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2.
Anaesthesia ; 74(11): 1381-1388, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31402449

RESUMO

Following abdominal surgery, the provision of postoperative analgesia with local anaesthetic infusion through both transmuscular quadratus lumborum block and pre-peritoneal catheter have been described. This study compared these two methods of postoperative analgesia following laparotomy. Eighty-two patients 18-85 years of age scheduled to undergo elective surgery were randomly allocated to receive either transmuscular quadratus lumborum block or pre-peritoneal catheter block. In the transmuscular quadratus lumborum group, an 18-gauge Tuohy needle was passed through the quadratus lumborum muscle under ultrasound guidance to reach its anterior aspect. A 20-ml bolus of ropivacaine 0.375% was administered and catheters placed bilaterally. In the pre-peritoneal catheter group, 20 ml of ropivacaine 0.375% was infiltrated at each of three subcutaneous sub-fascial levels, and pre-peritoneal plane catheters were placed bilaterally. Both groups received an infusion of ropivacaine 0.2% at 5 ml.h-1 , continued up to 48 h along with a multimodal analgesic regime that included regular paracetamol and patient-controlled analgesia with fentanyl. The primary end-point was postoperative pain score on coughing, assessed using a numerical rating score (0-10). Secondary outcomes were pain score at rest, fentanyl usage until 48 h post-operation, satisfaction scores and costs. There was no treatment difference between the two groups for pain score on coughing (p = 0.24). In the transmuscular quadratus lumborum group, there was a reduction in numerical rating score at rest (p = 0.036) and satisfaction scores on days 1 and 30 (p = 0.004, p = 0.006, respectively), but fentanyl usage was similar. In the transmuscular quadratus lumborum group, the highest and lowest blocks observed in the recovery area were T4 and L1, respectively. The transmuscular quadratus lumborum technique cost 574.64 Australian dollars more per patient than the pre-peritoneal catheter technique.


Assuntos
Abdome/cirurgia , Cateteres de Demora , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Ropivacaina/administração & dosagem , Ultrassonografia de Intervenção/métodos , Músculos Abdominais/efeitos dos fármacos , Músculos Abdominais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
3.
Acta Cir Bras ; 34(6): e201900608, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31432999

RESUMO

PURPOSE: To analyze the resistance to medial traction of abdominal wall muscles, before and after performing relaxing incisions. METHODS: Seventeen live pigs were used. After a median laparotomy, the handles were made in the rectus abdominis muscles (RAM) to fit the dynamometer. Step 1 (control phase): tensile strength measured without performing relaxant incisions. Step 2: A curvilinear relaxant incision was made on the anterior blade of the right RAM sheath and then the tensile strength was measured by the edge of the wound. The same procedure was adopted after incision of the left posterior blade. Step 3: Relaxing incisions were made in the right posterior and left anterior blade, so that both sides were left with a relaxing incision on both blades. Measurements of resistance were performed. RESULTS: There was no statistically significant difference between the sides. On the right and left side, all treatments reduced the tensile strength when compared to each other and to the control. There was a reduction of 12% and 9.8% after incision of the anterior and posterior blade, respectively. CONCLUSION: Relaxing incisions reduced tensile strength in the ventral abdominal wall.


Assuntos
Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Laparotomia/métodos , Resistência à Tração/fisiologia , Músculos Abdominais/fisiologia , Animais , Técnicas de Sutura , Suínos , Cicatrização/fisiologia
6.
Plast Reconstr Surg ; 143(4): 1051-1060, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30921120

RESUMO

BACKGROUND: The ideal body is characterized by a muscular physique and defined anterior abdominal wall. Despite diet and exercise, many are unable to achieve this desired result. Liposuction with abdominal etching is used to achieve high-definition abdominal aesthetics. The etching technique is performed with liposuction in a superficial plane, to create indentures consistent with "six-pack abs," or definition of vertical abdominal lines. METHODS: The authors' abdominal etching preoperative markings, surgical technique, and postoperative care are discussed. The surgeons' experience with abdominal etching in 50 consecutive patients is reviewed, including rate of complications and patient satisfaction. RESULTS: The average patient age was 36.4 years. We had an almost equal number of men (n = 26) and women (n = 24), with an average body mass index of 26.7 kg/m. The average blood loss was 275 ml, the average tumescence was 6 liters, and the average lipoaspirate was 5 liters. There were no major complications such as fat embolus, deep venous thrombosis, or intraabdominal injury. The most common minor postoperative complications were contour irregularities (12 percent), seromas (10 percent), and hyperpigmentation (2 percent). The majority of patients were satisfied (98 percent). The average length of postoperative follow-up was 27 months. CONCLUSIONS: Abdominal etching is a safe and effective method of creating a defined anterior abdominal wall for patients who desire the muscular definition of vertical abdominal lines. Almost all of our patients reviewed were satisfied with this procedure, maintained long-term results, and had an acceptable rate of complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Lipectomia/métodos , Gordura Subcutânea Abdominal/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
JSLS ; 23(1)2019.
Artigo em Inglês | MEDLINE | ID: mdl-30846894

RESUMO

Background: Robotic complex abdominal wall reconstruction (r-AWR) using transversus abdominis release (TAR) is associated with decreased wound complications, morbidity, and length of stay compared with open repair. This report describes a single-institution experience of r-AWR. Methods: A retrospective chart review was performed on patients who underwent r-AWR by a single surgeon (D.H.) from August 2015 through October 2018. Results: Fifty-five patients underwent r-AWR (16 males [29%] and 39 females [71%]) with a mean age of 60.2 (range 33 to 87) years and a mean body mass index of 34.6 (range 23 to 54) kg/m2. Forty-one patients presented with an initial ventral hernia (74.5%) and 14 with a recurrent hernia (25.5%). Five patients had a grade 1 hernia (9.1%), 46 had a grade 2 hernia (83.6%), and 4 had a grade 3 hernia (7.3%) according to the Ventral Hernia Working Group system. Thirty-four (62%) patients underwent TAR, 21 (38%) patients underwent bilateral retrorectus release, and 10 (18.2%) patients underwent concomitant inguinal hernia repair. Mean operative time with TAR was 294 (range 106 to 472) minutes and 183 (range 126 to 254) minutes without TAR. Mean length of stay was 1.5 (range 0 to 10) days. Mean follow-up was 10.7 (range 1 to 52) weeks with no hernia recurrences. Seromas occurred in 6 (10.9%) patients, with 2 (3.6%) requiring drainage. Two (3.6%) 30-day readmissions occurred with no conversions to open or 30-day mortalities. Conclusions: r-AWR with and without TAR is a safe and feasible procedure associated with a short LOS, low complication rate, and low recurrence even within the surgeon's learning curve experience.


Assuntos
Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Inguinal/cirurgia , Hérnia Ventral/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos
8.
Rev. bras. cir. plást ; 34(1): 23-40, jan.-mar. 2019. ilus, tab, graf
Artigo em Português | LILACS | ID: biblio-994538

RESUMO

Introdução: A necessidade de oferecer resultados com maior definição nas abdominoplastias nos compele a evoluir tecnicamente. O objetivo deste trabalho é apresentar a técnica de plicatura em Crossbow com suas três variantes, reforçando o conceito de aproximação vertical e horizontal da aponeurose dos músculos retos e oblíquos abdominais ao mesmo tempo, promovendo dois vetores diferentes de tração, culminando em uma maior definição da parede abdominal, principalmente na região do hipogastro e fossas ilíacas. Métodos: No período entre janeiro de 2016 e fevereiro de 2018, foram realizadas 22 cirurgias exclusivamente com a técnica Crossbow em seus tipos l, ll e lll, tanto em pacientes estéticos como pós-bariátricos. Resultados: Os resultados foram favoráveis tanto do ponto de vista estético, com maior definição do hipogastro, como do ponto de vista clínico, uma vez que nenhum paciente apresentou sinais ou sintomas diferentes de técnicas convencionais. Conclusão: A técnica Crossbow é simples e reprodutível, sendo mais um agregante na armamentária para melhorar a estética abdominal. Apesar de promover o reforço da região hipogástrica, tanto para tratamento primário como secundário desta região, só o aumento da casuística poderá demonstrar as possíveis vantagens do método.


Introduction: Owing to the need to deliver results with greater definition in abdominoplasties, techniques must evolve. The objective of this study was to introduce the crossbow technique for plication along with its three variants that reinforces the concept of vertical and horizontal alignments of the aponeurosis of the rectus and oblique abdominis muscles at the same time, promotes 2 different traction vectors, and culminates in a greater definition of the abdominal wall, mainly in the hypogastrium and iliac fossa regions. Methods: From January 2016 to February 2018, 22 surgeries were performed exclusively with the types l, ll, or lll crossbow technique, both in esthetic surgery cases and post-bariatric patients. Results: The results were favorable both from the esthetic point of view, with greater definition of the hypogastrium, and from a clinical point of view, as none of the patients showed signs or symptoms different from those of the conventional techniques. Conclusion: The crossbow technique is a simple and reproducible tool in the medical armamentarium to improve abdominal esthetics. Although it promotes the strengthening of the hypogastric region, both for primary and secondary treatments of this region, only a sample size increase can demonstrate the possible advantages of the method.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Músculos Abdominais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Parede Abdominal/anormalidades , Parede Abdominal/cirurgia , Aponeurose/anormalidades , Aponeurose/cirurgia
10.
Surgery ; 165(5): 996-1002, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30685071

RESUMO

BACKGROUND: Large incisional hernias require medialization of the rectus abdominis muscles to facilitate tension-free closure. Medialization may be achieved by Rives-Stoppa, anterior component separation, or posterior component separation. This study aims to compare medialization achieved by these techniques in postmortem human specimens. METHODS: First, the Rives-Stoppa procedure was performed. Subsequently, anterior and posterior component separation were performed on one side in each specimen, with each specimen functioning as its own control. Medialization was measured at three levels of the linea alba with three 1-kg weights. Both medialization obtained in addition to initial medialization after opening the linea alba and total medialization were measured. Results are presented as median and interquartile range. RESULTS: A total of 13 postmortem human specimens were included (Rives-Stoppa n = 13, component separation n = 10). Additional medialization after Rives-Stoppa was 1.2 cm (IQR: 0.3-2.2) for the anterior rectus sheath and 2.2 cm (IQR: 1.6-3.0) for the posterior rectus sheath (total medialization: 3.9 and 4.5 cm). For the anterior rectus sheath, additional medialization was 2.6 cm (IQR: 1.2-3.6) after anterior component separation and 1.9 cm (IQR: 0.4-3.4) after posterior component separation (P = .125, total medialization: 6.5 and 5.7 cm). For the posterior rectus sheath, additional medialization was 3.0 cm (IQR: 2.2-3.7) after anterior component separation and 5.2 cm (IQR: 4.2-5.9) after posterior component separation (P < .001, total medialization: 5.8 and 9.4 cm). CONCLUSION: Posterior component separation yielded significantly more medialization of the posterior rectus sheath compared with Rives-Stoppa and anterior component separation. Anterior component separation may provide marginally more medialization of the anterior rectus sheath.


Assuntos
Músculos Abdominais/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Músculos Abdominais/anatomia & histologia , Cadáver , Dissecação , Feminino , Humanos , Masculino , Resultado do Tratamento
11.
J Foot Ankle Surg ; 58(3): 562-566, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30683517

RESUMO

Achilles tendon ruptures can be counted as the most common traumatic ankle injuries. As such, there is a comparatively large set of treatment options including surgical and nonsurgical approaches. The purpose of this case report is to demonstrate a new technique for a specific subgroup of Achilles tendon ruptures that present with a large tendinous gap. We used a 2-step procedure designed to grant additional stability through an autograft from the anterior rectus sheath of the patient. Two patients were treated after suffering traumatic Achilles tendon ruptures on the left side with a gap of >3.5 cm and a high demand in daily activities. The reconstruction was performed using an upper quadrant recuts sheath as a WRAP-augmentation. After securing the transplant tissue, the abdominal wall was reconstructed using a Vicryl™-Prolene™ mesh (VYPRO®, Johnson & Johnson Medical GmbH, Ethicon Deutschland, Norderstedt, Germany). After, a standard approach to the Achilles tendon was performed with a Kirchmayr-Kessler suture. The end result was then stabilized with a rectus sheath WRAP over a length of 14 to 15 cm. On the cases reported here, multiple clinical follow-ups were performed over a 5-year period. We can report highly satisfying results, with a return to sports activity after 6 months and no complications. As such we believe the rectus sheath autograft an effective solution for Achilles tendon ruptures with large gaps in healthy patients that demonstrate a high demand in daily activities.


Assuntos
Músculos Abdominais/cirurgia , Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Aponeurose/transplante , Autoenxertos , Ruptura/cirurgia , Parede Abdominal/cirurgia , Humanos , Telas Cirúrgicas
12.
Surgery ; 165(2): 412-416, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30224083

RESUMO

INTRODUCTION: Transversus abdominis release is an increasingly used procedure in complex abdominal wall reconstruction. The transversus abdominis muscle is a primary stabilizer of the spine, yet little is known regarding the effect of transversus abdominis release on core stability, back pain, or hernia-specific quality of life. The purpose of our study was to investigate the effect of complex abdominal wall reconstruction using transversus abdominis release on patient quality of life and core stability function. METHODS: All patients undergoing complex abdominal wall reconstruction requiring transversus abdominis release from June 2016 through October 2016 at our institution were eligible for study inclusion. Back and hernia quality-of-life measures, including the Quebec Back Pain Scale and the Hernia Quality of Life Survey (HerQLes), in addition to patient core stability, as measured using the prone test and the Sahrmann Core Stability Test, were collected at the preoperative evaluation and at 6 months after surgery. Student's t test was used to determine the effect of complex abdominal wall reconstruction on quality of life and core stability. RESULTS: Twenty-one patients completed the preoperative and 6-month postoperative evaluations. Back pain scores significantly improved postoperatively overall and in each of the 6 subcategories measured using the Quebec Back Pain Scale (P = .001). There was also a statistically significant improvement in abdominal wall function as reflected by Hernia Quality of Life Survey scores (P < .001). There was no statistically significant difference in core stability as reflected in the average prone score (P = .6) or the Sahrmann Core Stability Test average score (P = .4). CONCLUSION: Abdominal wall reconstruction with transversus abdominis release leads to improved back pain and hernia quality of life and does not appear to negatively affect core stability in the short term.


Assuntos
Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Pelve/fisiologia , Amplitude de Movimento Articular/fisiologia , Dor nas Costas/cirurgia , Feminino , Hérnia Ventral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida
13.
Am J Surg ; 218(3): 533-536, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30591182

RESUMO

BACKGROUND: As posterior component separation techniques continue to gain popularity there is uncertainty regarding the degree of fascial advancement afforded by the various techniques. Our study seeks to compare the degree anterior rectus sheath translation seen in full transversus abdominus release compared to simple release of the posterior lamella of the rectus sheath. METHODS: Ten hemi-abdomens in five fresh cadavers were dissected. One hemi-abdomen underwent external oblique release. The contralateral hemi-abdomen underwent retrorectus dissection and initial release of the internal lamella of the internal oblique, followed by full transversus abdominus release. A 4 kg weight was suspended from the fascia and excursion was measured after 1) external oblique separation, 2) posterior lamella of the internal oblique separation, and 3) transversus abdominis separation. RESULTS: Average unilateral hemifascial translation after release of the external oblique provided an average unilateral hemi-fascial translation of 3.38 cm (+/- 0.69). Release of the posterior lamella of the internal oblique provided 3.98 cm (+/- 0.94). After transversus release the average translation increased to 4.31 cm (+/- 0.89). CONCLUSIONS: In this cadaveric study, the majority (92%) of fascial advancement afforded by posterior component separation was achieved by an intermediate step in the transversus abdominus release operation: division of the posterior lamella of the internal oblique.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Músculos Abdominais/cirurgia , Cadáver , Humanos
14.
Hernia ; 22(6): 1101-1111, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30244344

RESUMO

PURPOSE: The use of extraperitoneal mesh in place of intra-peritoneal mesh is gaining popularity in laparoscopic ventral hernia repair. We have adopted a robotic assisted laparoscopic technique using a lateral single-dock robotic access with retromuscular mesh placement after opening the ipsilateral posterior rectus fascia. In this study, we wanted to evaluate the changes in operative times during the initial experience with this novel technique. METHODS: The initial consecutive patients undergoing robotic assisted transabdominal retromuscular umbilical prosthetic repair (r-TARUP) using a 15 × 15 cm self-fixating mesh were prospectively entered in the study and the operative times during the separate steps of the surgical procedure were recorded. Complications were reported up to 4 week post operatively and quality of life was assessed using the EuraHS-QoL score. RESULTS: Over a 5 month inclusion period, 41 patients with either a primary (n = 34) or a trocar site hernia (n = 7) at the umbilicus were identified. All hernias had a mean diameter of less than 4 cm. The total OR time decreased significantly during the learning curve (tertile 1: 126 min versus tertile 3: 102 min; p = 0.002) due to a decrease in the skin-to-skin operating time (tertile 1: 81 min versus tertile 3:61 min; p = 0.002). The decrease in the retromuscular dissection time was the most significant of all the steps that comprised the console time (p = 0.004). The non-surgical time did not decrease (p = 0.15). The operation was performed on an outpatient basis in 68% of patients and with a one-night-stay in 29%. No complications related to the introduction of the robotic technique for this approach were observed and the early outcome is promising, with favorable quality-of-life evaluation at 4 weeks. CONCLUSIONS: The decrease in operative time during the adoption of r-TARUP was mainly related to the improved efficiency in the dissection phase of the procedure. The technique is reproducible and safe and the operative time compares favorably to published operative times for laparoscopic and open retromuscular umbilical hernia repair.


Assuntos
Hérnia Umbilical/cirurgia , Herniorrafia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Telas Cirúrgicas , Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Adulto , Idoso , Dissecação , Feminino , Herniorrafia/instrumentação , Herniorrafia/estatística & dados numéricos , Humanos , Laparoscopia , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos
15.
Urol Int ; 101(2): 219-223, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30089289

RESUMO

OBJECTIVES: The study aimed to investigate the expression of the integrin isoforms α7A and ß1A, expressed by myogenic precursor cells, and α7B and ß1D, expressed by mature muscle cells in the cremaster of patients affected by an undescended testis. METHODS: Fifteen samples of cremaster were obtained from patients undergoing surgery for an undescended testis. Thirty control specimens of cremaster were harvested from patients with congenital hydrocele or inguinal hernia. Immunofluorescent analysis was carried out using anti-α7A, ß1A, α7B, and ß1D integrin antibodies. Sections were observed using confocal laser scanning microscopy. RESULTS: As compared with controls, a significant loss of a α7B (p = 0.0355) and ß1D (p = 0.0069) integrins and a higher expression of α7A (p = 0.0003) and ß1A (p = 0.0150) was detected in the cremaster of patients affected by an undescended testis. CONCLUSIONS: Our data document a critical alteration of the cytoskeleton of cremasteric smooth muscle cells in patients with an undescended testis. This might explain the altered function in smooth muscle cells in cremaster implied during testicular descent. We therefore speculate that the postnatal splicing of α7A to α7B and of ß1A to ß1D integrins is delayed. This could account for the common clinical scenario of spontaneous descent of the testes in the first months of life.


Assuntos
Músculos Abdominais/química , Antígenos CD/análise , Criptorquidismo/metabolismo , Cadeias alfa de Integrinas/análise , Integrina beta1/análise , Miócitos de Músculo Liso/química , Músculos Abdominais/patologia , Músculos Abdominais/cirurgia , Estudos de Casos e Controles , Pré-Escolar , Criptorquidismo/patologia , Criptorquidismo/cirurgia , Citoesqueleto/química , Citoesqueleto/patologia , Imunofluorescência , Humanos , Lactente , Masculino , Microscopia Confocal , Miócitos de Músculo Liso/patologia
18.
Anesthesiology ; 129(4): 791-807, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29952817

RESUMO

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: One important example of impaired motor function after surgery is diaphragmatic dysfunction after upper abdominal surgery. In this study, the authors directly recorded efferent phrenic nerve activity and determined the effect of the upper abdominal incision. The authors hypothesized that phrenic motor output would be decreased after the upper abdominal incision; it was also hypothesized that blocking sensory input from the incision using thoracic epidural anesthesia would diminish this incision-induced change in phrenic motor activity. METHODS: Efferent phrenic activity was recorded 1 h to 10 days after upper abdominal incision in urethane-anesthetized rats. Ventilatory parameters were measured in unanesthetized rats using whole-body plethysmography at multiple time points after incision. The authors then determined the effect of thoracic epidural anesthesia on phrenic nerve activity and ventilatory parameters after incision. RESULTS: Phrenic motor output remained reduced by approximately 40% 1 h and 1 day after incision, but was not different from the sham group by postoperative day 10. One day after incision (n = 9), compared to sham-operated animals (n = 7), there was a significant decrease in spike frequency area-under-the-curve (median [interquartile range]: 54.0 [48.7 to 84.4] vs. 97.8 [88.7 to 130.3]; P = 0.0184), central respiratory rate (0.71 [0.63 to 0.79] vs. 0.86 [0.82 to 0.93]/s; P = 0.0460), and inspiratory-to-expiratory duration ratio (0.46 [0.44 to 0.55] vs. 0.78 [0.72 to 0.93]; P = 0.0023). Unlike humans, a decrease, not an increase, in breathing frequency has been observed after the abdominal incision in whole-body plethysmography. Thoracic epidural anesthesia attenuated the incision-induced changes in phrenic motor output and ventilatory parameters. CONCLUSIONS: Upper abdominal incision decreased phrenic motor output and ventilatory parameters, and this incision-induced impairment was attenuated by thoracic epidural anesthesia. The authors' results provide direct evidence that afferent inputs from the upper abdominal incision induce reflex inhibition of phrenic motor activity.


Assuntos
Músculos Abdominais/cirurgia , Anestesia Epidural/métodos , Neurônios Motores/fisiologia , Inibição Neural/fisiologia , Nervo Frênico/fisiologia , Vértebras Torácicas , Músculos Abdominais/efeitos dos fármacos , Músculos Abdominais/inervação , Animais , Feminino , Masculino , Modelos Animais , Neurônios Motores/efeitos dos fármacos , Inibição Neural/efeitos dos fármacos , Nervo Frênico/efeitos dos fármacos , Pletismografia Total/métodos , Ratos , Ratos Sprague-Dawley , Ferida Cirúrgica/tratamento farmacológico , Ferida Cirúrgica/fisiopatologia
19.
Aesthet Surg J ; 38(12): NP196-NP204, 2018 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-29897393

RESUMO

Background: Umbilical hernia is a common finding in patients undergoing abdominoplasty, especially those who are postpartum with rectus divarication. Concurrent surgical treatment of the umbilical hernia at abdominoplasty presents a "vascular challenge" due to the disruption of dermal blood supply to the umbilicus, leaving the stalk as the sole axis of perfusion. To date, there have been no surgical techniques described to adequately address large umbilical herniae during abdominoplasty. Objectives: To present an effective and safe technique that can address large umbilical herniae during abdominoplasty. Methods: A prospective series of 10 consecutive patients, undergoing concurrent abdominoplasty and laparoscopic umbilical hernia repair between 2014 and 2017 were included in the study. All procedures were performed by the same general surgeon and plastic surgeon at the Macquarie University Hospital in North Ryde, NSW, Australia. Data were collected with approval of our ethics committee. Results: At 12-month follow up there were no instances of umbilical necrosis, wound complications, seroma, or recurrent hernia. The mean body mass index was 23.8 kg/m2 (range, 16.1-30.1 kg/m2). Rectus divarication ranged from 35 to 80 mm (mean, 53.5 mm). Umbilical hernia repair took a mean of 25.9 minutes to complete (range, 18-35 minutes). Conclusions: We present a technique that avoids incision of the rectus fascia minimizes dissection of the umbilical stalk and is able to provide a gold standard hernia repair with mesh. This procedure is particularly suited to postpartum patients with large herniae (>3-4 cm diameter) and wide rectus divarication, where mesh repair with adequate overlap is the recommended treatment.


Assuntos
Abdominoplastia/métodos , Hérnia Umbilical/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Músculos Abdominais/cirurgia , Abdominoplastia/instrumentação , Adulto , Terapia Combinada/instrumentação , Terapia Combinada/métodos , Feminino , Seguimentos , Herniorrafia/instrumentação , Humanos , Laparoscopia/instrumentação , Estudos Prospectivos , Telas Cirúrgicas , Resultado do Tratamento
20.
Hernia ; 22(4): 627-635, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29721629

RESUMO

PURPOSE: Transversus abdominis plane (TAP) blockade with long-acting anesthetic can be used during open ventral hernia repair (VHR) with posterior component separation (PCS). TAP block can be performed under ultrasound guidance (US-TAP) or under direct visualization (DV-TAP). We hypothesized that US-TAP and DV-TAP provide equivalent postoperative analgesia following open VHR. METHODS: A retrospective review of patients undergoing open VHR with PCS who received TAP blocks with 266 mg of liposomal bupivacaine was performed. Data included demographics, comorbidities, length of stay (LOS), average postoperative day (POD) pain scores, and narcotic requirements (normalized to mg oral morphine). Statistical analysis utilized Student's t test and Fisher's exact test. RESULTS: Thirty-nine patients were identified (22 DV-TAP). There were no differences between the groups with respect to demographics, comorbidities, pre-operative pain medication usage (narcotic and non-narcotic) or herniorrhaphy-related data. The average POD0 pain score was lower for the DV-TAP group (2.35 vs 4.18; p = 0.019). Narcotic requirements on POD0 (48.0 vs 103.76 mg; p = 0.02), POD1 (128.45 vs 273.82 mg; p = 0.03), POD4 (54.29 vs 160.75 mg; p = 0.042), and during the complete hospitalization (408.52 vs 860.92 mg; p = 0.013) were lower in the DV-TAP group. There were no differences between initiation of diet or LOS. During the study, no changes were made to the VHR enhanced recovery pathway. CONCLUSIONS: DV-TAP blocks appear to provide superior analgesia in the immediate postoperative period. To achieve similar post-operative pain scores, patients in the US-TAP group required significantly more narcotic administration during their hospitalization. The study highlights DV-TAP as a valuable addition to VHR recovery pathways.


Assuntos
Músculos Abdominais/inervação , Músculos Abdominais/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Feminino , Humanos , Lipossomos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Entorpecentes/administração & dosagem , Manejo da Dor , Estudos Retrospectivos , Ultrassonografia de Intervenção
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