia. The abdominal rectus muscle diastasis is then plicated with double layer barbed suture. The umbilicus re-attached and skin sutured. Results 20 patients are repaired with this method, all as a day case surgery, without any immediate complication. Conclusion This new, relative simple, method is cost effective and may minimize the postoperative morbidity. The method may preferably appropriate for patients without excessive skin.

Intra-abdominal pressure during different methods of drug stimulation of gastrointestinal trast after operations on the abdominal cavity

Materials and methods . After Local Ethics Committee approval and obtaining informed consent, 103 patients were prospectively divided into 4 groups depending on the characteristics of post-operative intensive care. Patients were conducted surgery on the abdomen by laparotomy about peritonitis. In the 1 (control) group (n=27), patients after operation received stimulation of the gastrointestinal tract with metoclopramidum and neostigminum. In group 2 (n=24), patients received L-arginine and metoclopramidum. In the group 3 (n=25) patients received metoclopramidum and simeticonum. In group 4 (n=27), patients received L-arginine, metoclopramidum and simeticonum. The value of IAP studied preoperatively, after 1,2 and 3 days postoperatively. IAP was measured by indirect method in the bladder. Normal values of IAP we considered recommendations of World Abdominal compartment Society (WSACS). Also studied perfusion pressure in abdominal cavity (PP), ICU length of stay, length of stay in hospital, terms of restoring self-discharge of gases and timing recovery self-defecation. The end point of the study was 28 day after surgery. Statistical analysis of the data was performed using the software package Statistica v8.0. Results and Conclusion . Before surgery, we observed an increase in IAP in 63.1% of patients. The value of intra-abdominal pressure exceeded the upper limit of normal in 58.5% (p <0.001). After 1 day after surgery in all groups bowel dysmotility grew. Patients 1,3 and 4 groups IAP remained elevated, not statistically different from the preoperative. In 2 groups patients IAP was lower than in groups 3 and 4 by 28.6% (p <0.001) and 32.3% (p <0.001), respectively, 21.2% (p = 0.018) were lower than the preoperative. The maximum increase in IAP patients in all groups, we observed 2 days after surgery. The number of patients with increased IAP was different between groups. Thus, 1, 3 and 4 group 100% of patients had elevated IAP, whereas in group 2 – 20% of patients had normal its value. After 3 days after surgery IAP decreased in all groups. Most patients with elevated IAP was in groups 1 and 4 – 58.8% and 48.5%, respectively. In these groups, the mean value exceeded the norm by 27% (p = 0.037) and 39.6% (p <0.001) was on the preoperative level, but did not reach IAH 1. Patients 2 and 3 of the average value of IAP was lower relative to preoperative levels by 30.9% (p <0.001) and 30.1% (p = 0.04), respectively. PP was in the normal range and did not statistically differ between groups. The most rapid recovery after bowel surgery patients were 2 groups. The application of metoclopramide and L-arginine self discharge gas is observed after 2.22 days after surgery. This is 21.8% (p = 0.001) was lower than in group 1, 29.7% (p <0.001) – 3 group, 26.6% (p = 0.003) – 4 groups. Length of stay in ICU and stay in the hospital in group 2 decreased insignificantly. Mortality at 28 days is the same in all groups.

Gastroesophageal Reflux Disease (GERD) In Patients with Obstructive Sleep Apnoea Syndrome (OSAS)

Gastroesophageal reflux disease (GERD) is a common cause of chronic cough, heartburn, epigastric or retrosternal discomfort, chest pain and abdominal pain or esophagitis. Our patients with OSAS seldom manifest GERD symptoms. We suspected that obesity and high pressure in abdominal cavity may induce acid gastroesophageal reflux in these patients. The aim of the study was to test the hypothesis that obesity, cigarettes smoking or ventilatory and gas exchange abnormalities provoke GERD. We studied 21 consecutive patients with severe OSAS (mean AHI 44.9+/-23.8) before CPAP treatment, all without GERD clinical symptoms. Standard polysomnography, gastroscopy and 24-h oesophageal pH monitoring was performed. There were 6 females, 15 males, mean age 57+/-9 years, mean BMI 38+/-6 kg/m2. All patients presented with normal spirometric and gas exchange values (mean VC 3.64+/-1.23 1, 90% of normal, mean FEV1 2.61+/-0.95 1, 83% of normal, mean FEV1%VC 72%, mean PaO2 68.1+/-7.7 mmHg, mean PaCO2 40.8+/-5.8 mmHg, mean pH 7.42+/-0.02). GERD was diagnosed in 14 patients. Patients with GERD were younger, more often were cigarettes smokers (5/14). We did not fi nd statistically significant differences between severity of OSAS, BMI, ventilatory or gas exchange parameters and GERD.

Optimal level of pressure support ventilation for recovery from diaphragmatic fatigue in rabbits

To determine whether there is an optimal level of pressure support ventilation (PSV) for recovery from acute diaphragmatic fatigue. Prospective laboratory trial. Experimental laboratory. Twenty healthy adult New Zealand White rabbits. Diaphragmatic fatigue was induced with 50 Hz of phrenic nerve stimulation for 30 mins. Recovery was compared between inspiratory load + PSV of 0 cm H2O (L0), inspiratory load + PSV of 60 cm H2O (L60), inspiratory load + PSV of 80 cm H2O (L80), and PSV of 0 cm H2O without inspiratory load (SB) for 90 mins immediately after the end of the fatigue-inducing procedure. To add inspiratory load during the recovery phase, three pressure threshold valves, each having an opening pressure of -20 cm H2O, were used. After the fatigue-inducing procedure, diaphragmatic electromyogram and transdiaphragmatic pressure remained at baseline in both SB and L60, decreased in L80, and increased in L0. Recovery was assessed by abdominal cavity pressure (Pabd) generated by high-frequency (100 Hz) and low-frequency (20 Hz) stimulation. Pabd at 100 Hz recovered to baseline in L60 and SB but not in L0 and L80 (69.1%, 81.3%, 100.3%, and 100.7% of the baseline at 90 mins for L0, L80, L60, and SB, respectively). Pabd at 20 Hz did not differ among ventilatory settings. There is an optimal range of PSV assist level to improve recovery from diaphragmatic fatigue. Recovery was hampered not only by inadequate PSV but also by excessive PSV.