scholarly journals Mapping traction strength of the anterior rectus sheath in cadaver

2010 ◽  
Vol 25 (4) ◽  
pp. 347-349 ◽  
Author(s):  
Romar Ângelo Barbato Silveira ◽  
Fábio Xerfan Nahas ◽  
Bernardo Hochman ◽  
Felix Carlos Ocariz Bazzano ◽  
Carlos Roberto Amorim ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Rectus Sheath ◽  
Traction Force ◽  
Abdominal Wall Defects ◽  
Complete Excision ◽  
Anterior Rectus Sheath ◽  
Linea Alba ◽  
Hernia Formation ◽  
Significant Difference ◽  
Made In

PURPOSE: The tension at the aponeurotic edges of abdominal wall defects is an important factor of dehiscence and incisional hernia formation. The purpose of this study is to map and compare the traction force necessary for medial mobilization in various levels of the anterior rectus sheath in cadavers. METHODS: Twenty four adult male cadavers, raging from 22 to 59 years old, with the abdominal wall intact and without prior preservation techniques, were dissected. A complete excision of the linea alba was performed. Traction loops of 10 mm in diameter were made in the anterior rectus sheath and were placed: 2, 4, 6 and 8 cm below the lower edge of the umbilicus and 3, 6 and 9 cm above the upper edge of the umbilicus. Each loop was mobilized 10 mm in the medial direction, using an analog dynamometer. The values obtained in each level were compared using Friedman's analysis of Variance for p < 0.05. RESULTS: The average traction values obtained at the various levels were compared and there was no statistical significant difference. CONCLUSION: There is no variation in tension along the whole extension of the anterior rectus sheath.

scholarly journals A Variation of the Components’ Separation Technique that Preserves the Semilunaris for Treatment of Abdominal Wall Deformities

2021 ◽  
Author(s):  
Marcus Vinícius Jardini Barbosa ◽  
Fábio Xerfan Nahas ◽  
Lydia Masako Ferreira
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Rectus Sheath ◽  
Late Complications ◽  
Separation Technique ◽  
Tram Flap ◽  
Abdominal Wall Defects ◽  
Components Separation ◽  
Anterior Rectus Sheath ◽  
Components Separation Technique

AbstractThe variation of the components’ separation technique, which uses the anterior rectus sheath and the release of the oblique muscles, proved to be effective in tension reduction. This paper aimed to present the initial experience using a variation that preserves semilunaris through the incision of the lateral aspect of the rectus sheath. All of the 12 patients presented an abdominal wall defect that included incisional hernia, peritoneostomy, lateral implantation of the rectus muscle, and defect secondary to TRAM flap. The separation was done in the following stages: stage 1—anterior rectus sheath and stage 2—external oblique muscles. From the 12 patients, three presented early complications: seroma (n = 2) and epitheliolysis (n = 1). There were no recurrences or other late complications (48 months follow-up period). The separation of the anterior rectus sheath, and incision in the lateral recess to undermine the oblique muscles, allowed the treatment of abdominal wall defects, without late complications.

scholarly journals P037 TOTALLY ENDOSCOPIC SUBLAY REPAIR FOR DIASTASIS RECTI AND CONCOMITANT MIDLINE HERNIA: FIRST CASE VIDEO-REPORT

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Camillo Leonardo Bertoglio ◽  
Lorenzo Morini ◽  
Simona Grimaldi ◽  
Pietro Carnevali ◽  
Giovanni Ferrari
Keyword(s):  
Polyvinylidene Fluoride ◽  
Rectus Sheath ◽  
Barbed Suture ◽  
Preperitoneal Space ◽  
Anterior Rectus Sheath ◽  
Linea Alba ◽  
First Case ◽  
Diastasis Recti ◽  
Posterior Rectus Sheath ◽  
Sublay Repair

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

scholarly journals Evaluation of healing prosthetic materials polyester mesh resorbable film and collagen elastin matrix /polypropylene used in rabbits abdominal wall defects

2009 ◽  
Vol 24 (6) ◽  
pp. 476-483 ◽  
Author(s):  
Danielle Duck Schulz ◽  
Nicolau Gregori Czeczko ◽  
Osvado Malafaia ◽  
Gustavo Justo Schulz ◽  
Leticia Elizabeth A. Czeczko ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Adhesion Formation ◽  
Collagen Type I ◽  
Abdominal Wall Defects ◽  
Type I ◽  
Polyester Mesh ◽  
Collagen Formation ◽  
Collagen Iii ◽  
Microscopic Evaluation ◽  
Significant Difference

PURPOSE: To compare polyester with absorbable layer prosthesis with collagen-elastin/polypropylene prosthesis in the repair of abdominal wall defects. METHODS: The 16 studied rabbits were divided in groups A and B (euthanized on the 30th and 60th days, after the implant of the mesh). The animals underwent laparotomy and received a 2cm wall "defect" on each side of the Alba linea. The repair was made with the suture of a polyester mesh with absorbable film on the left side of the Alba Linea and with collagen-elastin/polypropylene mesh on the right side. Adherences were classified according to Nair Score and microscopic evaluation observing types I and III collagen formation and other immunohistochemical analyses. RESULTS: There were no significant differences in adhesion formation. The collagen type I showed higher deposition in polyester with absorbable layer. In group B, the difference between the meshes was significant, with higher collagen III deposition in polyester with absorbable layer (60º P.O.). About the metalloproteinases, the presence of MMP -1 and MMP-8 were about the same; the expression of MMP-13 increased near to the 60th day. CONCLUSIONS: There is no significant difference between the two meshes in adhesion formation and immunohystochemical evaluation. The polyester mesh resorbable film presented a higher deposition of collagen.

scholarly journals Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Hernia ◽  
2020 ◽  
Vol 24 (6) ◽  
pp. 1317-1324
Author(s):  
Y. Yurtkap ◽  
F. P. J. den Hartog ◽  
W. van Weteringen ◽  
J. Jeekel ◽  
G. J. Kleinrensink ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Abdominal Wall ◽  
Suture Material ◽  
Abdominal Pressure ◽  
Postoperative Phase ◽  
Burst Abdomen ◽  
Linea Alba ◽  
Custom Made ◽  
Suture Tension ◽  
Significant Difference

Abstract Purpose After closure of laparotomies, sutures may pull through tissue due to too high intra-abdominal pressure or suture tension, resulting in burst abdomen and incisional hernia. The objective of this study was to measure the suture tension in small and large bites with a new suture material. Methods Closure of the linea alba was performed with small bites (i.e., 5 mm between two consecutive stitches and 5 mm distance from the incision) and large bites (i.e., 10 mm × 10 mm) with Duramesh™ size 0 (2 mm) and PDS II 2-0 in 24 experiments on six porcine abdominal walls. The abdominal wall was fixated on an artificial computer-controlled insufflatable abdomen, known as the ‘AbdoMan’. A custom-made suture tension sensor was placed in the middle of the incision. Results The suture tension was significantly lower with the small bites technique and Duramesh™ when compared with large bites (small bites 0.12 N (IQR 0.07–0.19) vs. large bites 0.57 N (IQR 0.23–0.92), p  < 0.025). This significant difference was also found in favour of the small bites with PDS II 2-0 (p  < 0.038). No macroscopic tissue failure was seen during or after the experiments. Conclusion Closure of the abdominal wall with the small bites technique and Duramesh™ was more efficient in dividing suture tension across the incision when compared to large bites. However, suture tension compared to a conventional suture material was not significantly different, contradicting an advantage of the new suture material in the prevention of burst abdomen and incisional hernia during the acute, postoperative phase.

How safe is the use of prosthetic materials in the repair of abdominal-wall defects in malnourished subjects?

Open Medicine ◽  
2009 ◽  
Vol 4 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Mehmet Karahan ◽  
Hakan Kulacoglu ◽  
Duray Seker ◽  
Zafer Ergul ◽  
Aysel Kiziltay ◽  
...  
Keyword(s):  
Wound Healing ◽  
Abdominal Wall ◽  
Polypropylene Mesh ◽  
Histopathological Examination ◽  
Abdominal Wall Defect ◽  
Infectious Complications ◽  
Abdominal Wall Defects ◽  
Tissue Samples ◽  
Significant Difference ◽  
Histopathological Studies

AbstractIncisional hernias and abdominal-wall defects consume large amounts of healthcare resources. Use of mesh is effective in treatment of these disorders and can decrease the rate of recurrence. This experimental study focused on the safety of mesh use in the setting of malnutrition, a condition that impairs wound healing. Rats were divided into two groups: normally fed and food-restricted. An abdominal-wall defect, 2 by 2 cm, was covered with polypropylene mesh, 2.5 by 2.5 cm. After sacrifice of the rats at the 21st and 60th days, tissue samples were sent for tensiometric and histopathological studies. No significant difference in infectious complications was observed between the two groups. Tensiometry revealed no significant differences between the groups. On histopathological examination, the only difference noted was in the vascularization scores of normally fed rats. For malnourished subjects that survived after surgery, the use of polypropylene mesh appeared safe in the closure of abdominal-wall defects, with no increase in infection rate and satisfactory wound healing.

scholarly journals A clinically relevant in vivo model for the assessment of scaffold efficacy in abdominal wall reconstruction

2016 ◽  
Vol 8 ◽  
pp. 204173141668653 ◽  
Author(s):  
Jeffrey CY Chan ◽  
Krishna Burugapalli ◽  
Yi-Shiang Huang ◽  
John L Kelly ◽  
Abhay Pandit
Keyword(s):  
Abdominal Wall ◽  
Abdominal Wall Reconstruction ◽  
Rabbit Model ◽  
In Vivo Model ◽  
Abdominal Wall Defects ◽  
Tissue Samples ◽  
Collagen Formation ◽  
Hernia Formation ◽  
Surgical Meshes

An animal model that allows for assessment of the degree of stretching or contraction of the implant area and the in vivo degradation properties of biological meshes is required to evaluate their performance in vivo. Adult New Zealand rabbits underwent full thickness subtotal unilateral rectus abdominis muscle excision and were reconstructed with the non-biodegradable Peri-Guard®, Prolene® or biodegradable Surgisis® meshes. Following 8 weeks of recovery, the anterior abdominal wall tissue samples were collected for measurement of the implant dimensions. The Peri-Guard and Prolene meshes showed a slight and obvious shrinkage, respectively, whereas the Surgisis mesh showed stretching, resulting in hernia formation. Surgisis meshes showed in vivo biodegradation and increased collagen formation. This surgical rabbit model for abdominal wall defects is advantageous for evaluating the in vivo behaviour of surgical meshes. Implant area stretching and shrinkage were detected corresponding to mesh properties, and histological analysis and stereological methods supported these findings.

scholarly journals High incidence of inguinal hernias among patients with congenital abdominal wall defects: a population-based case–control study

2021 ◽  
Author(s):  
Arimatias Raitio ◽  
Nelly Kalliokoski ◽  
Johanna Syvänen ◽  
Samuli Harju ◽  
Asta Tauriainen ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Abdominal Wall ◽  
Case Control Study ◽  
Population Based ◽  
Case Control ◽  
Abdominal Wall Defects ◽  
Healthy Controls ◽  
Significant Difference ◽  
Control Study ◽  
Congenital Abdominal Wall Defects

AbstractThe aim of this nationwide population-based case–control study was to assess the incidence of inguinal hernia (IH) among patients with congenital abdominal wall defects. All infants born with congenital abdominal wall defects between Jan 1, 1998, and Dec 31, 2014, were identified in the Finnish Register of Congenital Malformations. Six controls matched for gestational age, sex, and year of birth were selected for each case in the Medical Birth Register. The Finnish Hospital Discharge Register was searched for relevant diagnosis codes for IH, and hernia incidence was compared between cases and controls. We identified 178 infants with gastroschisis and 150 with omphalocele and selected randomly 1968 matched, healthy controls for comparison. Incidence of IH was significantly higher in gastroschisis girls than in matched controls, relative risk (RR) 7.20 (95% confidence interval [CI] 2.25–23.07). In boys with gastroschisis, no statistically significant difference was observed, RR 1.60 (95% CI 0.75–3.38). Omphalocele was associated with higher risk of IH compared to matched controls, RR 6.46 (95% CI 3.90–10.71), and the risk was equally elevated in male and female patients.Conclusion: Risk of IH is significantly higher among patients with congenital abdominal wall defects than in healthy controls supporting hypothesis that elevated intra-abdominal pressure could prevent natural closure of processus vaginalis. Parents should be informed of this elevated hernia risk to avoid delays in seeking care. We also recommend careful follow-up during the first months of life as most of these hernias are diagnosed early in life. What is Known:• Inguinal hernia is one of the most common disorders encountered by a pediatric surgeon.• Prematurity increases the risk of inguinal hernia. What is New:• Children with congenital abdominal wall defects have a significantly higher risk of inguinal hernia than general population.• Families should be informed of this elevated hernia risk to avoid delays in seeking care.

scholarly journals Comparative analysis of autodermal graft and polypropylene mesh use in large incisional hernia defects reconstruction

2013 ◽  
Vol 70 (2) ◽  
pp. 182-188 ◽  
Author(s):  
Danilo Stojiljkovic ◽  
Predrag Kovacevic ◽  
Milan Visnjic ◽  
Irena Jankovic ◽  
Goran Stevanovic ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Hospital Stay ◽  
Abdominal Wall ◽  
Polypropylene Mesh ◽  
Synthetic Mesh ◽  
Abdominal Wall Defects ◽  
Tension Free ◽  
Large Incisional Hernia ◽  
Significant Difference ◽  
Duration Of Surgery

Background. Large defects of the abdominal wall caused by incisional hernia still represent a challenging problem in plastic, reconstructive, and abdominal surgery. For their successful tension-free repair a proper selection of reconstructive material is essential. In the last decades, the use of synthetic meshes was dominant while biological autodermal grafts were rarely used. The aim of the study was to comparatively analyse efficacy and safety of autodermal graft and polypropylene mesh in surgical treatment of large abdominal wall defects. Methods. This prospective comparative clinical study enroled 40 patients surgically treated for large incisional hernia repair in a 10-year period. The patients were divided into two equal groups consisting of 20 subjects and treated either by biological autodermal graft or by synthetic polypropylene mesh. The surgical techniques of reconstruction, duration of surgery, the occurrence of early, minor, and major (severe) and delyed complications and hospital stay were analyzed. The average follow-up took 2 years. Results. Statistically significant differences in demographic characteristics of patients and in size of defects were not found. The surgical technique of reconstruction with an autodermal graft was more complicated. The duration of surgery in patients treated with autodermal grafts was significantly longer. There was no statistically significant difference regarding occurrence of early, minor postoperative complications and hospital stay in our study. Two severe complications were registered in the synthetic mesh group: intestinal obstruction and enterocutaneous fistula. The recurrence rate was 10% in the autodermal graft group and 15% in the group with a synthetic mesh. Conclusion. Tension-free repair of large incisional hernia with autodermal grafts was unjustly neglected despite the fact that it is safe and effective. It can be applied in all cases where synthetic mesh are not indicated (presence of infection, immunodeficient patients, after radiotherapy). They are especially important in war surgery and in lack of funds when commercial grafts cannot be purchased.

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