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2.
Am Surg ; 85(10): 1113-1117, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657305

RESUMO

Although recommendations help guide surgeons' mesh choice in abdominal wall reconstruction (AWR), financial and institutional pressures may play a bigger role. Standardization of an AWR algorithm may help reduce costs and change mesh preferences. We performed a retrospective review of high- and low-risk patients who underwent inpatient AWR between 2014 and 2016. High risk was defined as immunosuppression and/or history of infection/contamination. Patients were stratified by the type of mesh as biologic/biosynthetic or synthetic. These cohorts were analyzed for outcome, complications, and cost. One hundred twelve patients underwent complex AWR. The recurrence rate at two years was not statistically different between high- and low-risk cohorts. No significant difference was found in the recurrence rate between biologic and synthetic meshes when comparing both high- and low-risk cohorts. The average cost of biologic mesh was $9,414.80 versus $524.60 for synthetic. The estimated cost saved when using synthetic mesh for low-risk patients was $295,391.20. In conclusion, recurrence rates for complex AWR seem to be unrelated to mesh selection. There seems to be an excess use of biologic mesh in low-risk patients, adding significant cost. Implementing a critical process to evaluate indications for biologic mesh use could decrease costs without impacting the quality of care, thus improving the overall value of AWR.


Assuntos
Parede Abdominal/cirurgia , Materiais Biocompatíveis/economia , Redução de Custos , Sobremedicalização/economia , Telas Cirúrgicas/economia , Algoritmos , Materiais Biocompatíveis/efeitos adversos , Estudos de Coortes , Humanos , Hospedeiro Imunocomprometido , Sobremedicalização/estatística & dados numéricos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Recidiva , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Telas Cirúrgicas/efeitos adversos , Telas Cirúrgicas/estatística & dados numéricos
3.
Khirurgiia (Mosk) ; (9): 38-43, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532165

RESUMO

OBJECTIVE: To optimize surgical approach in patients with large and giant postoperative ventral hernias through an analysis of early and long-term results of modern techniques of hernia repair. MATERIAL AND METHODS: There were 680 patients with postoperative ventral hernia over a 15-year period who underwent surgery in the Sklifosovsky Research Institute for Emergency Care and Medical Unit of the Ministry of Internal Affairs (445 (65.4%) women, 235 (34.6%) men). Mean age of patients was 63.2±14.2 years. Middle and elderly (employable) age patients (45-74 years) prevailed in the study (n=510, 75%). Hernia repair using «sublay¼ technique was performed in 490 (72%) patients without severe comorbidities and relative volume of hernial protrusion up to 18%. Submuscular-inlay technique was used in 95 (14%) patients with significant comorbidities and those over 50 years old or with a relative volume of hernial protrusion over 18%. We have applied a modified repair technique for the last 3 years in 5 (0.75%) patients with a giant postoperative ventral hernia and anterior abdominal tissue deficiency (partial or complete absence of some anatomical structures, for example, rectus muscle). A hybrid technology was applied in 12 patients with severe concomitant diseases, hernias W2 according to European qualifications or recurrent hernias, significant adhesions in the abdominal cavity or hernial sac. RESULTS: Early postoperative wound complications occurred in 27 (5.5%) patients including hematoma (n=12, 2.5%), infiltration (n=7, 1.4%), wound suppuration (n=8, 1.6%). Other complications were observed in 6 (1.2%) patients: pneumonia, pulmonary embolism, intestinal obstruction. Lethal outcomes were absent. Recurrences in long-term period were found in 18 (3.7%) patients. Submuscular-inlay technique of hernia repair was followed by early postoperative wound complications in 5 (5.1%) patients including hematoma (n=3, 3.2%), infiltration (n=1, 1%), wound suppuration (n=1, 1%). There was no mortality. No other early postoperative complications were observed. Recurrences were detected in 5 (5.2%) patients. Preoperative intra-abdominal pressure was 7-10 mm Hg in all patients with tissue deficit. This value did not exceed 12 mm Hg after repair due to creation of a «specified diastasis¼. Lethal outcomes were absent. There were no early and long-term recurrences or wound complications. Analysis of early and long-term results of the modified hybrid repair of the anterior abdominal wall did not reveal recurrences, local and systemic complications. Persistent minor diastasis between rectus muscles reinforced with a mesh implant was observed in 3 (25%) out of 12 patients. CONCLUSION: Thus, optimized and personalized approach in patients with large and giant postoperative ventral hernias considers all intra- and postoperative risk factors.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Idoso , Feminino , Hérnia Ventral/etiologia , Herniorrafia/efeitos adversos , Humanos , Hérnia Incisional/etiologia , Masculino , Pessoa de Meia-Idade , Recidiva , Telas Cirúrgicas
4.
Khirurgiia (Mosk) ; (8): 12-16, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31464268

RESUMO

OBJECTIVE: To define the indication for preventive mesh implantation in patients scheduled for laparotomy. MATERIAL AND METHODS: There were 108 patients divided into the control (52 patients without anterior abdominal wall hernia) and the main (56 patients with ventral hernia) groups. RESULTS: Predominance of collagen type III over type I was observed in patients older 60 years in the main group. The maximum ratio of collagen types I and III was 1.4 in the main group. The minimum number of inter-fiber spaces (n=5) was noted in patients aged 30-40 years. The maximum density of connective tissue was 250 pixels per inch. CONCLUSION: Analysis of connective tissue structures revealed some important age-related features and markers of connective tissue dysplasia in the main group. An indication for preventive mesh implantation in patients scheduled for laparotomy was determined.


Assuntos
Colágeno/análise , Doenças do Tecido Conjuntivo/complicações , Hérnia Ventral/prevenção & controle , Hérnia Incisional/prevenção & controle , Laparotomia/efeitos adversos , Telas Cirúrgicas , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adulto , Tecido Conjuntivo/química , Tecido Conjuntivo/patologia , Doenças do Tecido Conjuntivo/patologia , Hérnia Ventral/etiologia , Hérnia Ventral/patologia , Herniorrafia/métodos , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/patologia , Pessoa de Meia-Idade
5.
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.
BMC Surg ; 19(1): 103, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391112

RESUMO

BACKGROUND: Recurrence after incisional hernia repair is one of the major problems related with this operation. Our objective is to analyze the influence of abdominal wall surgery expertise in the results of the open elective repair of incisional hernia. METHODS: We have compiled the data of a cohort of patients who received surgery for an incisional hernia from July 2012 to December 2015 in a University Hospital. Data were collected prospectively and registered in the Spanish Register of Incisional Hernia (EVEREG). The short- and long-term complications between the groups of patients operated on by the Abdominal Wall Surgery (AWS) unit and groups operated on by surgeons outside of the specialized abdominal wall group (GS) were compared. RESULTS: During the study period, a total of 237 patients were operated on by the open approach (114 AWS; 123 GS). One hundred seventy-five patients completed a median follow-up of 36.6 months [standard deviation (SD) = 6]. Groups were comparable in terms of age, sex, body mass index (BMI), comorbidities, and complexity of hernia. Complications were similar in both groups. Patients in the AWS group presented fewer recurrences (12.0% vs. 28.9%; P = 0.005). The cumulative incidence of recurrence was higher in the GS group [log rank 13.370; P < 0.001; odds ratio (OR) = 37.8; 95% confidence interval (CI) = 30.3-45.4]. In the multivariate analysis, surgery performed by the AWS unit was related to fewer recurrences (OR = 0.19; 95%CI = 0.07-0.58; P < 0.001). CONCLUSION: Incisional hernia surgery is associated with better results in terms of recurrence when it is performed in a specialized abdominal wall unit.


Assuntos
Parede Abdominal/cirurgia , Competência Clínica , Procedimentos Cirúrgicos Eletivos/métodos , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Especialização , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Seguimentos , Herniorrafia/normas , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Recidiva , Resultado do Tratamento
7.
BMC Surg ; 19(1): 82, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286901

RESUMO

BACKGROUND: An open abdomen is often necessary for survival of patients after peritonitis, compartment syndrome, or in damage control surgery. However, abdominal wall retraction relieves delays and complicates abdominal wall closure. The principle of the newly fascia preserving device (FPD) is the application of anteriorly directed traction on both fascial edges over an external support through a longitudinal beam to relieve increased abdominal pressure and prevent fascial retraction. METHODS: Twelve pigs were randomly divided into two groups. Both groups underwent midline laparotomy under general anesthesia. Group one was treated with the new device, group two served as controls. The tension for closing the abdominal fascia was measured immediately after laparotomy as well as at 24 and 48 h. Vital parameters and ventilation pressure were recorded. Post mortem, all fascial tissues were histologically examined. RESULTS: All pigs demonstrated increases in abdominal circumference. In both groups, forces for closing the abdomen increased over the observation period. Concerning the central closing force after 24 h we saw a significant lower force in the FPD group (14.4 ± 3 N) vs. control group (21.6 ± 5.7 N, p < 0.001). By testing the main effects using an ANOVA analysis we found a significant group related effect concerning closing force and abdominal circumference of the FDP-group vs. control group (p < 0.001; p < 0.001). The placement of the device on chest and pelvis did not influence vital parameters and ventilation pressure. Histologic exam detected no tissue damage. CONCLUSIONS: This trial shows the feasibility to prevent fascial retraction during the open abdomen by using the new device. Thus, it is expected that an earlier closure of the abdominal wall will be possible, and a higher rate of primary closure will be attained.


Assuntos
Parede Abdominal/cirurgia , Fáscia , Laparotomia/instrumentação , Tração/instrumentação , Técnicas de Fechamento de Ferimentos/instrumentação , Animais , Modelos Animais de Doenças , Estudos de Viabilidade , Feminino , Humanos , Estudo de Prova de Conceito , Distribuição Aleatória , Suínos
9.
Plast Reconstr Surg ; 144(2): 197e-204e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348338

RESUMO

BACKGROUND: Abdominoplasty is one of the top five most commonly performed cosmetic procedures. Whereas widening of the linea alba is a well-accepted consequence of pregnancy, the changes to the rectus abdominis muscles are less well known and thus unappreciated and undertreated. METHODS: After institutional review board approval, the Northwestern Enterprise Data Warehouse identified nulliparous and multiparous women, aged 18 to 45 years, who underwent abdominal computed tomography between 2000 and the present. Measurements included the width and cross-sectional area of each rectus muscle, width of the linea alba, and circumference of the abdominal cavity at the level of the L3 vertebra. In addition, two case reports addressing these anatomical changes with muscle modification and mesh reinforcement are presented. RESULTS: Sixty women were identified that met our inclusion criteria: 15 nulliparous, 15 after one pregnancy (para 1), 15 after two pregnancies (para 2), and 15 after three or more pregnancies (para ≥ 3). The linea alba was significantly widened after one pregnancy from 1.14 cm to 2.29 cm, but did not significantly widen further with each subsequent pregnancy. The width of each rectus muscle was significantly widened from 6.00 ± 0.60 cm in nulliparous to 6.61 ± 0.58 cm in para 1, significantly widened again to 7.03 ± 0.46 cm in para 2, but not significantly widened after that (6.97 ± 1.00 cm in para 3). CONCLUSIONS: In addition to widening of the linea alba, pregnancy alters the shape of the rectus abdominis muscle. Correction of muscle width during abdominoplasty may be a necessary adjunct to achieve the proper tension in both primary and revision procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.


Assuntos
Abdominoplastia/métodos , Abdominoplastia/estatística & dados numéricos , Reto do Abdome/diagnóstico por imagem , Reto do Abdome/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Adulto , Estudos de Coortes , Bases de Dados Factuais , Estética , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Paridade , Satisfação do Paciente/estatística & dados numéricos , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
10.
Pediatr Surg Int ; 35(8): 895-901, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31165911

RESUMO

PURPOSE: Data regarding safety and feasibility of re-do ileal pouch anal anastomosis (IPAA) for failed ileal pouch in children are limited. In this study, we compared the short- and long-term outcomes of re-do IPAA in pediatric and adult populations in a case-matched setting. METHODS: Between March 2007 and June 2017, pediatric patients undergoing a transabdominal re-do IPAA by single surgeon were reviewed and case matched with adult counterparts. Short- and long-term outcomes including complications, functional outcomes, and quality of life of the two groups were compared. RESULTS: 60 patients were included (pediatric, n = 30; adult, n = 30). Time between index IPAA and re-do IPAA was shorter in the pediatric group (30 ± 26 vs 86 ± 74 months, p = 0.001). In the pediatric population, the existing pouch was more commonly used to construct the re-do pouch (n = 19 vs n = 12, p = 0.07). There was a trend towards the presence of less postoperative complications in pediatric group (n = 13 vs n = 20, p = 0.07). There were no reoperations or mortality. Long-term pouch survival was comparable between two groups (p = 0.96). Six re-do IPAAs failed in the study period. CONCLUSION: Re-do IPAA is safe and feasible in pediatric population with failed IPAA and can be performed with similar short- and long-term outcomes compared to adults in experienced hands.


Assuntos
Parede Abdominal/cirurgia , Doenças do Colo/cirurgia , Bolsas Cólicas/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Proctocolectomia Restauradora/efeitos adversos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Qualidade de Vida , Reoperação , Estudos Retrospectivos , Falha de Tratamento
11.
J Surg Oncol ; 120(3): 366-375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236956

RESUMO

BACKGROUND: Desmoid tumors are rare locally invasive, benign neoplasms that develop along aponeurotic structures. Current treatment is complicated by associated morbidity and high recurrence rates. METHODS: A retrospective, single-institution review identified 23 patients (age: 16-77) with extra-abdominal desmoid tumors who received CT-guided percutaneous cryoablation as either a first-line (61%) or salvage (39%) treatment in 30 sessions between 2014 and 2018. Median maximal lesion diameter was 69 mm (range: 11-209). Intent was curative in 52% and palliative in 48%. Contrast-enhanced cross-sectional imaging was obtained before and after treatment in addition to routine clinical follow-up. RESULTS: Technical success was achieved in all patients. The median follow-up was 15.4 months (3.5-43.4). Symptomatic improvement was demonstrated in 89% of patients. At 12 months, the average change in viable volume was -80% (range -100% to + 10%) and response by modified response evaluation criteria in solid tumors (mRECIST) was CR 36%, PR 36%, and SD 28% No rapid postablation growth or track seeding was observed. Four patients underwent repeat cryoablation for either residual or recurrent disease. Two patients sustained a major procedural complication consisting of significant neuropraxia. CONCLUSION: Cryoablation for desmoid tumors demonstrates a high degree of symptom improvement and local tumor control on early follow-up imaging with relatively low morbidity.


Assuntos
Criocirurgia/métodos , Fibromatose Agressiva/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adolescente , Adulto , Idoso , Extremidades/diagnóstico por imagem , Extremidades/patologia , Extremidades/cirurgia , Feminino , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
BMC Surg ; 19(1): 68, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242888

RESUMO

BACKGROUND: Clarifying the biomechanics of abdominal skin could lead to different uses for this tissue such as the ventral repair of hernias in patients with excess skin and incisional hernias. The objective of this study was to compare the maximum tensile strength of abdominal skin to commercial meshes and to verify whether or not it varies between aesthetic patients and massive weight-loss patients. METHODS: Experimental cross-sectional study. Skin samples sized 32 × 20 mm were taken from 15 abdominoplasties and 10 panniculectomies. The skin specimens were analyzed in vertical and horizontal tensile strength tests. Results were compared between the two groups including their traction directions. Commercial meshes were also tested. The results were analyzed using the Generalized Estimating Equation. RESULTS: The maximum tensile strength supported vertically by abdominal dermis was 403.5 ± 27.4 N in the abdominoplasty group and 425.9 ± 33.9 N in the panniculectomy group. Horizontally, the values were 596.5 ± 32.2 N and 612.5 ± 43.9 N respectively. The strengths between traction directions were significantly different (p < 0.001). There were no differences between the groups with regard to the maximum tensile strength (p = 0.472). Tested commercial meshes had the following values: polypropylene 104.6 N, low-weight polypropylene 54.4 N, polytetrafluorethylene (PTFE) 82.2 N, and hydrated porcine small-intestinal submucosa 60.0 N. CONCLUSION: In our study, the tensile strength of the tested human abdominal dermis samples, both aesthetic and post-bariatric, was superior to the commercial meshes. Therefore, in selected cases, abdominal dermis could be an alternative tool in abdominal reconstruction during panniculectomies with concomitant hernia repair.


Assuntos
Parede Abdominal/fisiologia , Herniorrafia/instrumentação , Telas Cirúrgicas , Resistência à Tração , Perda de Peso , Parede Abdominal/cirurgia , Abdominoplastia , Adulto , Animais , Estudos Transversais , Estética , Feminino , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Humanos , Hérnia Incisional/cirurgia , Masculino , Pessoa de Meia-Idade , Polipropilenos , Suínos , Adulto Jovem
13.
JSLS ; 23(2)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31097906

RESUMO

Background and Objective: The number of laparoscopic procedures increases annually with an estimated 3% of complications, one third of them linked to Verres' needle or trocar insertion. The safety and efficacy of ports insertion during laparoscopic surgery may be related the technique but also to trocar design. This study aims to compare physical parameters of abdominal wall penetration for 5 different trocars. Methods: Eleven pigs were studied. Five different commercially available trocars were randomically inserted at the midline. Real-time video recording of the insertions was achieved to measure the excursion of the abdominal wall and the time and distance the cutting surface of the bladed trocars was exposed inside the abdominal cavity. An especially designed hand sensor was developed and placed between the trocar and the hand of the surgeon to record force required for abdominal wall perforation. Results: Greater deformations and forces occurred in nonbladed as compared to bladed trocars, and in conical trocars as compared to pyramidal pointed ones, except for peritoneum perforation. Greater distance and time of blade exposure occurred in pyramidal laminae as compared to conical. Conclusion: The bladed trocars have lower forces and deformations in their introduction, and should be those that cause less injury and are more suitable for first entry. Conical and pyramidal trocars with the same blade size showed similar force, deformation, time, and distance of exposed blade.


Assuntos
Parede Abdominal/cirurgia , Laparoscopia/instrumentação , Animais , Desenho de Equipamento , Laparoscopia/métodos , Modelos Animais , Suínos
14.
Pan Afr Med J ; 32: 35, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31143340

RESUMO

Surgical site infections are frequent in developing countries. Cesarean section is one of the most common surgery among women in the world. This study aims to analyse the epidemiological, clinical, therapeutic and prognostic aspects of parietal suppurations after cesarean section in the Department of Gynecology and Obstetrics at the Yalgado Ouédraogo University Hospital in order to reduce their occurrence. We conducted a descriptive cross-sectional study over a period of 6 months, from 1st April 2015 to 30th September 2015. Out of 1998 cases of cesarean section, seventy patients had parietal suppurations, corresponding to an incidence of 3.5%. The average age of patients was 26.2 ± 6.1 years; the patients were predominantly housewives (77%). Emergency cesarean section was performed in all patients. Suppuration was mainly diagnosed in the 1st week (60%). Staphylococcus aureus was detected in 37.8% of cases. Second abdominal wall surgery was necessary in 34.3% of cases. Outcome was favorable in all patients. Parietal suppuration after cesarean is common. Second surgery is sometimes necessary. Further studies should be conducted to better identify factors favoring this disease in order to significantly reduce their incidence and therefore improve maternal prognosis.


Assuntos
Cesárea/efeitos adversos , Infecções Estafilocócicas/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Parede Abdominal/cirurgia , Adolescente , Adulto , Burkina Faso/epidemiologia , Estudos Transversais , Emergências , Feminino , Hospitais Universitários , Humanos , Incidência , Gravidez , Prognóstico , Infecções Estafilocócicas/microbiologia , Supuração , Infecção da Ferida Cirúrgica/microbiologia , Resultado do Tratamento , Adulto Jovem
15.
Cir Esp ; 97(5): 247-253, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30948213

RESUMO

Abdominal wall transplantation has been consolidated as an alternative to primary abdominal wall closure in intestinal and multiple organ transplant recipients. Given that it is feasible to obtain the visceral graft and the abdominal wall graft from the same donor, abdominal wall transplantation could offer satisfactory outcomes and be easily coordinated. Non-vascularized fascia is one of the alternatives for abdominal wall closure in transplantation. We report two cases of non-vascularized fascia transplantation in intestinal and multivisceral transplants, respectively. Both donors were young (23 and 18 years old). Both recipients had endured multiple previous surgeries, and no surgical alternatives for primary wall repair could be offered. In both cases, a complete abdominal wall flap was retrieved from the donor, however, due to the characteristics of the recipient's abdominal wall defect, only non-vascularized fascia was used after removing skin and subcutaneous cellular tissue from the graft. Abdominal wall transplantation is an option to consider for abdominal wall closure in patients with multiple previous surgeries and no alternatives for primary wall repair.


Assuntos
Parede Abdominal/cirurgia , Transplante de Órgãos/métodos , Técnicas de Fechamento de Ferimentos , Adolescente , Fáscia/transplante , Humanos , Intestinos/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto Jovem
16.
World J Surg ; 43(8): 1906-1913, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30980102

RESUMO

BACKGROUND: Incarceration of primary and incisional hernias often results in emergency surgery. The objective of this study was to evaluate the relation of defect size and location with incarceration. Secondary objectives comprised identification of additional patient factors associated with an incarcerated hernia. METHODS: A registry-based prospective study was performed of all consecutive patients undergoing hernia surgery between September 2011 and February 2016. Multivariate logistic regression was performed to identify risk factors for incarceration. RESULTS: In total, 83 (3.5%) of 2352 primary hernias and 79 (3.7%) of 2120 incisional hernias had a non-reducible incarceration. For primary hernias, a defect width of 3-4 cm compared to defects of 0-1 cm was significantly associated with an incarcerated hernia (OR 2.85, 95% CI 1.57-5.18, p = 0.0006). For incisional hernias, a defect width of 3-4 cm compared to defects of 0-2 cm was significantly associated with an incarceration (OR 2.14, 95% CI 1.07-4.31, p = 0.0324). For primary hernias, defects in the peri- and infra-umbilical region portrayed a significantly increased odds for incarceration as compared to supra-umbilical defects (OR 1.98, 95% CI 1.02-3.85, p = 0.043). Additionally, in primary hernias age, BMI, and constipation were associated with incarceration. In incisional hernias age, BMI, female sex, diabetes mellitus and ASA classification were associated with incarceration. CONCLUSION: For primary and incisional hernias, mainly defects of 3-4 cm were associated with incarceration. For primary hernias, mainly defects located in the peri- and infra-umbilical region were associated with incarceration. Based on patient and hernia characteristics, patients with increased odds for incarceration may be selected and these patients may benefit from elective surgical treatment.


Assuntos
Parede Abdominal/patologia , Hérnia Ventral/patologia , Hérnia Incisional/patologia , Parede Abdominal/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos , Feminino , Hérnia Ventral/cirurgia , Humanos , Hérnia Incisional/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Adulto Jovem
17.
World J Surg ; 43(8): 1914-1920, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31011821

RESUMO

BACKGROUND: Hernias severely impact patient quality of life (QoL), and 80% of patients need surgical operation. The primary outcome of the study is to assess improvements in balance, posture and deambulation after abdominal hernia repair. Moreover, the study investigated the improvement in the postoperative QoL. METHODS: Patients operated at the Policlinico "Paolo Giaccone" at Palermo University Hospital between June 2015 and June 2017 were identified in a prospective database. The functional outcome measures and QoL assessment scales used were numeric rating scale for pain, performance-oriented mobility assessment (POMA) scale, Quebec back pain disability scale, center of gravity (barycenter) variation evaluation, Short-Form (36) Health Survey (SF-36 test), sit-up test and Activities Assessment Scale (AAS). The timepoints at which the parameters listed were assessed for the study were 1 week before the surgical operation and 6 months later. RESULTS: The POMA scale showed a significant improvement, with an overall preoperative score of (mean; SD) 18.80 ± 2.17 and a postoperative score of 23.56 ± 2.24 with a p < 0.003. The improvement of the barycenter was significant with p = 0.03 and 0.01 for the right and left inferior limbs, respectively. Finally, common daily activities reported by the SF-36 test and by the AAS were significantly improved with a reported p of ≤0.04 for 5 of eight items and ≤0.002 for all items, respectively. CONCLUSIONS: The improvement in such physical measures proves the importance of abdominal wall restoration to recover functional activity in the muscle-skeletal complex balance, gait and movement performance.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Qualidade de Vida , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Hérnia Ventral/reabilitação , Humanos , Hérnia Incisional/reabilitação , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Período Pós-Operatório , Estudos Prospectivos , Psicometria , Quebeque , Recuperação de Função Fisiológica , Telas Cirúrgicas , Resultado do Tratamento
18.
World J Gastroenterol ; 25(14): 1775-1782, 2019 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-31011261

RESUMO

BACKGROUND: Open abdomen (OA) has been generally accepted for its magnificent superiority and effectiveness in patients with severe trauma, severe intra-abdominal infection, and abdominal compartment syndrome. In the meantime, OA calls for a mass of nursing and the subsequent enteroatomospheric fistula (EAF), which is one of the most common complications of OA therapy, remains a thorny challenge. CASE SUMMARY: Our team applied thermoplastic polyurethane as a befitting material for producing a 3D-printed "fistula stent" in the management of an EAF patient, who was initially admitted to local hospital because of abdominal pain and distension and diagnosed with bowel obstruction. After a series of operations and OA therapy, the patient developed an EAF. CONCLUSION: Application of this novel "fistula stent" resulted in a drastic reduction in the amount of lost enteric effluent and greatly accelerated rehabilitation processes.


Assuntos
Parede Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Fístula Intestinal/cirurgia , Impressão Tridimensional , Adulto , Anastomose Cirúrgica/efeitos adversos , Angiografia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Poliuretanos , Stents , Resultado do Tratamento
19.
Am Surg ; 85(3): 280-283, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30947774

RESUMO

Lumbar incisional hernias are difficult to repair because one of the hernia margins is bone, namely, the iliac crest. Previous studies have described the use of orthopedic bone anchors that fix a mesh onto the iliac crest. We present a novel technique for open repair of large lumbar incisional hernias using a double-mesh technique in combination with suture-loaded bone anchors to reattach the abdominal wall musculature onto the iliac crest. The surgical technique involves creating a preperitoneal plane behind the transversus abdominus and above the iliac crest and iliacus, below the iliac crest, with application of a Prolene mesh in this layer. This is followed by the drilling of suture-loaded Christmas Tree bone anchors™ along the rim of the iliac crest. The preloaded sutures are used to attach the myofascial component on the iliac crest, followed by the placement of a second Prolene mesh in an on-lay fashion. Drains are left in the preperitoneal and subcutaneous spaces. Unlike other reported techniques in the literature which only fix mesh onto the iliac crest, our technique with the use of Christmas Tree bone anchors™ allows for complete reconstruction of the lumbar abdominal wall defect and its myofascial components.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Telas Cirúrgicas , Âncoras de Sutura , Técnicas de Sutura , Parede Abdominal/cirurgia , Idoso , Herniorrafia/instrumentação , Humanos , Ílio/cirurgia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Polipropilenos
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