Closing the gap: evidence-based surgical treatment of rectus diastasis associated with abdominal wall hernias

Materials and methods. During the period from 2009 to 2020 in the clinic of the Department of Surgery and Proctology of the Shupyk National Healthcare University of Ukraine, the surgical treatment of 217 patients with IVH was analysed.The choice of laparoscopic hernioplasty or open allohernioplasty was made taking into account the size of the abdominal wall defect and the width of the rectus diastasis. By intraoperatively conducting a study during a surgery for IVH with an abdominal rectus diastasis involving approximation of the rectus muscles and measurement of IAP, it was found that with an abdominal rectus diastasis measuring up to 5 cm IAP increases to 5.6 ± 1.3 mm Hg and the abdominal wall defect is closed without an undue tension of the supporting tissues.Depending on the method of surgical treatment, patients were divided into 2 groups.In group I, 109 (21.5%) patients with small and medium-sized IVH with a diastasis of up to 5 cm underwent laparoscopic allohernioplasty, in particular, 63 patients underwent laparoscopic preperitoneal alloplasty and 46 underwent laparoscopic retromuscular alloplasty.Conclusions. For small and medium-sized IVH with an abdominal rectus diastasis of up to 5 cm, laparoscopic allohernioplasty with preperitoneal and retromuscular placement of the mesh implant and elimination of the diastasis is optimal. In comparison with open retromuscular allohernioplasty, it contributes to a significant reduction in the incidence of seroma (from 35.2% to 3.7%), postoperative wound suppuration (from 6.5% to 0%), inflammatory infiltrate (from 4.6% to 0%), chronic postoperative pain (from 6.4% to 2.6%), and recurrence of hernia (from 6.4% to 0%).

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Quality of life as a modern integral criterion for evaluating the effectiveness of surgical treatment of patients with hernias of the anterior abdominal wall in outpatient department

Bulletin of Pirogov National Medical & Surgical Center ◽

10.25881/bpnmsc.2019.49.27.015 ◽

2019 ◽

Vol 14 (1) ◽

pp. 72-76

Author(s):

A.N. Shikhmetov ◽

N.N. Lebedev

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Abdominal Wall ◽

Anterior Abdominal Wall ◽

Outpatient Department ◽

Integral Criterion

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Evidence-Based Veterinary Medicine: A Tool for Evaluating the Healing Process After Surgical Treatment for Cranial Cruciate Ligament Rupture in Dogs

Frontiers in Veterinary Science ◽

10.3389/fvets.2019.00065 ◽

2019 ◽

Vol 6 ◽

Cited By ~ 3

Author(s):

Stefania Pinna ◽

Carlotta Lambertini ◽

Lisa Grassato ◽

Noemi Romagnoli

Keyword(s):

Veterinary Medicine ◽

Surgical Treatment ◽

Cruciate Ligament ◽

Healing Process ◽

Evidence Based ◽

Cranial Cruciate Ligament ◽

Ligament Rupture ◽

Cruciate Ligament Rupture ◽

Cranial Cruciate Ligament Rupture

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Appendicitis in puerpeium: Case report

Acta chirurgica iugoslavica ◽

10.2298/aci1104111b ◽

2011 ◽

Vol 58 (4) ◽

pp. 111-112 ◽

Cited By ~ 1

Author(s):

Milica Berisavac ◽

Biljana Kastratovic-Kotlica ◽

V. Tosic ◽

N. Markovic ◽

S. Ljustina ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Early Detection ◽

Acute Appendicitis ◽

Abdominal Wall ◽

Clinical Signs ◽

Signs And Symptoms ◽

Laboratory Infection ◽

Infection Parameters ◽

Clinical Signs And Symptoms

Acute appendicitis in puerperium is often diagnosed too late, because clinical signs can be unrelaible. Abdominal wall rigidity is rarely noticed in puerpeium because of weak abdominal wall muscles, laboratory parameters are not enough relaible and atipycal appendix presentation makes difficulties in diagnosis3,4. Knowing clinical signs and symptoms of appendicitis, possible complications and their early detection, make a chance for a good surgical outcome. Measuring of axillar and rectal temperature can take confusion in, and prolong time until surgical treatment. Leucocytosis in puerperium is not valid for diagnosis. We report a case of patient in puerperium with high laboratory infection parameters. Diagnosis of appendicitis is made based on clinical signs and symptoms, that is proved intraoperatively and histologicaly. Appendectomy without perforation carries less risks for mother and fetus.

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Dermatofibrosarcoma protuberans at Niamey National Hospital: About 12 cases

African Journal of Oncology ◽

10.54266/ajo.1.2.42.pypn1827 ◽

2021 ◽

Vol 1 (2) ◽

pp. 49-51

Author(s):

A Soumaila ◽

AI Dourahamane ◽

I Dillé ◽

OS Galadima ◽

HM Zaki ◽

...

Keyword(s):

Surgical Treatment ◽

Abdominal Wall ◽

Recurrence Rate ◽

Dermatofibrosarcoma Protuberans ◽

Wide Excision ◽

Recidivism Rate ◽

Rare Tumor ◽

National Hospital ◽

Histological Evidence

AIM: To report the clinical and therapeutic aspects of dermatofibrosarcoma of Darier and Ferrand (DFS) to the National Hospital of Niamey. MATERIALS AND METHODS: These are 12 patients collected prospectively over three years. RESULTS: It concerns seven men and five women in whom the diagnosis of DFS was made on the basis of histological evidence. The average age was 46.5 years. The tumor was the majority on the trunk (abdominal wall and back) in seven patients or 58.33%. The extension assessment was negative in all patients and all benefited from surgical treatment. This treatment consisted of a wide excision with lateral and deep margins between three and five cm. The recidivism rate is 25% within 17 months. CONCLUSION: DFS is a rare tumor in Niamey. The trunk is its main location. Surgery is the best treatment. And the recurrence rate is still high.

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Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

Journal of Clinical Medicine ◽

10.3390/jcm11020331 ◽

2022 ◽

Vol 11 (2) ◽

pp. 331

Author(s):

Markus Regauer ◽

Gordon Mackay ◽

Owen Nelson ◽

Wolfgang Böcker ◽

Christian Ehrnthaller

Keyword(s):

Surgical Treatment ◽

Systematic Reviews ◽

Treatment Guidelines ◽

Screw Fixation ◽

External Rotation ◽

Treatment Algorithm ◽

Evidence Based ◽

Posterior Malleolus ◽

Anatomic Reduction

Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.

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