scholarly journals Experimental model to study correction of rectus diastasis by laparoscopy, in pigs

2003 ◽  
Vol 18 (spe) ◽  
pp. 69-76 ◽  
Author(s):  
Fábio Xerfan Nahas ◽  
Lydia Masako Ferreira

The use of swines as an experimental model to correct rectus diastasis by laparoscopy is described on this article. The correction of this deformity was achieved by the plication of the posterior rectus sheath with the insertion of two trocars on the inferior abdominal fold. One trocar was placed in the midline whereas the other was inserted laterally to the right rectus muscle. A continuous suture was made on the posterior rectus sheath with 0-Polipropilene. This suture was anchored at the anterior rectus sheath under direct vision. An incision of all layers was performed on the flank and the abdominal wall was turned inside out so that the area of plication could be assessed and evaluated. The experimental model described showed to be feasible to demonstrate the correction of rectus diastasis by laparoscopy.

2003 ◽  
Vol 18 (spe) ◽  
pp. 37-45 ◽  
Author(s):  
Fábio Xerfan Nahas ◽  
Lydia Masako Ferreira

The use of cadaver as an experimental model to evaluate tension of the abdominal wall after aponeurotic incisions and muscular undermining is described on this article. The tension required to pull the anterior and the posterior rectus sheaths towards the midline was studied in fresh cadavers at two levels: 3 cm above and 2 cm below the umbilicus. Traction measurement was assessed with a dynamometer attached to suture loops on the anterior and posterior recti sheaths, close to the midline, above and below the umbilicus. The quotient of the force used to mobilize the aponeurotic site to the midline and its resulting displacement was called the traction index. These indices were compared in three situations: 1) prior to any aponeurotic undermining; 2) after the incision of the anterior rectus sheath and the undermining of the rectus muscle from its posterior sheath; and 3) after additionally releasing and undermining of the external oblique muscle. The experimental model described showed to be feasible to demonstrate the effects on tension of the abdominal wall after incisions and undermining of its muscles and aponeurosis.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Camillo Leonardo Bertoglio ◽  
Lorenzo Morini ◽  
Simona Grimaldi ◽  
Pietro Carnevali ◽  
Giovanni Ferrari

Abstract Aim We describe in detail the step by step technique of the first case of TES repair at our institution. Methods We selected the case of a M2W3L3 hernia associated to xipho-umbilical diastasis recti in a young woman symptomatic for a progressively worsening back pain and local bulky sensation. Results The intervention is started directly with a suprapubic transverse incision of 2.5 cm and a circumferential, atraumatic retraction is inserted after a small incision of the anterior rectus sheath. Blunt dissection is further continued through this access by luxating the underlying rectus muscles to separate the preperitoneal space below the arcuate line. The pneumo-preperitoneum is then inducted through this port. Laparoscopic dissection allows for enlargement of the avascular space laterally and then two 5-mm trocars are placed on the bilateral aspects of rectus muscles. By means of a lap bipolar dissector the edge of posterior rectus sheath are incised from the arcuate line following the diastasis laterally up to the subxiphoid space. The Rives plane is recovered without opening of the linea alba. After reduction of the M2 hernia both the posterior sheath and the diastatic anterior fascia are sutured with a running long-resorbable 2/0 barbed suture. Polyvinylidene fluoride (PVDF) mesh fixed with the use of an hystoacrilic glue. Conclusion Minimally invasive extraperitoneal repair of small/medium hernia defects of the linea alba is gaining wide acceptance. Concomitant presence of rectum diastasis recti seems to be the ideal indication to approach the learning curve of such a technically demanding procedure


2009 ◽  
Vol 6 (3) ◽  
pp. 597-609
Author(s):  
JOHNSON KENT WRIGHT

Last year, Andreas Kalyvas and Ira Katznelson published a brief, bold book on a topic from which historians of political thought have tended to shy away, curiously enough—the relations between republicanism and liberalism as political ideologies in the age of the American and French Revolutions. Liberal Beginnings: Making a Republic for the Moderns is relentlessly polemical, blaming this neglect on the historians and theorists responsible for resurrecting the early modern republican tradition over the last few decades. Pocock, Skinner, Wood, Petit, and more are assailed for having indulged in what Kalyvas and Katznelson call “republican nostalgia”—that is, for having wrongly presented republicanism as an alternative to modern liberalism, rather than its parent and precursor. Instead, the authors of Liberal Beginnings set out to show the ways in which republicanism evolved into liberalism, in and through the works of a set of leading thinkers—Smith, Ferguson, Paine, Madison, Staël, and Constant. Their story has a happy ending. Whatever was valuable and actual in republicanism was smoothly incorporated into early liberalism, for which they turn the dictionary inside out in search of approbative adjectives—“situated,” “thick,” “sturdy,” “confident,” “open,” “immanent,” “heterogeneous,” and “syncretic.” How persuasive is their account? Not a few readers will detect a hint of protesting too much in this kind of cheerleading. “Thick,” “sturdy,” and “confident” are surely not the first terms to spring to mind in regard to this gallery of thinkers, Staël and Constant least of all. It also seems clear that Kalyvas's and Katznelson's coverage of French thought, confined almost entirely to that pair, is too cursory to sustain their case. At one end, Montesquieu and Rousseau, the titans who together defined republicanism for the revolutionary generation, make only the most fleeting of appearances in Liberal Beginnings. At the other, Tocqueville, acknowledged on all sides as the master thinker of French liberalism, is missing altogether. Nevertheless, the attempt at treating anglophone and French thinkers within a single interpretative framework is in itself a virtually unprecedented feat, for which Kalyvas and Katznelson should be congratulated. For who could doubt that they are on exactly the right path in chasing their prey onto French soil?


2021 ◽  
Vol 18 (1) ◽  
pp. 18-22
Author(s):  
Hazem Nour ◽  
Hany Mohamed ◽  
Mohamed Farid

Background: Chevrel’s technique provides tensionfree repair of midline incisional hernia, but wide skin and subcutaneous dissection increases rate of complications. Here, we evaluate the double mesh modification of Chevrel’s technique in midline incisional hernia repair. Methods: 22 patients with midline incisional hernia underwent double mesh modification of Chevrel’s technique. After excision of hernial sac with minimal dissection of the skin and subcutaneous tissue, the anterior rectus sheath is incised on both sides to create medial flaps that are sutured toeach other. Both recti abdominis muscles were dissected off the posterior rectus sheath, opening the retrorectus space. Prolene mesh was fixed in the retrorectus space with prolene sutures, and tailored to cover the bare area of anterior surface of both recti muscles and fixed to the lateral flaps of the anterior rectus sheath with interrupted prolene sutures. Results: We observed no recurrences, no skin necrosis, two cases of seroma, one case of superficial wound infection and one case of temporarychronic pain. Conclusion: Double mesh modification of Chevrel technique is an efficient method for treatment of midline incisional hernia, with minimal surgical site occurrences. Keywords: Chevrel technique, Double mesh technique, Midline incisional hernia


QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A Alshafaai ◽  
H M Omran ◽  
R Z A Lashin ◽  
H K Mohammed

Abstract Background tummy tuck surgery, also known as abdominoplasty, removes excess fat and skin and, in most cases, restores weakened or separated muscles creating and abdominal profile that is smoother and firmer. Diastasis recti means the belly sticks out because the space between left and right belly muscles has widened. The most notable symptom of anterior abdominal wall weakness or diastasis recti is a noticeable protrusion in the stomach. This protrusion is caused by weakness and separation of the muscles in the mid-abdomen. Objective It was to evaluate the relationship between the distance of recto-fascial or recto-fascial diastasis placation and intra-abdominal pressure changes during and immediately after abdominoplasty. Patient and Methodology In this study we demonstrated if there was relation between rectus diastasis width and the increase of intra-abdominal pressure, to evaluate this correlation before and immediately after the plication of anterior rectus sheath in abdominoplasty. Seventy five meeting the inclusion criteria were selected. Results This study enrolled 75 healthy female patients, the study took place at Al-Jamila Hospital, performed in a period of 10 months, starting from March 2017 till December 2017.


Author(s):  
Yalini Vigneswaran ◽  
Ava F. Bryan ◽  
Brian Ruhle ◽  
Lawrence J. Gottlieb ◽  
John Alverdy

Abstract Introduction Complex and recurrent paraesophageal hernia repairs are a challenge for surgeons due to their high recurrence rates despite the use of various prosthetic and suturing techniques. Methods Here we describe the use of vascularized fascia harvested from the posterior rectus sheath with peritoneum during robotic hiatal hernia repair in two patients with large complex diaphragmatic defects. Results Successful harvesting and onlay of the right posterior rectus sheath based on a falciform vascular pedicle was achieved robotically by rotating and securing the flap to the diaphragmatic hiatus as an onlay flap following cruroplasty of the hiatal defect. Conclusions In patients with difficult to repair large paraesophageal hernias, we demonstrate a promising new technique to restore the dynamic hiatal complex with the tensile strength of autologous vascularized fascia and peritoneum.


2006 ◽  
Vol 120 (3) ◽  
pp. 205-213 ◽  
Author(s):  
Guiqing Liao ◽  
Yuxiong Su ◽  
Jinming Zhang ◽  
Jinsong Hou ◽  
Yiyang Chen ◽  
...  

Reconstruction of the tongue after glossectomy is a primary objective in the process of improving the life quality of patients suffering from tongue cancer. We developed a new method of surgical reconstruction of the tongue after hemiglossectomy, with reinnervated rectus abdominis musculoperitoneal flaps. The rectus abdominis musculoperitoneal flap consisted of the rectus muscle, posterior rectus sheath, peritoneum, the 10th, 11th and 12th intercostal nerves, and the deep inferior epigastric artery and veins. Five patients underwent immediate reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy. The intercostal nerves were anastomosed to the descending branch of the hypoglossal nerve. All transplanted flaps survived. The peritoneum was replaced by squamous epithelium eight weeks after surgery. During the follow-up period, the contour and function of the reconstructed tongues was satisfactory. Our experience indicates that reconstruction of the tongue with rectus abdominis musculoperitoneal flaps after hemiglossectomy is a suitable, cosmetically acceptable method.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Dimitri Sneiders ◽  
Gijs de Smet ◽  
Floris den Hartog ◽  
Laura Verstoep ◽  
Anand Menon ◽  
...  

Abstract Aim To obtain tension-free closure for giant incisional hernia repair, anterior or posterior component separation (ACS, PCS) is often performed. In extreme patients, ACS and PCS may be combined. The aim of this study was to assess the additional medialization after simultaneous ACS and PCS. Material and Methods Fresh-frozen post mortem human specimens were used. Both sides of the abdominal wall were subjected to retro-rectus dissection (Rives-Stoppa), ACS and PCS, the order in which the component separation techniques (CST) were performed was reversed for the contralateral side. Medialization was measured at three reference points. Results ACS provided most medialization for the anterior rectus sheath, PCS provided most medialization for the posterior rectus sheath. After combined CST total median medialization ranged between 5.8 and 9.2 cm for the anterior rectus sheath, and between 10.1 and 14.2 cm for the posterior rectus sheath (depending on the level on the abdomen). For the anterior rectus sheath, additional PCS after ACS provided 15% to 16%, and additional ACS after PCS provided 32% to 38% of the total medialization after combined CST. For the posterior rectus sheath, additional PCS after ACS provided 50% to 59%, and additional ACS after PCS provided 11% to 17% of the total medialization after combined CST. Retro-rectus dissection alone contributed up to 41% of maximum obtainable medialization. Conclusions ACS provided most medialization of the anterior rectus sheath and PCS provided most medialization of the posterior rectus sheath. Combined CST provides marginal additional medialization, clinical use of this technique should be carefully balanced against additional risks.


Author(s):  
Gabriele Manetti ◽  
Maria Giulia Lolli ◽  
Elena Belloni ◽  
Giuseppe Nigri

Abstract Background Diastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is > 2 cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa’s technique that combines Rives–Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis. Methods It is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath. Results Seventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms. Conclusions This new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique.


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