Suprapubic Transverse Incision Research Articles

Successful myomectomy in a 36 weeks size fibroid uterus through a supra pubic transverse incision

Uterine fibroids are the commonest Gynecological benign tumor which affect reproductive age women. Surgical management of large fibroid uterus create multiple challenges to both surgeon and the patient. This is a case of large fibroid uterus in an unmarried lady, grown up to the level of xiphisternum which treated with successful myomectomy through a suprapubic transverse incision.

Previous Abdomen-Pelvic Surgeries in Infertility patients, their Effects on Tubal Factor Infertility and Safety of Laparoscopy

Aim: To see the types of previous abdomen pelvic surgeries, tubal factor involvement and safety of laparoscopy in infertile patients. Study design: This was a retrospective cross sectional study Place and duration: The study was conducted at Health Care Center Hospital pvt Ltd from July 2020 to June 2022. Methods: All patients with primary or secondary infertility who had history of abdomen- pelvic surgeries were included.Patients who had midline abdominal scar extending above umbilicus were excluded. Data was collected from hospital recordsand analyzed by SPSS version 25. Results: Pelvic adhesions were present in 50(48.5%) patients. Supra pubic transverse incision had 46.7% (24/60)adhesions and 50% (2/4) adhesions were seen in midline incision. 46 (45.06%)patient had tubal pathology.There was no access related injury to omentum or bowel. Access to peritoneal cavity was 100%andnoconversion to laparotomy. There was no delayed complications necessitating to reopen. Conclusion: Laparoscopy is safe in patients who had previous abdominal and pelvic surgery. Microsurgical techniques should be learnt to avoid complications. Keywords: Infertility, Laparoscopy, Abdomen- pelvic surgery, Adhesions.

Total Abdominal Hysterectomy for a 36 Weeks Size Fibroid Uterus through a Supra Pubic Transverse Incision

Introduction: Uterine fibroids are the commonest Gynecological benign tumor which affect reproductive age women. Surgical management of large fibroid uterus create multiple challenges to both surgeon and the patient. This is a cases of 36 weeks size fibroid uterus, grown up to the level of xiphisternum which treated with total abdominal hysterectomy through a suprapubic transverse incision. Case: 45-year-old, previously healthy multi-parous women presented with progressive abdominal distention for one to two years. Clinical and Ultrasound scan confirmed the fibroid uterus. She successfully underwent total abdominal hysterectomy through a supra-pubic transverse incision. Conclusion: Management of a fibroid uterus depends on patient’s age, fertility wishes, uterine preserving desires, symptomatology, site and size of the fibroids. Successful hysterectomy can be done through a supra-pubic transverse incision even for a 36 weeks size fibroid uterus in carefully selected cases.

Choice of specimen’s extraction site affects wound morbidity in laparoscopic colorectal cancer surgery

BackgroundThe choice for an ideal site of specimen extraction following laparoscopic colorectal surgery remains debatable. However, midline incision (MI) is usually employed for right and left–sided colonic resections while left iliac fossa or suprapubic transverse incision (STI) were reserved for sigmoid and rectal cancer resections.ObjectiveTo compare the incidence of surgical site infection (SSI) and incisional hernia (IH) in elective laparoscopic colorectal surgery for cancer and specimen extraction via MI or STI.MethodProspectively collected data of elective laparoscopic colorectal cancer resections between January 2017 and December 2019 were retrospectively reviewed. MI was employed for right and left–sided colonic resections while STI was used for sigmoid and rectal resections. SSI is defined according to the US CDC criteria. IH was diagnosed clinically and confirmed by CT scan at 1 year.ResultsA total of 168 patients underwent elective laparoscopic colorectal resections. MI was used in 90 patients while 78 patients had STI as an extraction site. Demographic and preoperative data is similar for two groups. The rate of IH was 13.3% for MI and 0% in the STI (p = 0.001). SSI was seen in 16.7% of MI vs 11.5% of STI (p = 0.34). Univariate and multivariate analysis showed that the choice of extraction site is associated with statistically significant higher incisional hernia rate.ConclusionMI for specimen extraction is associated with higher incidence of both SSI and IH. The choice of incision for extraction site is an independent predicative factor for significantly higher IH and increased SSI rates.

29 Suprapubic transverse skin incision with rostral retraction is an acceptable alternative for cesarean delivery in morbidly obese population

Introduction: Retracting the pannus using adhesive tape is one of the standard practices when the suprapubic transverse incision is needed. We hypothesized that taping pannus does not affect surgical site infection (SSI) rates. Methods: Singleton pregnancies with morbid obesity (body mass index [BMI]>40kg/m2) between 37 to 42w who delivered via scheduled c-section were identified. Demographics (age, parity, BMI), medical comorbidities (diabetes, hypertension, preeclampsia, chronic-lung disease, obstructive sleep apnea, smoking, substance abuse), surgical variables (type of incision [supra-umbilical vertical (VI), transverse incision taped (TIT) or without taped (TINT)], surgical times [skin to delivery (S-D), delivery to closure (D-C) and skin to closure (S-C)], type of subcuticular and skin closure, wound-vac placement, preoperative infection) and immediate neonatal outcomes (birthweight, gestational age of delivery, arterial cord gas, Apgar scores) were collected.

P037 TOTALLY ENDOSCOPIC SUBLAY REPAIR FOR DIASTASIS RECTI AND CONCOMITANT MIDLINE HERNIA: FIRST CASE VIDEO-REPORT

Abstract Aim We describe in detail the step by step technique of the first case of TES repair at our institution. Methods We selected the case of a M2W3L3 hernia associated to xipho-umbilical diastasis recti in a young woman symptomatic for a progressively worsening back pain and local bulky sensation. Results The intervention is started directly with a suprapubic transverse incision of 2.5 cm and a circumferential, atraumatic retraction is inserted after a small incision of the anterior rectus sheath. Blunt dissection is further continued through this access by luxating the underlying rectus muscles to separate the preperitoneal space below the arcuate line. The pneumo-preperitoneum is then inducted through this port. Laparoscopic dissection allows for enlargement of the avascular space laterally and then two 5-mm trocars are placed on the bilateral aspects of rectus muscles. By means of a lap bipolar dissector the edge of posterior rectus sheath are incised from the arcuate line following the diastasis laterally up to the subxiphoid space. The Rives plane is recovered without opening of the linea alba. After reduction of the M2 hernia both the posterior sheath and the diastatic anterior fascia are sutured with a running long-resorbable 2/0 barbed suture. Polyvinylidene fluoride (PVDF) mesh fixed with the use of an hystoacrilic glue. Conclusion Minimally invasive extraperitoneal repair of small/medium hernia defects of the linea alba is gaining wide acceptance. Concomitant presence of rectum diastasis recti seems to be the ideal indication to approach the learning curve of such a technically demanding procedure

Clinical Outcomes of Totally Laparoscopic Living Donor Right Hepatectomy

Initial concerns regarding healthy donor’s safety and graft integrity, need for acquiring surgical expertise in both laparoscopic liver surgery and living donor transplantation (LDLT) have delayed the development of laparoscopic donor hepatectomy in adult-to-adult LDLT. However, decreased blood loss, less postoperative pain, shorter length of stay in hospital, and excellent cosmetic outcome have well been validated as the advantage of laparoscopic hepatectomy. Hence, the safety and feasibility for laparoscopic donor should be further investigated. We report initial experiences and adequate inclusion criteria for totally laparoscopic living donor right hepatectomy. Totally laparoscopic living donor right hepatectomy in 13 cases were performed from May 2016 up to April 2017. For this procedure, the donors’ right portal vein with long segment of more than 5 mm were preferentially included. However, the bile duct anomaly was preoperatively evaluated with magnetic resonance cholangiopancreatography (MRCP) and was not excluded for totally laparoscopic approach. The 1st case used 2D conventional rigid 30° rigid laparoscopic system and the next 12 cases used 3D flexible laparoscopic system. In 8 cases, hepatic duct anomalies (Type 2, 3a, 3b) were identified. Mean operation time was about 463 min and the warm ischemic time was within 15 minutes. During operation, there was no transfusion and the inflow control like Pringle maneuver was not used at all. V5 or V8 were reconstructed in 12 cases and large right inferior hepatic vein was prepared for anastomosis in 6 cases. All grafts were removed through the supra-pubic transverse incision. The donors were discharged at mean 7 days after hepatectomy. Bile leakage was identified in only 1 case and resolved after the biliary stent insertion by ERCP. During the short-term follow-up period in the donors except this case, complications were not confirmed. Conclusively, totally laparoscopic right donor hepatectomy in adult-to-adult LDLT can be initially attempted after enough experiences of laparoscopic hepatectomy and LDLT. However, the true benefits of totally laparoscopic living donor right hepatectomy should be fully assessed through various experiences from multi-institutes.

The analgesic efficacy of transversus abdominis plane (TAP) block after total abdominal hysterectomy: a randomized controlled trial

<p style="margin-bottom: 0in;"><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em><strong>Objective: </strong></em></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">To assess the effectiveness of surgical TAP block in providing post-operative analgesia in women undergoing total abdominal hysterectomy through supra pubic transverse incision under general anaesthesia<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em><strong>Design: </strong></em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">A randomized controlled study<br /></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em><strong>Setting: </strong></em></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">Professorial Unit, Colombo South Teaching Hospital, Kalubowila<br /></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><strong><em>Population: </em></strong></span></span><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">A total of forty women scheduled to undergo total abdominal hysterectomy for benign conditions<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Methodology: </em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">Women were randomized and the intervention arm received TAP block. Both arms received standard analgesia. The pain was assessed by visual analogue pain score at specific time intervals.<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Main outcome measure: </em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">Requirement of pethidine for pain relief for 24 hours and assessment of post-operative pain using a visual analogue scale at specific intervals up to 24 hours<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Results: </em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">Compared to controls, in women who received TAP block, there was a statistically significant reduction in pain at 30 minutes (pain score 4.5+1.3 vs. 5.4+1.0, p=0.02), at 1h (4.4±1.0 vs. 5.2±0.7, p=0.01), at 2h (4.0±0.9 vs. 4.8±0.7, p=0.01), at 3h (3.6±0.8 vs. 4.3±0.7, p=0.01), at 6hrs (2.8±0.9 vs. 3.0±0.7, p=0.001), and at 12hrs (2.1±1.0 vs. 3.0±0.9, p=0.01). At 24hrs, there was no significant difference in pain reduction. (1.4±0.5 vs. 1.8±0.7, p=0.11). The cumulative morphine requirement was also significantly less in the TAP group at all the time points.<br /></span></span><strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;"><em>Conclusion: </em></span></span></strong><span style="font-family: Times New Roman,serif;"><span style="font-size: small;">The TAP block provided highly effective postoperative analgesia following total abdominal hysterectomy and the cumulative morphine requirement was also significantly less in the TAP group at all the time points. It should be considered as part of a multimodal approach to anaesthesia and enhanced recovery in patients undergoing abdominal surgery.<br /><br /></span></span>DOI: <a href="http://dx.doi.org/10.4038/sljog.v36i1.6954">http://dx.doi.org/10.4038/sljog.v36i1.6954</a> <em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2014; 36: 5-10

Tratamento do câncer colorretal em idosos extremos: relato de caso e revisão da literatura

Com o envelhecimento da população brasileira, cada vez mais o cirurgião colorretal se defrontará com pacientes chamados de idosos extremos, com idade superior a 75 ou 85 anos e apresentando diagnóstico de câncer colorretal (CaCR). A conduta é controversa diante desses casos. Este trabalho relata a abordagem de uma paciente de 97 anos com diagnóstico de adenocarcinoma de reto alto e faz uma revisão da literatura sobre o assunto. Esta paciente foi submetida à retossigmoidectomia paliativa vídeo-assistida, com incisão suprapúbica transversa para confecção da anastomose colorretal primária e retirada do espécime cirúrgico. Foi incluída no programa de reabilitação multimodal pós-operatória (fast-trac) para cirurgia colorretal, apresentou boa evolução e recebeu alta hospitalar no terceiro dia de pós-operatório. O estudo anatomopatológico da peça mostrou tratar-se de adenocarcinoma moderadamente diferenciado, invasor até a muscular própria e metastático em 2 de 12 linfonodos dissecados. De acordo com a literatura, em pacientes selecionados com mais de 75 anos, a cirurgia colorretal eletiva para CaCR pode ser realizada com taxa de morbimortalidade semelhante àquela de pacientes jovens, obtendo-se sobrevidas geral e livre de doença favoráveis. Comorbidades não definem isoladamente o prognóstico e nem contraindicam o procedimento.

Laparoscopy-Assisted Proctocolectomy for Ulcerative Colitis: A More Rational Approach

Purpose: To evaluate a modified approach to a proctocolectomy for ulcerative colitis using a laparoscopy-assisted technique. Methods: Four 5-mm ports (epigastric, umbilical, and left and right lower quadrants) are used for colonic mobilization without ligation of the mesenteric vessels. A low suprapubic transverse incision is then made, and the colon is pulled out with sequential ligation of mesenteric vessels. The remainder of the endorectal dissection and pull-through is performed in a conventional manner. At the end of the procedure, the right lower quadrant port site is converted to an ileostomy. Results: Seven patients underwent this approach over 2 years. There were five girls, and the mean age was 10.3 ± 3.9 years. All operations were successfully performed, and the mean operating time was 8.5 ± 1.1 hours. The operative time decreased from 10 hours for the first case to 7.25 hours for the last case. The mean number of hospital days was 5.5 ± 0.5. There was one postoperative small-bowel obstruction,...

Anterior abdominal wall adhesions after laparotomy or laparoscopy

To determine the frequency of postoperative adhesions to the anterior abdominal wall peritoneum that could affect safe placement of the initial laparoscopic umbilical cannula at subsequent procedures. Prospective cohort study. Reproductive endocrinology and infertility service of a tertiary care referral hospital. Two hundred fifteen women, 124 with prior abdominal surgery and 91 with no prior surgery. Surgical histories were reviewed, abdominal skin scars noted, and extent of anterior abdominal wall adhesions prospectively recorded. Statistical analysis was performed with the chi2 test. No anterior abdominal wall adhesions were present in 91 patients with no previous surgery or 45 patients with previous laparoscopy (12 had more than 1 laparoscopy; p <0.001 vs laparotomy). Seventeen (59%) of 29 patients with a midline vertical incision had anterior wall adhesions (p <0.05 vs suprapubic transverse incision). Eleven (28%) of 39 with a suprapubic transverse incision had anterior wall adhesions (p <0.001 vs no surgery or laparoscopy). Ninety-six percent of adhesions involved omentum and 29% included bowel. Prior laparotomy, whether through a midline vertical or suprapubic transverse incision, significantly increased the frequency of anterior abdominal wall adhesions, and these adhesions may complicate the placement of the laparoscopic cannula through the umbilicus.

Risk of anterior abdominal wall adhesions increases with number and type of previous laparotomy

Adhesions to the anterior abdominal wall after previous midline vertical laparotomy were found in 68% of patients undergoing laparoscopy (Childers et al: Gynecol Oncol 50:221, 1993). We reviewed the prevalence of anterior wall adhesions in patients with previous laparotomy incisions who underwent laparoscopy (>95% of patients) or laparotomy. The prevalence of omental and/or bowel adhesions to the anterior abdominal wall in proximity to the umbilicus were tallied and analyzed by incision site (midline vertical or suprapubic transverse) and number of previous laparotomies (one or more than one). The following table illustrates the number of patients in each category with anterior abdominal wall adhesions. While the prevalence of adhesions is increased with more than one previous laparotomy this did not reach statistical significance (Chi-square test). A midline vertical laparotomy does significantly increase the risk for anterior wall adhesions compared to a transverse incision (p<0.05). However, it should be noted that 28% of patients with a previous suprapubic transverse incision (Pfannenstiel or Maylard) had omental and/or bowel adhesions. In this series, one patient with two previous transverse incisions had an incidental enterotomy. We currently employ the technique of LUQ trocar placement in patients with previous midline and suprapubic transverse incisions.

Endoscopic suspension of vaginal prolapse

A new alternative for the surgical treatment of vaginal prolapse is presented in which the prolapse vagina is brought towards the abdominal wall using an extraperitoneal abdomino perineal approach with endoscopic control. The technique consists of a small suprapubic transverse incision to expose the abdominis rectus muscle aponeurosis. A Stamey needle is passed retropubically to the vagina and the extremity of a helicoidal suture previously made in the vaginal wall is introduced in the eye of the needle. It is then withdrawn to bring the thread to the suprapubic region. The maneuver is repeated on the other side and the threads are tied up over the aponeurosis of the rectus abdominis muscles, bringing the vagina to its original position. Endoscopic control is important to avoid bladder perforation.

The versatile deep inferior epigastric (inferior rectus abdominis) flap

The deep inferior epigastric vascular system nourishes a vast area of the anterior abdominal wall and offers a versatile variety of tissue combinations to the reconstructive surgeon for local or free flap transfer. Its supply to and beyond the rectus abdominis muscle provides the basis for flap design. Eighteen cases are presented to illustrate various muscle, myocutaneous and myosubcutaneous flaps that have been used to date to repair defects in the extremities and in the head and neck. The ease of dissection, coupled with the large calibre and length of the vascular stem, are key factors which combine to offer a speedy and a reliable technique. The donor site scar has been improved by the use of a suprapubic transverse incision to dissect the pedicle and this exposure provides access to the iliac crest for bone grafts where indicated. Time will evaluate this technique and further designs and modifications will undoubtedly be forthcoming. Meanwhile the initial results have been most promising.

Subcutaneous Inguinal Vasectomy in Conjunction with Abdominal Prostatectomy

The procedure described obviates the complications of scrotal surgery (vasitis hematoma abscess formation etc.) and allows prophylactic bilateral vasectomy to be incidental to prostatectomy. 93 successful performances were carried out from 1965-1967. Usually a suprapubic transverse incision was used. The vasectomy was carried out after exposure of the rectus fascia and prior to prostatic enucleation to avoid retrograde infection. The fibrous sheath of the vas was incised. Then the vas was delivered from its envelope clamped and cut with a Bovie knife or a scalpel. The 2 ends were ligated (chromic catgut) or fulgurated. Postoperative urinary antiseptics were administered to 89 of the men. No postoperative epididymitis occurred. Advantages of the operation include: 1) performance of vasectomy through same incision as prostatectomy 2) avoidance of manipulation of scrotum and 3) saving of operative time.