scholarly journals Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits

2005 ◽  
Vol 20 (5) ◽  
pp. 347-352 ◽  
Author(s):  
Alberto Goldenberg ◽  
Jacques Matone ◽  
Wagner Marcondes ◽  
Fernando Augusto Mardiros Herbella ◽  
José Francisco de Mattos Farah
Keyword(s):  
Inflammatory Response ◽  
Abdominal Wall ◽  
Peritoneal Cavity ◽  
Abdominal Cavity ◽  
Mesh Fixation ◽  
Rabbit Model ◽  
Laparoscopic Approach ◽  
Preperitoneal Space ◽  
Similar Amount ◽  
The Right

PURPOSE: Compare, in a rabbit model, the inflammatory response and adhesions formation following surgical fixation of polypropilene and Vypro mesh in the inguinal preperitoneal space. METHODS: Fourteen male New Zealand rabbits, weighing between 2.000 to 2.500 g were used. A midline incision was made and the peritoneal cavity was exposed. The 2,0X1,0 cm polypropylene mesh was fixed in the left flank and secured to the margins with 3-0 prolene in a separate pattern. In the right flank, a 2,0X1,0 cm Vypro II mesh was sewn in the same way. After the post surgical period, the animals were again anesthetized and underwent laparoscopic approach, in order to identify and evaluate adhesions degree. Both fixed prosthesis were excised bilaterally with the abdominal wall segment, including peritoneum, aponeurosis and muscle and sent to a pathologist RESULTS: Operative time ranged from 15 to 25 minutes and no difficulties in applying the mesh were found. From the 14 polypropylene meshes fixed to the intact peritoneum, 11 had adhesions to the abdominal cavity (78,6%). Concerning Vypro mesh, 12 animals developed adhesions from the 14 with mesh fixation (85,7%). Histological examination of tissues harvested revealed fibroblasts, collagen, macrophages and lymphocytes between the threads of the mesh. CONCLUSION: Polypropylene and Vypro mesh, when implanted in the peritoneal cavity of rabbits provoke similar amount of adhesions. Vypro mesh tissues had higher fibrosis resulting in better mesh incorporation to the abdominal wall.

Surgical Anatomy of the Retroperitoneal Spaces Part II: The Architecture of the Retroperitoneal Space

2010 ◽  
Vol 76 (1) ◽  
pp. 33-42 ◽  
Author(s):  
Petros Mirilas ◽  
John E. Skandalakis
Keyword(s):  
Urinary Bladder ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Anterior Part ◽  
Abdominal Cavity ◽  
Surgical Anatomy ◽  
Preperitoneal Space ◽  
Renal Fascia ◽  
Pelvic Wall ◽  
Prevesical Space

The extraperitoneal space extends between peritoneum and investing fascia of muscles of anterior, lateral and posterior abdominal and pelvic walls, and circumferentially surrounds the abdominal cavity. The retroperitoneum, which is confined to the posterior and lateral abdominal and pelvic wall, may be divided into three surgicoanatomic zones: centromedial, lateral (right and left), and pelvic. The preperitoneal space is confined to the anterior abdominal wall and the subperitoneal extraperitoneal space to the pelvis. In the extraperitoneal tissue, condensation fascias delineate peri- and parasplanchnic spaces. The former are between organs and condensation fasciae, the latter between this fascia and investing fascia of neighboring muscles of the wall. Thus, perirenal space is encircled by renal fascia, and pararenal is exterior to renal fascia. Similarly for the urinary bladder, paravesical space is between the umbilical prevesical fascia and fascia of the pelvic wall muscles—the prevesical space is its anterior part, between transversalis and umbilical prevesical fascia. For the rectum, the “mesorectum” describes the extraperitoneal tissue bound by the mesorectal condensation fascia, and the pararectal space is between the latter and the muscles of the pelvic wall. Perisplanchnic spaces are closed, except for neurovascular pedicles. Prevesical and pararectal (presacral) and posterior pararenal spaces are in the same anatomical level and communicate. Anterior to the anterior layer of the renal fascia, the anterior interfascial plane (superimposed and fused mesenteries of pancreas, duodenum, and colon) permits communication across the midline. Thus parasplanchnic extraperitoneal spaces of abdomen and pelvis communicate with each other and across the midline.

scholarly journals Selective Germline Genome Edited Pig Meninges Grafts for the Abdominal Wall Closure in Damage Control Surgery

2020 ◽  
Author(s):  
Lijin Zou ◽  
Youlai Zhang ◽  
Ying He ◽  
Hui Yu ◽  
Jun Chen ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Abdominal Wall ◽  
Damage Control ◽  
Abdominal Wall Reconstruction ◽  
Rabbit Model ◽  
Damage Control Surgery ◽  
Electrolyte Balance ◽  
Abdominal Wall Defects ◽  
Temporary Abdominal Closure

AbstractReconstruction of abdominal wall defects is still a big challenge in surgery, especially where there is insufficient fascia muscular or excessive tension of the defects in emergency and life-threatening scenarios. Indeed, the concept of damage control surgery has been advanced in the management of both traumatic and nontraumatic surgical settings. The strategy requires abridged surgery and quick back to intensive care units (ICU) for aggressive resuscitation. In the damage control laparotomy, patients are left with open abdomen or provisional closure of the abdomen with a planned return to the operating room for definitive surgery. So far, various techniques have been utilized to achieve early temporary abdominal closure, but there is no clear consensus on the ideal method or material for abdominal wall reconstruction. We recently successfully created the selective germline genome-edited pig (SGGEP) and here we aimed to explore the feasibility of in vivo reconstruction of the abdominal wall in a rabbit model with SGGEP meninges grafts (SGGEP-MGs). Our result showed that the SGGEP-MGs could restore the integrity of the defect very well. After 7 weeks of engraftment, there was no sign of herniation observed, the grafts were re-vascularized, and the defects were well repaired. Histologically, the boundary between the graft and the host was very well integrated and there was no strong inflammatory response. Therefore, this kind of closure could help restore the fluid and electrolyte balance and to dampen systemic inflammatory response in damge control surgery while ADM graft failed to establish re-vascularization as the same as the SGGEP-MG. It is concluded that the meninges of SGGEP could serve as a high-quality alternative for restoring the integrity of the abdominal wall, especially for damage control surgery.

scholarly journals One-stage Laparoscopic Nephrectomy and Ovariohysterectomy for Concurrent Dioctophymosis and Pyometra in a Bitch

2018 ◽  
Vol 46 ◽  
pp. 4
Author(s):  
Hellen Fialho Hartmann ◽  
Marília Teresa De Oliveira ◽  
João Pedro Scussel Feranti ◽  
Gabriela Pesamosca Coradini ◽  
Bibiana Zoppas Pierezan ◽  
...  
Keyword(s):  
Abdominal Cavity ◽  
Laparoscopic Approach ◽  
Renal Parenchyma ◽  
Laparoscopic Nephrectomy ◽  
Intermediate Hosts ◽  
Polyglactin 910 ◽  
Invasive Approach ◽  
One Stage ◽  
Port Access ◽  
The Right

Background: Dioctophyme renale, also known as “giant kidney worm”, is a cosmopolitan parasite, which usually affects domestic and wildlife canids in wetlands. Nephrotomy and nephrectomy are the only treatment options. Laparoscopic nephrectomy for dioctophymosis was first performed in veterinary patients in the late 90’s. Canine pyometra is one of themost frequent surgical disorder in the small animal setting. The purpose of this study was to report a case of successful one-stage laparoscopic approach for nephrectomy and ovariohysterectomy in a bitch.Case: A female stray dog, rescued from a riverside community, was presenting hematuria. Abdominal echography revealed presence of Dioctophyme renale worms within the right renal parenchyma. Moreover, the uterus was moderately filled by anechoic content. The patient was clinically stable and undergone laparoscopy. A 10-mm trocar was established at the middle third of the right flank, followed by 12-mmHg CO2 insufflation. The telescope was inserted and a giant worm wasseen free within the abdominal cavity. A second 10-mm port was inserted cranial and dorsally to the first one. The parasite was retrieved using a laparoscopic Kelly forceps. A third 5-mm trocar was inserted in a classic laparoscopic triangulation port positioning. Renal artery and vein were individually triple ligated using titanium clips and then transected. The rightovarian pedicle was sequentially coagulated and transected using laparoscopic bipolar forceps. The right kidney was then dissected and detached from the abdominal wall, followed by cauterization and transection of the left ovarian pedicle. The uterus was exposed out of the abdominal cavity through the 5-mm port access. Uterine body and vessels were double ligated using polyglactin 910, with transfixating ligatures, and then transected. The opening of the retrieval bag was exposed through the cranial port site incision. Eight dioctophyme worms and the kidney sections were withdrawn through the sacusing a Kelly hemostat. Abdominal wounds were closed in two layers using cross-mattress polyglactin 910 sutures. Skinwas closed using interrupted horizontal mattress nylon sutures. Patient was discharged on the early post-op, receiving tramadol chloride and sodium dipyrone for three days and enrofloxacin for seven days. The patient recovered uneventfully. Owner was contacted by phone eight months following surgery, which informed the bitch was clinically stable.Discussion: Riverside stray dogs present high incidence of dioctophymosis worldwide, due to irregular feeding and consequent intake of intermediate hosts. The reported patient met those features, without previous background regarding infestation episode. It presented hematuria, which usually results from renal parenchyma consumption by the worms. The patient was retrieved nine dioctophyme worms. Laparoscopic approach for nephrectomy has already been reported in veterinary patients, as well as three-port lap-assisted OVH have been performed. Innovative aspect of this case report concerns the one-stage laparoscopic approach for both nephrectomy and OVH. Moreover, the procedures required only three-port access, which was considered a suitable and safe minimally invasive approach in dogs affected by Dioctophyme renale and concurrent indication for OVH. The three-port access shown is adequate to perform one-stage nephrectomy and ovariohysterectomy in bitches, for reaching benefits of laparoscopic surgery in comparison to conventional approaches.Keywords: canine, endosurgery, kidney, laparoscopy, videosurgery.

scholarly journals Parasitic Myoma: A Very Rare Case Report aAnd Review of Literature

2019 ◽  
Vol 17 (1) ◽  
pp. 50-53
Author(s):  
Md Manir Hossain Khan ◽  
Jobaida Sultana
Keyword(s):  
Abdominal Wall ◽  
Blood Supply ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Low Grade ◽  
Review Of Literature ◽  
Rare Case Report ◽  
History Of ◽  
The Right ◽  
Further Development

A 32 years old unmarried women presented with periumbilical colickey abdominal pain which shiftted to the right iliac fossa with anorexia, vomiting and low grade fever. She had history of open myomectomy 4 years back for menorrhagia with multiple fibroids (myomas). On examination, the pointing sign, Rovsing's sign, McBurney's sign &Blumberg's sign were positive. Then she was diagnosed as a case of acute appendicitis. Ultrasonography revealed nothing significant. Appendicectomy was done through right Grid Iron incision. Appendix was found inflammed, swollen and there was collection of fluid in the peritoneal cavity. During closure, incidentally a solid mass about 5 ><4 ><2.5 cm was found exterior to the peritoneum near the incision at the abdominal wall. The mass was excised. Subsequently histopathotology confirmed a leiomyoma (Myoma or parasitic fibroid). The parasitic myoma may develop spontaneously as pedanculatedsubcerousmyomaloose their uterine blood supply or iatrogenically from retained fragment of myoma from previous myomectomy or hysterectomy and get blood supply from abdominal wall. Even small bits displaced into the abdominal cavity can result in parasitic fibroids. This case is reported here to give emphasis on the surveilence of parasitic myoma during myomectomy or hysterectomy for fibroid uterus and all tissue pieces that are morcellated should be delligently removed for the prevention of further development of parasitic myoma. Journal of Surgical Sciences (2013) Vol. 17 (1) : 50-53

scholarly journals Case Report of A Neonate with Congenital Superior Lumbar Hernia

2018 ◽  
Vol 2 (2) ◽  
pp. 51
Author(s):  
Stephanus Haryanto Hokardi ◽  
Neil Angelo S. Sael
Keyword(s):  
Intestinal Obstruction ◽  
Ct Scan ◽  
Abdominal Wall ◽  
Bowel Movement ◽  
Laparoscopic Approach ◽  
Lumbar Hernia ◽  
Transversus Abdominis ◽  
Hernia Defect ◽  
Lumbar Area ◽  
The Right

Background: congenital lumbar hernias are rare. It constitutes to 20% of all lumbar hernias which is less than 1.5% of all the abdominal wall hernias. There are no more than 50 cases reported in literature till date. We report a case of congenital lumbar hernia in a preterm female neonate located on the superior lumbar triangle. Case: a preterm female neonate was born, presented with a mass at the right lumbar area with a size of 8x8 cm, round, movable with bluish discoloration, well delineated border, no visible veins, increases in size when the patient cries, and reduces easily. Ultrasonography revealed a right posterolateral abdominal mass measuring 4.2x2.88x1.59 cm. CT scan revealed right posterolateral mid-abdominal wall hernia with protrusion and no intestinal obstruction. The patient underwent exploratory laparotomy, where hernia defect was about 2 cm in diameter in the right posterior abdominal wall, pararenal area, and just below the 12th rib. The ascending colon and parts of the ileum were adherent inside the hernia defect at the right lumbar area. Primary closure of the hernia defect was done by suturing the psoas major and the transversus abdominis and internal oblique muscles. The postoperative, patient had good bowel movement, no abdominal distention or vomiting. Feeding was then started and well tolerated. After two weeks follow-up, there were no signs or symptoms of intestinal obstruction such as nausea and vomiting. Patient is being fed regularly and passes bowel movement almost 2-3 times a day. Conclusion: appropriate diagnosis of the extent of the defect through the advent of CT scan and early detection of other congenital anomalies should be routine in these cases. Open surgery with primary repair is almost always done but we can consider laparoscopic approach in the future with uncomplicated lumbar hernias.

scholarly journals Infection on the meshes implantation area in the abdominal wall of rats with induced bacterial peritonitis

2006 ◽  
Vol 21 (3) ◽  
pp. 155-160 ◽  
Author(s):  
Geraldo Alberto Sebben ◽  
Sérgio Luiz Rocha ◽  
Luiz Carlos Von Bahten ◽  
Maria de Lourdes Pessole Biondo-Simões ◽  
Fernando Henrique Azevedo Ramos ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Bacterial Growth ◽  
Clinical Symptoms ◽  
Abdominal Cavity ◽  
Positive Culture ◽  
Preperitoneal Space ◽  
Control Group ◽  
Bacterial Peritonitis ◽  
Implantation Sites ◽  
Group B

PURPOSE: Evaluate incidence of bacterial growth on implanted meshes in the abdominal wall of rats after to induce bacterial peritonitis. METHODS: 36 rats were used. They were allocated in two groups: group B, experiment group (n =18) and group S, control group (n =18). They were submitted to the implant of polypropylene meshes on the abdominal wall, at the preperitoneal space. Then, in the animals of the experiment group, the induction of peritonitis was made through the inoculation in the peritoneal cavity of standardized solution of Escherichia coli. In the animals of the control group it was made through the inoculation of physiologic solution. The animals of both groups were reallocated in three subgroups of six animals and observed until the reoperations time, for evaluation of the implantation sites, collection of the meshes for cultures, evaluation of the abdominal cavity and peritoneal lavage for cultures. The reoperations occurred in 24, 48 and 72 hours. RESULTS: All the animals of the experiment group presented clinical symptoms of peritonitis. The cultures of the meshes taken off from the implantation sites were positive in 83% of the animals when the moment of the evaluations was of 24 hours, decreasing to 33% in 48 hours and 17% in 72 hours. Globally, it was of 44%. In the animals of the control group there was no case of positive culture neither in the meshes, nor in the peritoneal lavages. CONCLUSIONS: The experimental model used was effective, producing 100% of peritonitis. The incidence of bacterial growth on the implanted polypropylene meshes was 83% in 24 hours, decreasing with the time.

scholarly journals TO THE QUESTION OF THE OPERATION "HYSTEROPEXIA ABDOMINALIS ANTERIOR"

2020 ◽  
Vol 5 (5) ◽  
pp. 445-451
Author(s):  
S. V. Ter-Mikaelyants
Keyword(s):  
Abdominal Wall ◽  
Ovarian Cyst ◽  
Anterior Abdominal Wall ◽  
Abdominal Cavity ◽  
Broad Ligament ◽  
The Other ◽  
Abdominal Wound ◽  
The Right ◽  
Methods Of Treatment

Hysteropexia abdominalis anterior - suturing of the uterus to the anterior abdominal wall is a relatively new operation. Although it was first adopted by Koeberl) back in 1869, it was forgotten until the 80s. The free Coeberl suffered from strong constipation, which did not give in to any cure, the cause of which Koeberl saw in the pressure on the rectum of the bent back of the uterus. The patient reached such a state that energetic intervention was necessary. In view of these indications, Koeberl decided to make the womb and to strengthen the uterus in the abdominal wound in such a position that its body could not be thrown backwards. Opening the abdominal cavity, the operator removed the healthy ovary; the resulting leg, i.e. broad ligament, tube and lig. ovarii sewed it into the abdominal wound. The result was satisfactory. Ten years later, Schroeder) performed this operation on a patient with a posterior bend of the uterus and a small ovarian cyst, accompanied, in addition, by the dance of St. Witt. After removing the cyst, he sewed the leg to the anterior abdominal wall. In 1880, L. Tait) performed two operations, one in February, the other in April. In both cases, it was about the backward bends; In addition, the patients suffered from ovarian inflammation, which did not respond to any other methods of treatment. The operator removed the inflamed, slightly enlarged ovaries, lifted the uterus and, when suturing the abdominal wound, passed the needle so that it captured part of the tissue in the area of ​​the fundus of the uterus and, thus, sewed the fundus of the uterus to the abdominal wall. In both cases, the results were satisfactory, at least until 1883. In 1881, he also, in one case of persistent retroflexio uteri, performed a blanching and a ligament of the right ovary and a left wide ligament in the belly. This case is cited by Snger in Centr. f.Gyn. 1888, No. 2.

scholarly journals STRENGTH COMPARISON OF DIFFERENT METHODS OF CLOSING THE ANTERIOR ABDOMINAL WALL DEFECT (EXPERIMENTAL STUDY)

2020 ◽  
Vol 73 (6) ◽  
pp. 1217-1222
Author(s):  
Oleksandr Yu. Ioffe ◽  
Tetiana V. Tarasiuk ◽  
Mykola S. Kryvopustov ◽  
Oleksandr P. Stetsenko ◽  
Yuri P. Tsiura ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Abdominal Cavity ◽  
Mesh Fixation ◽  
Adhesion Formation ◽  
Parietal Peritoneum ◽  
Control Group ◽  
Defect Closure ◽  
Experimental Group

The aim of the study is to compare the mesh implantation and the strength of the mesh fixation to the anterior abdominal wall by modelling the intraperitoneal onlay mesh repair (IPOM) with and without aponeurotic defect closure. Materials and methods: The experimental animals were randomly divided into 2 groups of 6 rabbits. In experimental group IPOM was modelled without hernia defect closure, in control group – with its suturing. The macroscopic assessment of the severity of adhesions, histological examination of the removed “anterior abdominal wall – mesh” complex and strength of the mesh fixation to the anterior abdominal wall were performed on the 90th day. Results: In both groups, the displacement or complete separation of the mesh from the parietal peritoneum was not observed. The extent of adhesion formation in the abdominal cavity and strength of the mesh fixation are comparable in both groups (p > 0.05). In the experimental group, the mesh was surrounded by scar tissue, mesothelioma lining was not traced. There were also moderate signs of inflammation, which were not seen in the control group. Conclusions: The strength of the mesh fixation to the parietal peritoneum and its implantation into the anterior abdominal wall is comparable with or without aponeurotic defect closure during the experimental modelling of IPOM.

scholarly journals P029 HOW DOES THE MADRID APPROACH WORK

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Luis Alberto Blázquez ◽  
Diego Oto ◽  
Belén Porrero ◽  
José Manuel Molina ◽  
Paula Pastor ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Inguinal Ligament ◽  
Preperitoneal Space ◽  
Tissue Scaffold ◽  
Polyester Mesh ◽  
Absorbable Mesh ◽  
The Right ◽  
Transverse Abdominus ◽  
Medium Weight

Abstract Aim The Madrid APPROACH is the combination of an absorbable mesh and a permanent retromuscular mesh for the treatment of the complex abdominal wall problems. It has been controversial because of the need of two different meshes. We present a clinic case to show the utility of this technique and how it allows rebuilding the inguinal ligament. Material and Methods 78 years old woman who underwent a right ilioinguinal and obturatriz lymphadenectomy due to a melanoma. Incisional hernia fixed in 2018 with a retromuscular polyester mesh. New incisional iliac hernia (L3) over the right iliac vessels, with an absence of inguinal ligament, right rectus atrophy, and the previous mesh being part of the sac. Surgery: incision over the previous scar. Wide dissection of the preperitoneal space, Retzius space and lateral to the cuadratus lumborum, retrodiafragmatic dissection, lateral transverse abdominus release, and cross-over to the retrorectal left space. Preperitoneal BioA mesh and an upper 40x40cm medium weight polipropilene mesh set to both Cooper ligaments. Results After two and a half months, a PET-TC showed the BioA mesh perfectly adapted to the abdominal wall and rebuilt a new inguinal ligament. Also intense FDG capitation of the mesh due to the high cellular metabolism. Two years later the patient has a continent abdominal wall, the follow up TC shows the disappearance of the absorbable mesh and the perfect abdominal wall rebuilt. Conclusions The BioA mesh acts like a tissue scaffold for new conjunctive tissue as we see the intense FDG captation. The Madrid APPROACH allows giving response to very complex abdominal wall problems.

scholarly journals Evaluation of the positioning of the tip of the Veress needle during creation of closed pneumoperitoneum in pigs

2006 ◽  
Vol 21 (1) ◽  
pp. 26-30 ◽  
Author(s):  
João Luiz Moreira Coutinho Azevedo ◽  
Rodrigo Santa Cruz Guindalini ◽  
Albino Augusto Sorbello ◽  
Cássio Edvan Paulino da Silva ◽  
Otávio Cansanção Azevedo ◽  
...  
Keyword(s):  
Peritoneal Cavity ◽  
Liquid Flow ◽  
Initial Pressure ◽  
Veress Needle ◽  
Preperitoneal Space ◽  
Saline Injection ◽  
Recovery Test ◽  
Flow Test ◽  
Drop Tests ◽  
The Right

PURPOSE: Erroneous punctures and insufflations are frequent with the use of the Veress needle. Mistaken injections of gas in the preperitoneal space are not rare. The purpose of this research is to evaluate the correct positioning of the tip of the needle during creation of pneumoperitoneum. METHODS: The needle was inserted into the peritoneal cavity. Tests to assess the positioning of the needle tip were carried out. Pressure, flow rate and volume were periodically recorded and the needle was removed, being immediately reinserted into the right hypochondrium and placed in the preperitoneal space. RESULTS: The liquid flow test was always positive in the peritoneal cavity. No resistance to saline injection into the peritoneal cavity was observed, but increased resistance to saline injection into the preperitoneal space was observed in 45.5% of the cases. Some saline was recovered in 63.5% of the cases in the peritoneal cavity, and in 54.5% in the preperitoneal space. Saline drop test was positive in 66.6% of the cases in the peritoneal cavity and in 45.5% in the preperitoneal space. In the peritoneal cavity, initial pressure lower than 5 mm Hg was observed, and this pressure gradually increased during 123 seconds until reaching 15 mm Hg. In the preperitoneal space, initial pressure was 15 mm Hg. CONCLUSIONS: Aspiration, liquid flow and saline drop tests are important, whereas recovery test is inconclusive. Initial pressure of approximately 5 mm Hg indicates that the tip of the needle is in the peritoneal cavity. The peritoneal cavity should hold ten times as much volume of gas as the preperitoneal space. The increase in pressure and volume in the peritoneal cavity can be predicted by statistics.

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