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1.
Yonsei Med J ; 63(5): 446-451, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35512747

RESUMO

PURPOSE: This study aimed to evaluate the cumulative recurrence rate and risk factors for recurrent abdominal wall endometriosis (AWE) after surgical treatment. MATERIALS AND METHODS: A retrospective cohort study was conducted at a single gynecological surgery center between January 2004 and December 2020. Patients who were surgically treated and followed up for at least 6 months after surgery were selected. RESULTS: Eighteen patients with pathologically diagnosed AWE were included in this study. The median follow-up duration was 22.5 months (range, 6-106). The median age was 37 years (range, 22-48), and 33.3% of the patients were nulliparous. Among the patients included in our study, 55.6% complained of a mass with cyclic pain, and 27.8% had a palpable mass. In addition, 22.2% of patients experienced recurrence with 17.5±9.7 months of mean time to recurrence. The cumulative recurrence rates at 24 and 60 months after surgical treatment of AWE were 23.8% and 39.1%, respectively. There were no statistically significant risk factors for the recurrence of AWE, including postoperative medical treatment. CONCLUSION: The recurrence rate of AWE appears to be correlated with the follow-up duration. There was no statistically significant risk factor for the recurrence of AWE. Unlike ovarian endometriosis, postoperative hormonal treatment does not seem to lower the recurrence of AWE. The findings of the current study may help healthcare providers in counselling and managing patients with AWE.


Assuntos
Parede Abdominal , Endometriose , Parede Abdominal/cirurgia , Adulto , Endometriose/cirurgia , Feminino , Humanos , Dor , Recidiva , Estudos Retrospectivos , Fatores de Risco
2.
J Am Coll Surg ; 234(5): 918-927, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35426406

RESUMO

BACKGROUND: Despite advancements in abdominal wall reconstruction (AWR) techniques, hernia recurrences (HRs), surgical site occurrences (SSOs), and unplanned hospital readmissions persist. We sought to develop, validate, and evaluate machine learning (ML) algorithms for predicting complications after AWR. METHODS: We conducted a comprehensive review of patients who underwent AWR from March 2005 to June 2019. Nine supervised ML algorithms were developed to preoperatively predict HR, SSOs, and 30-day readmission. Patient data were partitioned into training (80%) and testing (20%) sets. RESULTS: We identified 725 patients (52% women), with a mean age of 60 ± 11.5 years, mean body mass index of 31 ± 7 kg/m2, and mean follow-up time of 42 ± 29 months. The HR rate was 12.8%, SSO rate was 30%, and 30-day readmission rate was 10.9%. ML models demonstrated good discriminatory performance for predicting HR (area under the receiver operating characteristic curve [AUC] 0.71), SSOs (AUC 0.75), and 30-day readmission (AUC 0.74). ML models achieved mean accuracy rates of 85% (95% CI 80% to 90%), 72% (95% CI 64% to 80%), and 84% (95% CI 77% to 90%) for predicting HR, SSOs, and 30-day readmission, respectively. ML identified and characterized 4 unique significant predictors of HR, 12 of SSOs, and 3 of 30-day readmission. Decision curve analysis demonstrated that ML models have a superior net benefit regardless of the probability threshold. CONCLUSIONS: ML algorithms trained on readily available preoperative clinical data accurately predicted complications of AWR. Our findings support incorporating ML models into the preoperative assessment of patients undergoing AWR to provide data-driven, patient-specific risk assessment.


Assuntos
Parede Abdominal , Hérnia Ventral , Parede Abdominal/cirurgia , Idoso , Feminino , Hérnia Ventral/etiologia , Hérnia Ventral/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Estudos Retrospectivos , Fatores de Risco
3.
Acta Chir Plast ; 64(1): 31-38, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35397778

RESUMO

BACKGROUND: Over recent years, liposuction has become the most commonly used surgical procedure used to refine male and female body contours. In the last four decades, the incidence of breast cancer has increased. Of these patients, there are more women requiring breast reconstruction who have undergone liposuction in the past. There is little in the literature that discusses harvesting perforator flaps from previously liposuctioned donor sites. The authors report on their experience and review the current literature on the autologous abdominal-based free flap for breast reconstruction after previous liposuction of the abdominal wall. METHODS: Five electronic databases were searched (Medline (PubMed), Scopus, Web of Science, Cochrane) from inception to March 2021. Also, we searched our patients records and included our experience. RESULTS: We included three cases who had previous liposuction prior to their breast reconstruction procedure. We report no flap loss in our cases. Moreover, the database search showed 30 patients (83.33%) underwent deep inferior epigastric perforator (DIEP) reconstruction. The age ranged from 32 to 73 years (mean of 51.7 years). The mean length of reconstruction after liposuction is 8.9 years, ranging from 1.5 years to 23 years reported in 23 patients. Seven patients (19.4%) had partial loss of the flap. Twenty patients (55.55%) had CT angiography pre-operatively for the assessment of the perforators. CONCLUSION: A careful combination of preoperative scanning, handheld Doppler and clinical examination reduce the chance of an unsuccessful outcome.


Assuntos
Parede Abdominal , Neoplasias da Mama , Retalhos de Tecido Biológico , Lipectomia , Mamoplastia , Retalho Perfurante , Parede Abdominal/cirurgia , Adulto , Idoso , Neoplasias da Mama/cirurgia , Artérias Epigástricas , Feminino , Retalhos de Tecido Biológico/cirurgia , Humanos , Lipectomia/métodos , Masculino , Mamoplastia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Hernia ; 26(2): 557-565, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35377083

RESUMO

BACKGROUND: Surgical mesh is widely used not only to treat but also to prevent incisional hernia formation. Despite much effort by material engineers, the 'ideal' mesh mechanically, biologically and surgically easy to use remains elusive. Advances in tissue engineering and nanomedicine have allowed new concepts to be tested with promising results in both small and large animals. Abandoning the concept of a pre-formed mesh completely for a 'pour in liquid mesh' has never been tested before. MATERIALS AND METHODS: Thirty rabbits underwent midline laparotomy with closure using an absorbable suture and small stitch small bites technique. In addition, their abdominal wall closure was reinforced by a liquid nanofibrous scaffold composed of a fibrin sealant and nanofibres of poly-ε-caprolactone with or without hyaluronic acid or the sealant alone, poured in as an 'onlay' over the closed abdominal wall. The animals were killed at 6 weeks and their abdominal wall was subjected to histological and biomechanical evaluations. RESULTS: All the animals survived the study period with no major complication. Histological evaluation showed an eosinophilic infiltration in all groups and foreign body reaction more pronounced in the groups with nanofibres. Biomechanical testing demonstrated that groups treated with nanofibres developed a scar with higher tensile yield strength. CONCLUSION: The use of nanofibres in a liquid form applied to the closed abdominal wall is easy to use and improves the biomechanical properties of healing fascia at 6 weeks after midline laparotomy in a rabbit model.


Assuntos
Parede Abdominal , Hérnia Incisional , Nanofibras , Parede Abdominal/cirurgia , Animais , Herniorrafia/métodos , Humanos , Hérnia Incisional/cirurgia , Coelhos , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura/efeitos adversos
5.
Can J Surg ; 65(2): E264-E265, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35396268

RESUMO

SummaryRecent years have seen considerable increases in both the demand for, and complexity of, ventral hernia repairs. This has led to calls for abdominal wall surgery to become a recognized subspecialty in the United States and Europe, with some centres responding by forming specialized, multidisciplinary teams for abdominal wall reconstruction. At present, however, no Canadian city has followed suit. In this article, we outline the major arguments underlying the drive toward the centralization of complex abdominal wall services.


Assuntos
Parede Abdominal , Hérnia Ventral , Parede Abdominal/cirurgia , Canadá , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Telas Cirúrgicas , Estados Unidos
6.
Pan Afr Med J ; 41: 23, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35291355

RESUMO

The abdominal cavity has long been used to absorb cerebrospinal fluid (CSF) in a ventriculoperitoneal (VP) procedure in hydrocephalus patients. Although this procedure is quite common, some complications can potentially arise. This study aimed to report a case of pseudocyst formation as a rare complication (<5% incidences) following a VP shunt insertion. A case of a 62-year-old male patient with a history of communicating hydrocephalus post-VP shunt insertion presented with symptoms of acute progressive right abdominal pain and was found a formation of large abdominal wall pseudocyst. An upper abdominal computed tomography (CT) scan showed a well-defined cystic mass lesion located intraperitoneally in the right hypochondrium. He subsequently underwent an exploratory laparotomy and surgical excision of the pseudocyst, followed by improved symptoms experienced. Clinicians must be aware of this complication because early diagnosis and prompt management will eventually improve outcomes for reducing abdominal pain and improving the patient's quality of life.


Assuntos
Parede Abdominal , Cistos , Hidrocefalia , Parede Abdominal/cirurgia , Cistos/diagnóstico , Cistos/etiologia , Cistos/cirurgia , Humanos , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Derivação Ventriculoperitoneal/efeitos adversos
7.
Plast Reconstr Surg ; 149(5): 1204-1213, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35311754

RESUMO

BACKGROUND: Abdominal wall reconstruction persists as a challenging surgical issue with a multitude of management strategies available. The aim of this study was to examine the efficacy of resorbable synthetic mesh onlay plane against biologic mesh in the intraperitoneal plane. METHODS: A single-center, two-surgeon, 5-year retrospective review (2014 to 2019) was performed examining subjects who underwent abdominal wall reconstruction in the onlay plane with resorbable synthetic mesh or in the intraperitoneal plane with biologic mesh. A matched paired analysis was conducted. Data examining demographic characteristics, intraoperative variables, postoperative outcomes, and costs were analyzed. RESULTS: Eighty-eight subjects (44 per group) were identified (median follow-up, 24.5 months). The mean age was 57.7 years, with a mean body mass index of 30.4 kg/m2. The average defect size was 292 ± 237 cm2, with most wounds being clean-contaminated (48.9 percent) and 55 percent having failed prior repair. Resorbable synthetic mesh onlay subjects were significantly less likely (4.5 percent) to experience recurrence compared to biologic intraperitoneal mesh subjects (22.7 percent; p < 0.026). In addition, mesh onlay suffered fewer postoperative surgical-site occurrences (18.2 percent versus 40.9 percent; p < 0.019) and required fewer procedural interventions (11.4 percent versus 36.4 percent; p < 0.011), and was also associated with significantly lower total costs ($16,658 ± $14,930) compared to biologic intraperitoneal mesh ($27,645 ± $16,864; p < 0.001). CONCLUSIONS: Abdominal wall reconstruction remains an evolving field, with various techniques available for treatment. When faced with hernia repair, resorbable synthetic mesh in the onlay plane may be preferable to biologic mesh placed in the intraperitoneal plane because of lower long-term recurrence rates, surgical-site complications, and costs. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Parede Abdominal , Produtos Biológicos , Hérnia Ventral , Parede Abdominal/cirurgia , Hérnia Ventral/etiologia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Humanos , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento
8.
BMJ Case Rep ; 15(3)2022 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-35351768

RESUMO

Ectopic extramammary Paget's disease describes an exceedingly rare intraepithelial adenocarcinoma arising within non-apocrine tissues. We present a case report of E-EPMD arising on the lower abdomen without underlying secondary malignancy in a 56-year-old female patient. We performed a wide local excision of the lesion with subsequent mini abdominoplasty reconstruction.


Assuntos
Parede Abdominal , Abdominoplastia , Doença de Paget Extramamária , Transplantes , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Doença de Paget Extramamária/patologia , Doença de Paget Extramamária/cirurgia , Transplantes/patologia
11.
Sci Rep ; 12(1): 3545, 2022 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-35241748

RESUMO

An ostomy is a surgical procedure by which an artificial opening in the abdominal wall, known as a stoma, is created. We assess the effects of stoma location on the abdominal wall mechanics. We perform three-dimensional finite element simulations on an anatomy model which was generated on the basis of medical images. Our simulation methodology is entirely based on open source software. We consider seventeen different locations for the stoma incision (trephine) and we simulate the mechanical response of the abdominal wall when an intraabdominal pressure as high as 20 kPa is applied. We focus on factors related to the risk of parastomal hernia development such as the deformation experienced by the abdominal wall, the stress levels supported by its tissues and the corresponding level of trephine enlargement. No significant dependence was found between stoma location and the levels of abdominal wall deformations or stress supported by tissues, except for the case with a stoma located on the linea alba. Trephine perimeter and area respectively increased by as much as [Formula: see text] and [Formula: see text]. The level of trephine deformation depends on stoma location with considerably higher trephine enlargements found in stomas laterally located with respect to the rectus abdominis muscle.


Assuntos
Parede Abdominal , Hérnia Incisional , Estomas Cirúrgicos , Parede Abdominal/cirurgia , Fenômenos Biomecânicos , Humanos , Hérnia Incisional/cirurgia , Reto do Abdome/cirurgia
12.
Trials ; 23(1): 204, 2022 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-35264227

RESUMO

BACKGROUND: Surgical site infection (SSI) represents a major burden for patients, doctors, and health systems around the world. The aim of this trial is to assess whether the practice of using separate sterile gloves and instruments to close wounds at the end of surgery compared to current routine hospital practice can reduce surgical site infection at 30-days post-surgery for patients undergoing clean-contaminated, contaminated, or dirty abdominal surgery. METHODS: This study protocol describes a pragmatic, international, multi-centre, 2-arm, cluster randomised controlled trial, with an internal pilot. Clusters are defined as hospitals within low- and middle-income countries (LMICs) defined by the Development Assistance Committee (DAC) Official Development Assistance (ODA) list, where there are at least 4 eligible hospitals per country. Hospitals (clusters) must be in LMICs where glove and instrument change are not currently routine practice. Patients (adults and children) undergoing emergency or elective abdominal surgery for a clean-contaminated, contaminated, or dirty operation are eligible for inclusion. Before closing the abdominal wall, surgeons and the scrub nurse will change gloves and use separate, sterile instruments (intervention), versus no changing gloves or using separate, sterile instruments (standard practice, control). The primary outcome is SSI within 30 days after surgery, using the Centre for Disease Control (CDC) criteria. Secondary outcomes are SSI before point of hospital discharge, and readmission, reoperation, length of hospital stay, return to normal activities, and death up to 30-days after surgery. A 12-month internal pilot, including 12 clusters and approximately 600 participants, aims to assess adherence to allocation and follow-up of patients. The main trial is powered to detect a minimum reduction in the primary outcome from 16 to 12%. A total of 12,800 participants will be recruited from 64 clusters (hospitals) each including at least 200 participants. DISCUSSION: Change of gloves and sterile instruments prior to fascial closure in abdominal surgery is a low-cost, simple, intraoperative intervention which involves all members of the surgical and scrub team. If effective at reducing SSI, this practice could be readily implemented across all contexts. The findings of this trial will inform future guideline updates from international healthcare organisations, including the World Health Organization. TRIAL REGISTRATION: ClinicalTrials.gov NCT03980652. Registered on 9 July 2019.


Assuntos
Parede Abdominal , Infecção da Ferida Cirúrgica , Técnicas de Fechamento de Ferimentos , Parede Abdominal/cirurgia , Adulto , Criança , Países em Desenvolvimento , Equipamentos e Provisões , Humanos , Estudos Multicêntricos como Assunto , Pobreza , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecção da Ferida Cirúrgica/prevenção & controle
13.
Comput Intell Neurosci ; 2022: 1054299, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35330595

RESUMO

The aim of the study is mainly to study the subject of BoNT-A injection to improve IAH in rats undergoing abdominal angioplasty. The study problem in surgery, especially in ICU, burn, and trauma centers, intra-abdominal hypertension (IAH), and abdominal compartment syndrome (ACS) are common complications. At present, there are various treatments for IAH. The intramuscular injection of Botulinum toxin type A (BoNT-A) into the abdominal wall has received a lot of attention. Based on this, this study proposes a method for measuring abdominal pressure, applies BoNT-A to reduce abdominal pressure in the IAH state of abdominal wall angioplasty, and explores a way to increase the compliance of the abdominal wall under the premise of maintaining the sealing of the abdominal cavity, so as to realize the expansion of the abdominal cavity. A method is achieved to reduce intra-abdominal pressure and eliminate or alleviate ACS. The results of the experiment showed that when the rats in the control group were injected with the same amount of normal saline as the rats in the experimental group, the IAP was significantly higher than that in the experimental group (P < 0.05). This shows that BoNT-A increases the compliance of the abdominal wall while maintaining the closure of the abdominal cavity, thereby increasing the volume of the abdominal cavity and alleviating the state of IAH in rats.


Assuntos
Parede Abdominal , Toxinas Botulínicas Tipo A , Queimaduras , Hipertensão Intra-Abdominal , Parede Abdominal/cirurgia , Animais , Queimaduras/complicações , Hipertensão Intra-Abdominal/tratamento farmacológico , Hipertensão Intra-Abdominal/etiologia , Ratos
14.
Chirurgia (Bucur) ; 117(1): 5-13, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35272749

RESUMO

Incisional hernia (IH) is a postoperative defect of the abdominal wall through which the contents of the peritoneal cavity are externalized beneath the skin in a peritoneal sac. IH differs in anatomic complexity, but also in its associated comorbidities and surgical history. As IH enlarges, complications occur and these become part of its natural history. The goal of the study is to review the impact of loss of domain upon abdominal wall before and after abdominal wall reconstruction. The absence of anatomical and functional linea alba leads to a combination of muscular disturbances, chronic respiratory and gastrointestinal conditions, and psychosocial issues. The pathophysiological changes are also due to the decrease of the intra-abdominal pressure (IAP). During repair, the sudden reintroduction of the viscera into an unprepared cavity leads to a sudden increase in cavity volume and an increase in IAP with fatal pathophysiological implications. For an optimal repair, preoperatively, the abdominal wall must be augmented by achieving the following objectives: reducing the volume of the sac contents, optimizing compliance, enlargement of the container. At the same time, for the optimal repair, the following must be taken into account: increased knowledge about this condition to manage systemic and local changes, CT scan evaluation, monitoring IAP, plateau pressure (PP), and Positive End Expiratory Pressure (PEEP). In conclusion, the goals can be achieved by systemic optimization with a multidisciplinary team, using Preoperative Progressive Pneumoperitoneum (PPP) and/or Botox (BTX), and abdominal wall reconstruction through a mesh with augmented component separation technique.


Assuntos
Parede Abdominal , Hérnia Incisional , Músculos Abdominais , Parede Abdominal/cirurgia , Humanos , Hérnia Incisional/cirurgia , Pneumoperitônio Artificial/métodos , Resultado do Tratamento
15.
Ann Transplant ; 27: e934595, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35228508

RESUMO

Short bowel syndrome is the most common etiology of intestinal failure, resulting from either resections of different intestinal segments or a congenital condition. Due to the absence or considerable reduction of intestinal loops in the abdominal cavity, patients with short bowel syndrome present with atrophy and muscle retraction of the abdominal wall, which leads to loss of abdominal domain and elasticity. This complication is an aggravating factor of intestinal transplantation since it can prevent the primary closure of the abdominal wall. A vast array of surgical techniques to overcome the challenges of the complexity of the abdominal wall have been described in the literature. The aim of our study was to review the modalities of abdominal wall closure in intestinal/multivisceral transplantation. Our study consisted of a systematic review following the methodological instructions described in the PRISMA guidelines. Duplicate studies and studies that did not meet the criteria for the systematic review were excluded, especially those without relevance and an explicit relationship with the investigated theme. After this step, 63 articles were included in our study. The results obtained with these techniques have been encouraging, but a high incidence of wound complications in some reports has raised concerns. There is no consensus among transplantation centers regarding which technique would be ideal and with higher success rates and lower rates of complications.


Assuntos
Parede Abdominal , Transplante de Órgãos , Procedimentos Cirúrgicos Reconstrutivos , Parede Abdominal/cirurgia , Humanos , Incidência , Intestinos/cirurgia , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos
16.
BMC Surg ; 22(1): 100, 2022 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-35303836

RESUMO

BACKGROUND: It is a big challenge to repair a large abdominal wall defect after tumor resection, and en bloc resection with vascularized tissue reconstruction might be an alternative to achieve an improved survival for abdominal wall tumors. CASE PRESENTATION: A 45-year-old woman presented with a 1-year history of persistent abdominal pain of the right lower quadrant and a mass with dermal ulceration. An enhanced computed tomography scan and biopsy of the mass were performed to achieve the definite diagnosis of abdominal mucinous adenocarcinoma. After four courses of "FOLFOX" chemotherapy, the tumor grew to 6 × 5 cm during preoperative examination. Thereafter, we removed the tumor and involved tissues and organs and repaired the sizeable abdominal wall defect used by biological meshes and vascularized anterolateral thigh flaps. The patient suffered green drainage of 450 ml in the abdominal cavity and intestinal anastomotic fistula, for which she readmitted and recovered afterward. CONCLUSIONS: Biological mesh combined with vascularized anterolateral thigh flaps could effectively repair the large abdominal wall defect and restore the biological function of the abdominal wall.


Assuntos
Parede Abdominal , Adenocarcinoma Mucinoso , Procedimentos Cirúrgicos Reconstrutivos , Parede Abdominal/cirurgia , Adenocarcinoma Mucinoso/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Coxa da Perna/cirurgia
17.
World J Surg Oncol ; 20(1): 86, 2022 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-35292079

RESUMO

BACKGROUND: Malignant transformation of abdominal wall endometriosis is extremely rare. Clear cell carcinoma and endometrioid carcinoma are the two most prevalent histological subtypes of malignant endometriosis. To date, approximately, thirty cases of clear cell carcinoma arising from abdominal wall endometriosis have been described worldwide. CASE PRESENTATION: We report two cases of clear cell carcinoma developing postoperatively in the anterior abdominal wall in women with a history of extensive endometriosis. Histopathology of the resected abdominal wall tumor demonstrated benign endometriosis contiguous with features of clear cell carcinoma. These histological features satisfied Sampson's criteria which are required for diagnosing malignant endometriosis. Both patients were successfully managed with platinum-based adjuvant chemotherapy following cytoreductive surgery. CONCLUSION: Clear cell carcinoma arising from the abdominal wall endometriosis is a rare, highly aggressive cancer with a propensity to recur or metastasize. Due to the limited publications on this clinical entity, there are no clearly established protocols regarding adjuvant treatment, and an evaluation of prognostic factors is lacking. Clinicians must have a high index of suspicion for malignant endometriosis of the abdominal wall, particularly in patients with an abdominal wall mass, prior abdominal surgery, and long-standing endometriosis. By presenting our case, we expect to raise awareness and study of this rare endometriosis-related neoplasm.


Assuntos
Parede Abdominal , Adenocarcinoma de Células Claras , Carcinoma Endometrioide , Endometriose , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma de Células Claras/cirurgia , Carcinoma Endometrioide/patologia , Endometriose/complicações , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia/patologia
18.
Rev Col Bras Cir ; 49: e20213152, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35239848

RESUMO

INTRODUCTION: the botulinum toxin A (BTA) has been used to achieve a chemical component separation, and it has been used with favorable outcomes for the repair of complex ventral hernia (CVH) with and without loss of domain (LD). The aim of this study is to describe our early experience with the chemical component separation in the United Sates. METHODS: a retrospective observational study of all patients who underwent ventral hernia repair for CVH with or without LD between July 2018 and June 2020. Preoperative BTA was injected in all patients via sonographic guidance bilaterally, between the lateral muscles to achieve chemical denervation before the operation. Patient demographics, anatomical location of the hernia, perioperative data and postoperative data are described. RESULTS: 36 patients underwent this technique before their hernia repair between July 2018 to June 2020. Median age was 62 years (range 30-87). Median preoperative defect size was 12cm (range 6-25) and median intraoperative defect size was 13cm (range 5-27). Median preoperative hernia sac volume (HSV) was 1338cc (128-14040), median preoperative abdominal cavity volume (ACV) was 8784cc (5197-18289) and median volume ration (HSV/ACV) was 14%. The median OR time for BTA administration was 45 minutes (range 28-495). Seroma was the most common postoperative complication in 8 of the patients (22%). Median follow up was 43 days (range 0-580). CONCLUSION: preoperative chemical component separation with BTA is a safe and effective adjunct to hernia repair in CVH repairs where a challenging midline fascial approximation is anticipated.


Assuntos
Parede Abdominal , Toxinas Botulínicas Tipo A , Fármacos Neuromusculares , Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Botulínicas Tipo A/uso terapêutico , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Pessoa de Meia-Idade , Fármacos Neuromusculares/uso terapêutico , New York , Cuidados Pré-Operatórios
19.
Trials ; 23(1): 198, 2022 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-35246206

RESUMO

BACKGROUND: Patients undergoing emergency surgery for peritonitis are at increased risk of abdominal wall-related complications. In patients with peritonitis, the risk of incisional hernia (IH) is extremely elevated. The evaluation of quality of life of patients with incisional hernia showed lower mean scores on physical components of health-related quality of life and body image. Furthermore, the arise of a post-operative abdominal wall complication (i.e., wound dehiscence, evisceration and IH) greatly increases morbidity and mortality rates and prolongs the hospitalization. METHODS: The present study aims to evaluate the efficacy of the use of a swine dermal collagen prosthesis implanted preperitoneally as a prophylactic procedure in urgency/emergency setting against abdominal wall complications in patients operated with contaminated/infected field in peritonitis. The sample size was defined in 90 patients divided in two arms (prosthesis positioning versus normal wall abdominal closure). The follow-up will be performed at 3, 6, and 12 months after surgery. The percentage of incisional hernias, wound infections, and adverse events will be investigated by physical examination and ultrasound. DISCUSSION: The objective is to evaluate the possibility to reduce the incisional hernia rate in patients undergoing urgent/emergent laparotomy in contaminated/infected field with peritonitis by using swine dermal collagen prosthesis preperitoneal positioning as a prophylactic procedure. TRIAL REGISTRATION: ClinicalTrials.gov NCT04681326. Registered (retrospectively after first patient recruited) on 23 December 2020.


Assuntos
Parede Abdominal , Técnicas de Fechamento de Ferimentos Abdominais , Produtos Biológicos , Hérnia Incisional , Peritonite , Parede Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/prevenção & controle , Hérnia Incisional/cirurgia , Peritonite/etiologia , Peritonite/prevenção & controle , Peritonite/cirurgia , Estudos Prospectivos , Próteses e Implantes/efeitos adversos , Qualidade de Vida , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversos
20.
Biomed Res Int ; 2022: 7221203, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35211623

RESUMO

Despite the popularity of breast reconstruction with abdominal flap, the integrity of the abdominal wall gets compromised after the operation. To decrease donor site morbidity, researchers have developed various inlay or onlay graft materials. However, the indications of use are unclear and dependent on the subjective decision of the surgeons. In this study, we have investigated donor site morbidities in breast reconstruction with free abdominal flap surgery in which graft materials were not used. We reviewed 461 consecutive cases for the preoperative characteristics of patients, intraoperative details, and postoperative donor site complications from May 2013 to March 2019. While 386 patients underwent deep inferior epigastric perforators (83.7%), muscle sparing type 2 transverse rectus abdominis musculocutaneous flaps were performed in 75 patients (16.3%). Bilateral dissection of the pedicle was performed in 162 patients, compared to unilateral dissection in 299 patients. The mean follow-up duration was 22.7 months. The overall complication rate in the donor site was 7.2%. The flap height was significantly associated with the overall complication. While majority of them were delayed wound healing (n = 28, 6.1%), there were four cases of hematoma (0.9%). There were two cases of bulging (0.4%), which occurred in patients receiving bipedicle dissection; however, there was no case of hernia. Conclusions. Breast reconstruction with an abdominal free flap can be safely performed without fascia reinforcement graft even with bilateral dissection of the pedicle. With complete preservation of fascia and zigzag fascial incision, a low incidence of abdominal bulging can be obtained even with bilateral harvesting of the flap.


Assuntos
Parede Abdominal/irrigação sanguínea , Parede Abdominal/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Mamoplastia/métodos , Doadores de Tecidos , Coleta de Tecidos e Órgãos/efeitos adversos , Técnicas de Fechamento de Ferimentos Abdominais , Adulto , Idoso , Feminino , Sobrevivência de Enxerto , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
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