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1.
Acta Cir Bras ; 35(10): e202001001, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33206869

RESUMO

PURPOSE: Incisional hernia (IH) is a frequent complication of median laparotomy. The use of prophylactic mesh to reduce IH incidence has gained increasing attention. We hypothesized that in an animal model, linea alba prophylactic reinforcement with a three-dimensional T-shaped polypropylene mesh results in greater abdominal wall resistance. METHODS: Study was performed in 27 rabbits. After abdominal midline incision, animals were divided into three groups according to the laparotomy closure method used: (1)3D T-shaped coated mesh; (2)3D T-shaped uncoated mesh; and (3) closure without mesh. After 4 months, each animal's abdominal wall was resected and tensiometric tests were applied. Results included IH occurrence, adhesions to the mesh, and wound complications. RESULTS: There was no significant difference between the groups in maximum tensile strength (p=0.250) or abdominal wall elongation under maximum stress (p=0.839). One rabbit from the control group developed IH (p=1.00). Small intestine and colon adhesions occurred only in the uncoated mesh group (p<0.001) and the degree of adhesions was higher in this group compared to the coated mesh group (p<0.05). CONCLUSION: Use of the current 3D T-shaped prophylactic mesh model did not result in a significant difference in tensiometric measurements when compared with simple abdominal wall closure in rabbits.


Assuntos
Parede Abdominal , Hérnia Ventral , Hérnia Incisional , Parede Abdominal/cirurgia , Animais , Hérnia Ventral/cirurgia , Polipropilenos , Coelhos , Telas Cirúrgicas , Aderências Teciduais/prevenção & controle
2.
Khirurgiia (Mosk) ; (10): 88-94, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047591

RESUMO

Conventional «open¼ procedures for ventral hernias and diastasis recti are widely known, used everywhere and have a great number of author's improvements related to surgeon's experience, availability of modern information, equipment and materials. K. LeBlanc and W. Booth (1993) reported IPOM-method with non-adhesive coating that is considered a milestone in surgery of anterior abdominal wall and ventral hernia. This technique has gained recognition among surgeons around the world due to its technical simplicity, minimal invasiveness and high reproducibility. However, certain disadvantages of this technique have been shown over the past time that justified advisability of searching for another methods of anterior abdominal wall reinforcement. Thus, E-Milos, LIRA, TESAR, eTEP, REPA, TARM, TARUP techniques are currently available. This review is devoted to technical features of these techniques, their potential advantages and disadvantages.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Parede Abdominal/anatomia & histologia , Hérnia Abdominal/cirurgia , Hérnia Ventral/patologia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Reprodutibilidade dos Testes , Telas Cirúrgicas
3.
Khirurgiia (Mosk) ; (10): 116-122, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047595

RESUMO

Massive localized lymphedema (MLL) is a rare disease observed in people with morbid obesity. MLL is easily confused with soft tissue sarcoma. Therefore, MLL is sometimes called as pseudosarcoma in the literature. MLL was initially described by G. Farshid and S. Weiss in 1998. However, etiology of MLL is still unknown despite certain relationships with injuries, operations and hypothyroidism. Since the term «MLL¼ was introduced only 20 years ago, there are no reliable statistical data on the prevalence of MLL. According to the World Health Organization data (2016), 13% of the adult world population are obese. Therefore, the risk of MLL is increased in these people. Thigh is the most common site of lesion. Abdominal wall lesion is rare and can cause diagnostic difficulties due to large dimensions and appearance. We report a 50-year-old obese woman with MLL of anterior abdominal wall. She experienced discomfort while walking and sleeping due to giant MLL of anterior abdominal wall that significantly reduced quality of life. Removal of MLL (weight 22160 g) was followed by favorable cosmetic and functional outcome. Analysis of differences between MLL and soft tissue sarcoma in the era of «obesity epidemic¼ is valuable for correct diagnosis and treatment of this rare complication. This report is the first case of MLL, registered in Russia. In our opinion, this is associated with insufficient awareness of physicians about this complication of obesity. We hope our observation will help clinicians to identify and treat this complication.


Assuntos
Parede Abdominal/cirurgia , Linfedema/cirurgia , Obesidade Mórbida/complicações , Parede Abdominal/patologia , Feminino , Humanos , Linfedema/diagnóstico , Linfedema/etiologia , Pessoa de Meia-Idade , Qualidade de Vida
5.
Rev Col Bras Cir ; 47: e20202544, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32965302

RESUMO

OBJECTIVE: to study the characteristics of women undergoing abdominal surgery with suspected abdominal wall endometriosis or abdominal wall tumor, and to assess the association with age, race and previous cesarean delivery. METHOD: retrospective and analytical study carried out from January 2000 to December 2019, at the General Surgery Service of Hospital Universitário Antônio Pedro (HUAP) at Universidade Federal Fluminense (UFF). Medical records of 100 patients with abdominal wall endometriosis and other types of abdominal wall tumors were analyzed. Age, color, previous history of cesarean section or abdominal surgery and histopathological data were verified. The patients were classified as young adults (aged between 18 and 28 years and 11 months) and adults. The SPSS program was used for data analysis, Fisher's test with a significance level of 0.05. RESULTS: abdominal wall endometriosis with histopathological confirmation was found in 22%, the mean age was 52.28 ± 18.66 which was lower when compared to other diagnoses. There was an association between previous cesarean section and abdominal wall endometriosis (p <0.005). CONCLUSION: the women with a diagnosis of abdominal wall endometriosis had undergone previous cesareans (the majority) and were in an active reproductive age. Although the brown skin women were the most frequent, there was no statistical difference.


Assuntos
Parede Abdominal/patologia , Cesárea/efeitos adversos , Endometriose/diagnóstico , Complicações Pós-Operatórias , Parede Abdominal/cirurgia , Adulto , Idoso , Endometriose/etiologia , Endometriose/cirurgia , Feminino , Hospitais Universitários , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Adulto Jovem
6.
Khirurgiia (Mosk) ; (7): 39-44, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736462

RESUMO

OBJECTIVE: To evaluate an effectiveness of light strengthened polypropylene endoprosthesis in the treatment of patients with middle and large ventral hernias. MATERIAL AND METHODS: Early and long-term outcomes of surgical treatment were analyzed in 60 patients with middle and large ventral hernias. Onlay hernia repair was performed. Patients were divided into two groups by 30 patients. Abdominal wall repair with conventional polypropylene endoprosthesis was performed in the first group, light strengthened endoprosthesis was used in the second group. RESULTS: Application of light strengthened polypropylene endoprosthesis was accompanied by reduced inflammatory response and higher intensity of reparative processes in the area of implantation in early postoperative period. Moreover, we observed better functional state of abdominal rectus muscles in long-term postoperative period in the same group. Improved physical component of health by 4.5% was found in the 2nd group. As a result, incidence of excellent outcomes increased by 13.3%, good results by 6.7%, incidence of satisfactory results decreased by 20%. Recurrent hernia was absent. CONCLUSION: Light strengthened endoprosthesis is effective and advisable in patients with middle and large ventral hernia.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas , Materiais Biocompatíveis , Herniorrafia/instrumentação , Humanos , Luz , Masculino , Polipropilenos , Próteses e Implantes , Recidiva
7.
Cir. pediátr ; 33(3): 146-148, jul. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193558

RESUMO

INTRODUCCIÓN: La bolsa colónica congénita (BCC) es una malformación poco común en la que se produce una dilatación variable del colon asociada a malformación anorrectal (MAR); generalmente presenta una fístula hacia el tracto genitourinario. CASO CLÍNICO: Paciente femenino de 2 días de vida, sin antecedentes médicos de relevancia, presenta distensión abdominal y ano imperforado. Es sometida a colostomía, presenta evolución irregular con débitos altos a través de la colostomía, se realizan estudios contrastados de imagen donde se observa exteriorización errónea de asa de yeyuno, se somete a laparotomía exploratoria donde se comprueba lo descrito y además se reporta como hallazgo incidental agenesia colónica con desembocadura del íleon en una bolsa de 6 cm de diámetro que se conecta con la vejiga. DISCUSIÓN: La BCC es una patología común en ciertos países orientales y extremadamente rara en países occidentales; en Ecuador no se encontraron registros de casos reportados. Se debe realizar un correcto análisis prequirúrgico de los pacientes con MAR para conseguir una adecuada planificación y abordaje quirúrgico, disminuyendo con ello la morbimortalidad en el paciente


INTRODUCTION: Congenital pouch colon (CPC) is a rare malformation. It causes variable dilatation of the colon associated with anorectal malformation (ARM), usually presenting a fistula towards the genitourinary tract. CLINICAL CASE: 2-day-old female patient, with no relevant medical history. She had abdominal distension and imperforate anus. She underwent colostomy. She had an irregular evolution with high colostomy debits. Contrast imaging studies were performed, which demonstrated an erroneous exteriorization of the jejunal loop. She underwent an exploratory open surgery, which confirmed the previous diagnosis and incidentally found colonic agenesis, with ileum entering in a pouch of 6 cm of diameter that connects with the bladder. DISCUSSION: CPC is a common pathology in certain eastern countries and extremely rare in western countries. In Ecuador, no records of reported cases were found. A correct pre-surgical analysis of ARM patients should be carried out to achieve an adequate planning and surgical approach, thus reducing morbidity and mortality


Assuntos
Humanos , Feminino , Recém-Nascido , Colo/anormalidades , Colo/cirurgia , Parede Abdominal/cirurgia , Colostomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fístula Intestinal/cirurgia , Radiografia Abdominal
9.
Surgery ; 168(3): 532-542, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32527646

RESUMO

BACKGROUND: The best treatment for the combined defects of midline and lateral incisional hernia is not known. The aim of our multicenter study was to evaluate the operative and patient-reported outcomes using a modified posterior component separation in patients who present with the combination of midline and lateral incisional hernia. METHODS: We identified patients from a prospective, multicenter database who underwent operative repairs of a midline and lateral incisional hernia at 4 centers with minimum 2-year follow-up. Hernias were divided into a main hernia based on the larger size and associated abdominal wall hernias. Outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. RESULTS: Fifty-eight patients were identified. Almost 70% of patients presented with a midline defect as the main incisional hernia. The operative technique was a transversus abdominis release in 26 patients (45%), a modification of transversus abdominis release 27 (47%), a reverse transversus abdominis release in 3 (5%), and a primary, lateral retromuscular preperitoneal approach in 2 (3%). Surgical site occurrences occurred in 22 patients (38%), with only 8 patients (14%) requiring procedural intervention. During a mean follow-up of 30.1 ± 14.4 months, 2 (3%) cases of recurrence were diagnosed and required reoperation. There were also 4 (7%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) in the postoperative score compared with the preoperative score. CONCLUSION: The different techniques of posterior component separation in the treatment of combined midline and lateral incisional hernia show acceptable results, despite the associated high complexity. Patient-reported outcomes after measurement of the European Registry for Abdominal Wall Hernias Quality of Life score demonstrated a clinically important improvement in quality of life and pain.


Assuntos
Parede Abdominal/cirurgia , Abdominoplastia/métodos , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Dor Pós-Operatória/epidemiologia , Abdominoplastia/efeitos adversos , Idoso , Feminino , Seguimentos , Hérnia Ventral/diagnóstico , Herniorrafia/efeitos adversos , Humanos , Hérnia Incisional/diagnóstico , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Qualidade de Vida , Recidiva , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Surgery ; 168(3): 543-549, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32576404

RESUMO

BACKGROUND: The goal of our study was to compare results in patients with large midline incisional hernia using modified anterior component separation versus preoperative botulinum toxin and following Rives repair, with a focus on surgical site occurrences, possibility of fascial closure, duration of hospital stay, and hernia recurrence rate. METHODS: From to March 2016 to June 2019, a prospective comparative study was performed in 80 consecutive patients with large midline incisional hernias and hernia transverse diameters between 11 and 17 cm under elective hernia repair at our tertiary center. Two groups were analyzed prospectively: 40 patients with preoperative botulinum toxin administration and following open Rives repair (botulinum toxin group) were compared with 40 patients who underwent open component separation during that period (component separation group). RESULTS: All large midline incisional hernias were classified W3, with mean transverse and longitudinal defect diameters of 14.9 cm (11.8-16.5) and 24 cm (11-28), respectively. Complete fascial closure was possible in all patients in the preoperative botulinum toxin group. No complications occurred during the administration of preoperative botulinum toxin, but surgical site complications were most frequent in the component separation group, especially skin necrosis (12.5%, P = .020). At a median of 19.6 months (range, 11-35) of postoperative follow-up, 2 cases of hernia recurrence (8.9%) were reported, all of them in the component separation group. CONCLUSION: Botulinum toxin allows getting a successful downstaging from surgical repair to Rives technique in patients with large midline incisional hernia, especially with hernia transverse diameters between 11 and 17 cm. These results contribute to minimize disadvantages associated to the anterior component separation.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Hérnia Ventral/terapia , Herniorrafia/métodos , Hérnia Incisional/terapia , Cuidados Pré-Operatórios/métodos , Músculos Abdominais/diagnóstico por imagem , Músculos Abdominais/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Hérnia Ventral/diagnóstico , Humanos , Hérnia Incisional/diagnóstico , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X
11.
Surgery ; 168(1): 141-146, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32499045

RESUMO

BACKGROUND: Little data exist to inform discharge opioid prescribing for patients undergoing abdominal wall reconstruction. The aim of this study was to evaluate postoperative, patient-reported opioid use after abdominal wall reconstruction. We hypothesized that the majority of patients undergoing open abdominal wall reconstruction would require between 16 and 30 opioid tablets after discharge. METHODS: Postoperative, patient-reported opioid use was collected prospectively for all patients undergoing elective, open abdominal wall reconstruction at a single high-volume center. All opioid medications were converted to an equivalent number of 5 mg oxycodone tablets. The primary outcome was the total number of opioid tablets taken within 30 days of hospital discharge after abdominal wall reconstruction. RESULTS: Ninety-eight patients were included. Median hernia width was 15 cm (interquartile range 12-19), 42% were recurrences, and all underwent transversus abdominis release. At the 30-day follow-up visit, 24% reported no postdischarge opioid use, and 76% reported taking 15 tablets or fewer. Of the 23 patients who used no opioids on the day before discharge, 16 (70%) reported taking no opioids after discharge. CONCLUSION: Most patients reported taking fewer opioid tablets than prescribed and fewer than our hypothesis within 30 days of abdominal wall reconstruction. Opioid use on the day before discharge may allow for prognostication of outpatient opioid requirements to prevent overprescribing.


Assuntos
Parede Abdominal/cirurgia , Analgésicos Opioides/administração & dosagem , Herniorrafia/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia
12.
Cir Esp ; 98(9): 507-509, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-32354491

RESUMO

Pandemic by the COVID-19 has found us unprotected to provide an adequate and rapid sanitary response. The hospital network of our public health system has provided most of the resources for the treatment of patients affected by the infection. Non-essential (non-priority) surgeries have been postponed. The optimal and proportionate reestablishment of these non-priority surgeries can be a problem. This article offers a technical and non-technical view of reestablishment non-priority surgeries from the perspective of abdominal wall surgery.


Assuntos
Parede Abdominal/cirurgia , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
13.
Chirurgia (Bucur) ; 115(2): 140-147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369717

RESUMO

The risk of developing an abdominal wall hernia is high in the cirrhotic patient, due to the association of ascites, hypoalbuminemia and amyotrophy in connection with undernutrition frequently associated with cirrhosis. Thus, almost 20% of cirrhotic patients develop an umbilical hernia. Parietal surgery is more at risk in cirrhotic patients and its indications must be discussed on a case-by-case basis. The objective of this work was to review the entire literature on wall surgery in order to best define the surgical indications and the specifics of their management. The bibliographic research was done on Pubmed over the period from January 1995 to December 2019, using French and English as publication languages. The keywords retained were "hernia" [Mesh] and "liver cirrhosis" [Mesh]. In an elective situation, preoperative ascites control is recommended. A parietal prosthesis can be used, even in the case of uninfected ascites, preferably in the retromuscular position. Laparoscopy should be used with caution, due to the bleeding risk. No recommendation can be made on the use of prophylactic intra-abdominal drainage. The literature data do not allow the trans-jugular route portosystemic shunt recommendation, nor the use of a peritoneal-vesical pump to decrease the volume of ascites before parietal surgery in cirrhotic patients.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Cirrose Hepática/complicações , Ascite/etiologia , Ascite/terapia , Hérnia Umbilical/etiologia , Hérnia Umbilical/cirurgia , Hérnia Ventral/etiologia , Humanos
14.
J Laparoendosc Adv Surg Tech A ; 30(6): 659-665, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32311282

RESUMO

Inguinal hernia repair (IHR) is one of the most commonly performed general surgery operations. Currently, an inguinal hernia can be repaired through an open, laparoscopic, or robot-assisted approach. Herein, we detail our perioperative evaluation and management of patients with a groin hernia as well as our surgical technique for the performance of the laparoscopic transabdominal preperitoneal IHR.


Assuntos
Parede Abdominal/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Telas Cirúrgicas , Humanos
15.
JSLS ; 24(2)2020.
Artigo em Inglês | MEDLINE | ID: mdl-32327919

RESUMO

Introduction: Positioning-related neural injuries are an inherent risk in surgery, particularly in robotic-assisted abdominal wall reconstruction because of unique patient positioning and increased operative times. The implementation of intraoperative neurophysiological monitoring should be considered in such cases. Methods: This was a two-armed study with one prospective intervention group and one retrospective control group. All patients underwent robotic abdominal wall reconstruction at an academic center. The prospective arm underwent robotic reconstruction from January through July 2019. The retrospective database reviewed patients who underwent the same procedure from August 2015 through July 2018. Factors assessed included: demographics (age, gender, body mass index, comorbidities), surgical details (American Society of Anesthesiologists class, procedure, operative time, positioning), outcomes (length of stay, 30-d readmission, reoperation), and any new-onset intraoperative or postoperative neuropathy. Patients were seen in the clinic postoperatively at weeks 1 and 6. Results: Ten patients were included in the prospective arm. All received intraoperative neurophysiological monitoring using somatosensory evoked potentials. They were compared with 47 patients in the retrospective arm who underwent surgery without intraoperative neurophysiological monitoring. One position-related neural response from baseline was detected intraoperatively in the prospective arm; however, there were no peripheral neurological symptoms present postoperatively. Two patients in the control group developed transient peripheral neuropathies that resolved within 6 weeks. Demographics, surgical procedures, and length of surgery were similar in both groups. The prospective group had a higher rate of preoperative neuropathy and intraoperative use of vasopressors. Conclusion: Incorporation of neurophysiological monitoring in robotic surgery is feasible and may lead to the prevention and reduction in positioning-related injuries.


Assuntos
Parede Abdominal/cirurgia , Monitorização Neurofisiológica , Doenças do Sistema Nervoso Periférico/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Posicionamento do Paciente , Projetos Piloto , Estudos Prospectivos , Reoperação , Estudos Retrospectivos , Adulto Jovem
17.
Plast Reconstr Surg ; 145(5): 909e-916e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332527

RESUMO

BACKGROUND: The abdomen is a common donor site in autologous breast reconstruction. The authors aimed to determine whether pregnancy following autologous breast reconstruction increases the risk of incisional hernia repair. METHODS: All women younger than 50 years who underwent abdominally based autologous breast reconstruction between 2005 and 2016 were identified. Patients with less than 20 months of follow-up were excluded. Demographics, operative details, outcomes, incisional hernia repair occurrence, and pregnancy history were analyzed. RESULTS: Five hundred nineteen patients underwent autologous breast reconstruction with 890 free flaps [free transverse rectus abdominis musculocutaneous, n = 645 (72.5 percent); deep inferior epigastric perforator, n = 214 (24.0 percent); pedicled transverse rectus abdominis musculocutaneous, n = 18 (2.0 percent); and superficial inferior epigastric artery, n = 13 (1.5 percent)]. Average follow-up was 57.2 months (range, 9.5 to 312.8 months). Fourteen women became pregnant, with mean postpregnancy follow-up of 31.2 months (range, 5.4 to 70.8 months; pregnancies, n = 18). Age of nonpregnant patients (mean, 43.1 years; range, 20.6 to 50.0 years) was higher than that of pregnant patients (mean, 32.1 years; range, 27.1 to 37.9 years) (p < 0.0001); in univariate analysis, age was not associated with incisional hernia repair. Twelve pregnant patients (66.7 percent) underwent cesarean delivery. No statistically significant differences existed between groups regarding flap type and closure technique. Zero pregnant patients underwent incisional hernia repair, compared with a 6.1 percent incisional hernia repair rate in nonpregnant patients (p = 0.339). In multivariate analysis, prior incisional hernia, hematoma, fascial dehiscence, and reoperation predicted incisional hernia repair. CONCLUSION: The authors' results demonstrate that there may not be an increased risk of incisional hernia repair associated with pregnancy following autologous breast reconstruction despite additional weakening of the abdominal wall. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Parede Abdominal/cirurgia , Hérnia Incisional/epidemiologia , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações na Gravidez/epidemiologia , Retalhos Cirúrgicos/efeitos adversos , Adulto , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Mamoplastia/métodos , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/cirurgia , Estudos Retrospectivos , Medição de Risco , Retalhos Cirúrgicos/transplante
18.
Plast Reconstr Surg ; 145(5): 1173-1181, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332535

RESUMO

BACKGROUND: This study is the first to correlate sonographic findings of subcutaneous tissue to structural and biomechanical properties. METHODS: Precisely sized tissue specimens (59 samples) were collected from five abdominoplasty procedures. A Philips Lumify L12-4 linear array probe, connected to an Android tablet, was used to obtain ultrasound images of the superficial fascial system. A no. 1 Vicryl suture on a CTX needle placed though a needle guide within a three-dimensionally printed template ensured equal bites of subcutaneous tissue across specimens. Suture pull-out strength was measured until failure at a displacement rate of 2.12 mm/second using an Admet MTEST Quattro. Mean gray value for the superficial fascial system in associated ultrasonographic images was quantified by CellProfiler. RESULTS: Superficial fascial system visualization can be accomplished using high-resolution portable ultrasound. Comparing multiple specimens' imaging, interpatient and intrapatient variability of superficial fascial system quantity and structural characteristics are apparent. The superficial fascial system is highly abundant in some patients, but has limited presence in others. Individual-specimen mean gray value and whole-patient mean gray value positively correlated with tissue tensile strength (p = 0.006) and patient-average tissue tensile strength (p = 0.036), respectively. Whole-patient mean gray value accounted for 98.5 percent of the variance seen in patient-average tensile strength, making it a strong predictor for tensile strength. CONCLUSIONS: Portable ultrasound and image-processing technology can visualize, quantify, and predict subcutaneous tissue strength of the superficial fascial system. The superficial fascial system quantity correlates with suture tensile strength. Clinically, preoperative superficial fascial system quantification may aid in outcome predictions, manage patient expectations, and potentially lower complication rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, V.


Assuntos
Parede Abdominal/fisiologia , Processamento de Imagem Assistida por Computador , Tela Subcutânea/diagnóstico por imagem , Parede Abdominal/cirurgia , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Fenômenos Biomecânicos/fisiologia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Técnicas de Sutura/efeitos adversos , Resistência à Tração/fisiologia , Ultrassonografia
19.
Ann R Coll Surg Engl ; 102(6): e122-e124, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326743

RESUMO

A 42-year-old woman was referred for consideration of left-sided mastectomy and immediate reconstruction. She previously had a bilateral breast augmentation using silicone implants. She desired to maintain her breast size and natural appearance. Owing to the availability of sufficient abdominal tissue, the option of an immediate unilateral breast reconstruction and contralateral augmentation with a differentially split deep inferior epigastric perforator flaps was offered to the patient. The patient had a successful reconstructive and contralateral symmetrising procedure with an uneventful postoperative recovery. She was satisfied with her breast size, which was achieved without the use of implants. In selected patients the free deep inferior epigastric perforator flap provides an appropriate option for unilateral breast reconstruction and contralateral breast augmentation. It has numerous advantages including making use of available excess abdominal tissue and avoiding implant related complications.


Assuntos
Mamoplastia/métodos , Retalho Perfurante/transplante , Parede Abdominal/irrigação sanguínea , Parede Abdominal/cirurgia , Adulto , Mama/patologia , Mama/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Artérias Epigástricas/transplante , Feminino , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Satisfação do Paciente , Retalho Perfurante/irrigação sanguínea , Resultado do Tratamento
20.
JSLS ; 24(1)2020.
Artigo em Inglês | MEDLINE | ID: mdl-32265582

RESUMO

Background and Objectives: The aim of this retrospective monocentric study was to evaluate results and recurrence rate with long-term follow-up after laparoscopic incisional/ventral hernia repair. Methods: This was a retrospective, single-center, observational trial, collecting data from patients who underwent laparoscopic incisional/ventral abdominal hernia repair using the open intraperitoneal onlay mesh technique and a single mesh type. All patients signed an informed consent form before surgery. Results: A total of 1,029 patients were included. The median surgery time was 40 min (range 30-55) and the median length of hospital stay was 2 d (range 2-3). Intraoperative complications occurred in two of 1,029 patients (0.19%), whereas early postoperative surgical complications (within 30 d) occurred in 50 patients (4.86%). Postoperative complications according to Clavien-Dindo classification were as follows: I, 3.30% (34 of 1,029); II, 0.97% (10 of 1,029); IIIB, 0.58% (six of 1,029); IV, 0.00% (none of 1,029); and V, 0.00% (none of 1,029). During follow-up, bulging mesh was diagnosed in 58 of 1,029 patients (5.6%), and hernia recurred in 40 of 1,029 patients (3.9%). A mesh overlap equal to or greater than 4 cm appeared to be a significant protective factor for hernia recurrence (P < .001); a mesh overlap equal or greater than 5 cm appeared to be a significant protective factor for bulging (P < .001), whereas the use of resorbable fixing devices was a significant risk factor for hernia recurrence (odds ratio, 111.53, P < .001, 95% confidence interval, 21.53-577.67). Conclusion: This study demonstrates that laparoscopic repair of ventral/incisional abdominal wall hernias is a safe, effective, and reproducible procedure. Identified risk factors for recurrence are an overlap of less than 4 cm and the use of resorbable fixation means.


Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Herniorrafia/instrumentação , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Telas Cirúrgicas , Resultado do Tratamento
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