scholarly journals Combination of autoplasty with autodermoplasty in the treatment of lateral abdominal hernias

2012 ◽  
Vol 93 (2) ◽  
pp. 250-255
Author(s):  
A A Botezatu ◽  
I N Nurmeev
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
State Institution ◽  
Case Histories ◽  
Treatment Results ◽  
Surgical Department ◽  
Lateral Abdominal Wall ◽  
New Methods ◽  
Abdominal Hernias

Aim. To improve the outcomes of treatment in patients with lateral abdominal hernias by combining autoplastic methods with autodermoplasty. Methods. 42 case histories of patients with lateral abdominal wall hernias, operated in the first surgical department of the State Institution «Republican Clinical Hospital», Tiraspol city, from 2001 to 2011 were subjected to retrospective analysis. In all of the cases surgical treatment was performed. Combined methods of hernioplasty, which combine autoplasty with autodermoplasty, were applied. The authors’ personal patented method of hernioplasty was also used among others. Results. According to the classification of Chevrel-Rath (2000) 23 (54.7%) of the patients had inferolateral hernias, 5 (11.9%) patients - supra-lateral hernias, 8 (19%) patients - lumbar hernias, there were also 2 (4.8%) patients each with transrectal, pararectal and paracolostomy hernias. Despite their small number in the total amount of postoperative hernias (17.5%), 26 (65%) patients had large and giant lateral hernias, while recurrences were present in 7 (16.7%) cases. Treatment results were satisfactory. Complications and recurrence occurred in 1 (2.9%) patient each. Conclusion. The combination of autoplasty with autodermoplasty is an effective method of treatment for inferolateral, supra-lateral, pararectal, transrectal, paracolostomy and lateral hernias; during lumbar hernias autodermoplasty even with two autodermal grafts was not as effective, and therefore justified is the search for new methods of hernioplasty.

FEATURES OF OPHTHALMIC CARE FOR PATIENTS WITH COMPLICATED CATARACTS

2020 ◽  
pp. 84-89
Author(s):  
Inna Ivanovna Lapkina
Keyword(s):  
Health Care ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Key Words ◽  
Outpatient Treatment ◽  
Practical Application ◽  
Unified Approach ◽  
Case Histories ◽  
High Prevalence

Today, around 50 million people worldwide suffer from cataracts, more than a half of them need surgical treatment. High prevalence of this pathology in Ukraine, the need to improve the provision of ophthalmic care to patients, and the reform of the health care system have made the research relevant. Concomitant diseases and special conditions of the eye increase the risk of intra− and postoperative complications, worsen the functional parameters of patients after surgery. In order to develop a unified approach to the treatment of complicated cataracts based on diagnostically related groups of patients, a retrospective analysis of case histories of patients with different variants of complications related to the condition of the lens itself, its ligament apparatus and other structures of the eye was conducted. In each case, the surgeon has to choose the appropriate modification of cataract phacoemulsification surgery. The study proposed the classification of cataract phacoemulsification modifications on the basis of the techniques and the sequence of operation stages, taking into account the classification of the degrees of turbidity of the lens, proposed by L. Buratto. It has been noted that in complicated cases, according to the indications of the patient, surgery may be performed on several modifications of cataract phacoemulsification. The developed classification made it possible to generalize the various variants of pathology and greatly facilitate the choice of tactics of surgical treatment in complicated cataracts. It can be used not only for practical application, but also for improving the qualification of trained professionals. The prospect of further research is to identify contraindications for outpatient treatment of the patients with complicated cataracts. Key words: cataract complication, classification of phacoemulsification modifications, diagnostically related groups.

Efficacy evaluation of case-specific approach for surgical treatment of incisional ventral hernia

2021 ◽  
Vol 93 (5) ◽  
pp. 1-5
Author(s):  
Svetlana Sokolova ◽  
Andrey Sherbatykh ◽  
Konstantin Tolkachev ◽  
Vladimir Beloborodov ◽  
Vadim Dulskiy ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
Ventral Hernia ◽  
Anterior Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Long Term Results ◽  
Treatment Results ◽  
Specific Approach ◽  
Incisional Ventral Hernia

The Aim of research is to improve the results of surgical treatment of incisional ventral hernia by applying a case-specific approach and a new method of plastic repair of anterior abdominal wall. The prospective controlled dynamic study is based on incisional ventral hernia treatment results with the use of meshed endoprostheses among 219 patients. On-lay alloplasty was used in patients younger than 60 years of age, without severe concomitant pathology, with small and medium hernias and anterior abdominal wall defect of up to 10 cm (W1 - W2). The article shows a selection algorithm for anterior abdominal wall plastic repair method. It goes through advantages of the author’s proprietary technique. The article displays frequency and patterns of complications, life quality of the patients after various prosthetic plastic repairs. In the main group, positive treatment results were observed in 65.0%, long-term results of the operation were observed in 88.4%, complications occurred in 13.6%, relapse in 4.5%. «On lay» treatment tactics showed positive results in 59.4%, long-term results of the operation were observed in 74.7%, complications occurred in 40%, relapse in 3.1%. After «sub lay» intervention, excellent results were observed in 40.0% of patients, long-term results of the operation were observed in 81.9%, complications occurred in 12%, and relapse in 1.4%.

scholarly journals Optimization of surgical treatment of abdominal hernias in patients with obesity

2021 ◽  
Vol 180 (1) ◽  
pp. 73-80
Author(s):  
V. I. Belokonev ◽  
V. P. Zakharov ◽  
D. B. Grachev ◽  
S. Y. Pushkin ◽  
Z. V. Kovaleva ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
Clinical Manifestations ◽  
Side Surface ◽  
Negative Consequences ◽  
Systemic Complications ◽  
Mathematical Algorithm ◽  
Results Of Treatment ◽  
Clinical Observations

Introduction. Among patients with primary and postoperative ventral hernias, obesity of various degrees is observed in more than 50 % of patients. A severe complication of obesity is the development of panniculus – a skin-subcutaneous apron of varying severity. The hernia surgeon often performs a panniculectomy, which requires justification, taking into account both the positive and negative consequences.The objective was to improve the results of treatment of patients with hernias who are obese by developing a mathematical algorithm of indications for removing the skin-subcutaneous apron.Methods and materials. The analysis of surgical treatment of 253 obese patients with hernia aged 20 to 90 years was performed. There were 44 males (17.4 %) and 209 females (82.6 %). There are 2 groups: the first (comparison group) included 129 patients whom the hernia excision was performed without removing the skin-subcutaneous apron; the second (main group) – 124 patients who had the excision of the skin-subcutaneous apron during surgery. Indications for panniculus removal were based on the proposed mathematical algorithm, which took into account the size, clinical manifestations, associated complications, and possible consequences after surgeries while preserving it.Results. When considering the abdomen in patients with hernias and obesity from the side surface, the hanging apron in relation to the abdominal wall forms a truncated cone, or two conjugated cones that form significantly different moments of forces acting on the abdominal wall at different stages of development of the panniculus, and, therefore, can serve as the basis for the development of classification. Based on this mathematical model, the following classification of changes in the anterior abdominal wall in hernias and obesity is proposed: saggy belly; cutaneoussubcutaneous apron I, II, III degrees, which are based on calculated mathematical indicators and clinical manifestations of the disease. When treating patients with hernias and obesity during operations, the following tactical algorithms were followed: with a saggy stomach and panniculus of the 1st degree, the removal of the skin-subcutaneous apron can be refused; with the 2nd and 3rd degrees, its preservation contributes to the recurrence of the hernia due to the action of moments of forces that shift and pull the abdominal wall down.Conclusions. Clinical observations of patients with hernias and obesity have shown that the removal of the skinsubcutaneous apron did not lead to an increase in the frequency of wound and systemic complications, and therefore it should be considered a necessary stage of surgery.

scholarly journals ANALYSIS OF NONSURGICAL POSTOPERATIVE VENTRAL HERNIA PREDICTORS

2017 ◽  
Vol 34 (6) ◽  
pp. 5-11
Author(s):  
S N Lebedev ◽  
A V Fedoseev ◽  
A S Inyutin ◽  
S Yu Muraviyev
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Prospective Analysis ◽  
Case Histories ◽  
Endoprosthetic Replacement ◽  
Midline Laparotomy ◽  
Urgent Surgery ◽  
Connective Tissue Dysplasia ◽  
Blood Erythrocyte

Aim. The aim of this study was to detect the predictors of the postoperative herniation in midline laparotomy as the most frequent type of approach in urgent surgery. The study included retro-and-prospective analysis of 398 case histories. Analysis was performed according to 45 signs. Materials and methods. The following parameters were taken into account: Kettle index, anterior abdominal wall status, presence of the signs of undifferentiated connective tissue dysplasia, hard physical labour, use of bandage in the postoperative period as well as blood erythrocyte and hemoglobin indices, bilirubin and creatinine levels. Separately, the following parameters were assessed: presence of aponeurosis defects (physically and by US data) and presence of hernia outpouching. Results. According to the obtained data, the indications to preventive endoprosthetic replacement of the anterior abdominal wall were formed. Conclusions. Combination of some factors, not connected with surgical treatment, raises the risk for herniation, being the indication to preventive endoprosthesis replacement of the abdominal wall.

scholarly journals External Oblique Muscle Schwannoma: A Rare Anatomical Presentation

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Daniel Paramythiotis ◽  
Diamantoula Pagkou ◽  
Moysis Moysidis ◽  
Niki Mantha ◽  
Angeliki Cheva ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Surgical Excision ◽  
Cystic Mass ◽  
Oblique Muscle ◽  
Surgical Department ◽  
Lateral Abdominal Wall ◽  
Benign Schwannoma ◽  
First Case ◽  
Upper Abdominal ◽  
Internal Oblique

Introduction. Schwannomas or neurilemmomas are rare, benign, and usually solitary lesions that arise from the nerve sheath. In the majority of cases, these tumors involve the extremities, head, neck, and trunk. Case Presentation. In the present study, a 52-year-old man presented to our surgical department for the evaluation of a symptomatic lump in his left lateral abdominal wall. CT and MRI confirmed the presence of a cystic mass located between the external and internal oblique muscles. Histopathology and immunohistochemistry confirmed it to be benign schwannoma. Discussion. Schwannomas have rarely been reported in the abdominal wall. To the best of our knowledge, this is the first case of schwannoma located in the left upper abdominal wall and the fifth case of abdominal wall schwannoma reported according to the reviewed medical literature. Conclusion. Benign schwannoma should be included in the differential diagnosis of cystic and symptomatic lesions of the abdominal wall. The treatment of choice is surgical excision, and recurrence is extremely rare.

scholarly journals DRENAJE QUIRÚRGICO EXTRAPERITONEAL DE ABSCESO DEL PSOAS: FUNDAMENTO ANATÓMICO. Drenaje quirúrgico extraperitoneal de absceso del psoas: Fundamento anatómico

2016 ◽  
Vol 7 (2) ◽  
pp. 100-106
Author(s):  
Alejandro M Russo ◽  
Alejandra Garretano ◽  
Andrés Pouy ◽  
Gabriela Wagner ◽  
Juan M Costa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Surgical Treatment ◽  
Emergency Room ◽  
Abdominal Wall ◽  
Peritoneal Cavity ◽  
Parietal Peritoneum ◽  
Complete Relief ◽  
Extraperitoneal Approach ◽  
Lateral Abdominal Wall ◽  
Formalin Fixed

El espacio extraperitoneal se encuentra delimitado por el peritoneo parietal y las paredes de la cavidad abdómino-pélvica. Al igual que la cavidad peritoneal este espacio puede ser asiento de diversas colecciones, como ser hematomas, tumores y supuración. Con el advenimiento de las nuevas técnicas de imagen, se ha contribuido no solo al mejor diagnóstico de estas patologías sino también a su mejor manejo. El objetivo de este trabajo es mostrar la anatomía del abordaje extraperitoneal del comparti-miento del psoas y su aplicación al tratamiento de un paciente. Para esto se utilizaron 5 cadáveres adultos fijados previamente en solución en base a formol. Se realizó disección bilateral de la pared antero-lateral del abdomen reclinando la bolsa peritoneal para a continuación abordar el compartimiento del músculo psoas. Este conocimiento fue utilizado en el tratamiento quirúrgico de una paciente que consultó por un absceso del compartimiento del psoas derecho. En las preparaciones cadavéricas, se observó cómo al rebatir el peritoneo parietal se expone la totalidad del compartimiento muscular del psoas. Este procedi-miento fue realizado a la paciente consiguiendo el drenaje completo de la cavidad abscedada, quien tuvo una buena evolución y fue dada de alta a los 7 días. Los hallazgos demuestran una vez más como el conocimiento anatómico sigue estando vigente en la práctica clínica, siendo la comprensión del espacio extraperitoneal fundamental no solo para el anatomista sino también para el cirujano.  The retroperitoneal space is bounded by the parietal peritoneum and the posterior abdominal wall. Just like the peritoneal cavity, this region can host multiple effusions such as hematomas, tumors and suppuration. With the development of new radiological technics, both diagnosis and management of these conditions has improved. The purpose of this paper is to demonstrate the anatomy of the extraperitoneal approach of the psoas compartment and its application to a patient´s surgical treatment. For this purpose 5 formalin-fixed adult cadavers were used. Bilateral dissection of the antero-lateral abdominal wall was performed in every specimen. Once the parietal peritoneum was mobilized the psoas compartment was approached. This knowledge was used during the surgical treatment of a patient who attended to the emergency room with a right psoas compartment abscess. In the cadaveric specimens, the psoas muscular compartment was approached after mobilizing the parietal peritoneum medially. This procedure was carried out in the patient resulting in complete drainage of the purulent effusion. The patient had complete relief of the symptoms and was discharged 7 days after the procedure. These findings show that the anatomic knowledge is still important in clinical practice. Understanding the extraperitoneal space is crucial for both anatomists and surgeons. 

scholarly journals SIMULTANEOUS INTERVENTIONS IN PATIENTS WITH COMPLICATED FORMS OF POSTOPERATIVE VENTRAL HERNIA AND ANTERIOR ABDOMINAL WALL DEFORMATIONS

2019 ◽  
Vol 26 (1) ◽  
pp. 88-93
Author(s):  
Oksana Yu. Gerbali ◽  
Aleksandr V. Kosenko
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Wall Deformation ◽  
Ventral Hernias ◽  
Postoperative Intestinal Obstruction

The aim is to optimize the treatment of patients with postoperative ventral hernias, anterior abdominal wall deformations and cholelithiasis.Materials and methods. 36 patients with complicated forms of postoperative ventral hernias, anterior abdominal wall deformation and cholelithiasis aged 36–74 years, under the 12:24 male/ female ratio were studied. According to the classification of Toskin — Zhebrovsky, smallsized, medium-sized, extensive and gigantic hernias were observed in 3 (8.3%), 12 (33.3%), 15 (41.7%) and 6 (16.7%) patients, respectively. According to the SWR-classification, the hernia of the median, lateral and combined localization was observed in 14 (38.9%), 7 (19.4%) and 15 (41.7%) patients, respectively. All patients were operated. Both autoplastic and prosthetic techniques of operations were used. Various forms of the anterior abdominal wall deformation were eliminated with the help of abdominoplasty. Laparoscopic cholecystectomy was performed simultaneously in all patients.Results. Postoperative complications occurred in 11 (30.5%) patients, with persistent seroma prevailing (6–54.5% of patients). In 3 (27.2%) patients wound suppuration was observed, in 1 (9.1%) — early postoperative intestinal obstruction. Postoperative pneumonia was observed in one patient.Conclusion. Success in the surgical treatment of such patients is determined by whether an individualized differentiated approach was used in choosing the method of surgery and the management of patients in the postoperative period.

scholarly journals Laparoscopic alloplasty of troacary hernia paraumbilically area

2019 ◽  
Vol 2 (8) ◽  
pp. 47-52
Author(s):  
Ia.P. Feleshtynsky ◽  
V. А. Dadayan
Keyword(s):  
Surgical Treatment ◽  
Length Of Stay ◽  
Early Postoperative Period ◽  
Surgical Department ◽  
Abdominal Hernias ◽  
Scientific Justification ◽  
Group 5 ◽  
Group 2 ◽  
Surgical Tactics ◽  
Number Of Faces

Currently, researchers continue to debate about the choice of surgical treatment for such hernias, which is more appropriate to use: classic laparoscopic alogioplasty or a modified laparoscopic alloplasty technique. Objective. The scientific justification for the choice of surgical tactics and improve the results of surgical treatment of trocar hernias of the paraumbilical site and prove the effectiveness of the proposed method. Materials and methods. The article presents the results of the analysis of surgical treatment of trocar abdominal hernias in 64 patients aged 30 to 75 years. During the analysis, we divided the patients into two groups equal in number of faces, the inclusion factor in the first group was classical laparoscopic alogioplasty (32 patients), and the second group included patients who underwent our modified surgery - laparoscopic alloplasty of postoperative trocar hernias paraumbilical plot. Research results and discussion. When conducting a comparative analysis of the course of the early postoperative period in patients of the first group, we found that seroma was observed in 12.5% (4) patients, the second group – in 6.3% (2) patients. Postoperative wound infection was observed in only one (3.1%) patient of the first group. The length of stay of patients in the clinic, in the inpatient department, ranged from 7 to 2 days. Patients of the first group - 5 ± 2.12 (p <0.05) days, and patients of the second group - 2 ± 1.31 (p <0.05) days, respectively. Findings. Therefore, we found that laparoscopic alloplasty of trocar hernias of the abdomen has significant advantages over open by reducing the frequency of postoperative complications by more than two times from the side of the wound. In addition, the length of stay of such patients in the surgical department is reduced by 2.5 times, which, in turn, significantly reduces costs. During the prospective observation of patients  who underwent laparoscopic allogernioplasty of trocar abdominal hernias (within three years after the intervention), we can state that the elimination of the defect by the proposed method is not accompanied by relapse.  

scholarly journals ABDOMINOPLASTY IN THE SURGICAL TREATMENT OF PATIENTS WITH COMPLEX ABDOMINAL WALL DEFECTS

2019 ◽  
Vol 19 (2) ◽  
pp. 63-67
Author(s):  
G. R. Salimov ◽  
R.B. Lysenko
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
Subcutaneous Fat ◽  
Abdominal Wall Defects ◽  
Municipal Hospital ◽  
Surgical Department ◽  
Excess Skin ◽  
Simultaneous Operations ◽  
Type Size ◽  
Surgical Tactics

Patients with complex abdominal wall defects usually have deformations of the abdomen, which may remain after the operation, and require the solution of a whole ramge of problems. Quite often, abdominal wall defects are combined with a variety of aesthetic deformities that are associated with abnormal postoperative scars, trophic ulcers, and fistulas. Though the restoration or improvement of abdominal wall functionality is the main goal of alloplasty for complex abdominal wall defects, the cosmetic aspects of the operation, sometimes far more important for patients, deserve special attention. The choice of optimal operative access largely depends on lateral surgery, but most surgeons do not pay special attention to it and mainly use framing incisions above the defect or protrusion. By this time, such values ​​as the type, size of the incision, depth, and borders of flaps flaking are reported empirically and often lead to additional deformation of the operative area and the development of complications. Abdominoplasty is one of the most controversial operations in aesthetic and plastic surgery, where complications reach 27.5-30.8%. The concept of "abdominoplasty" provides techniques for the operational correction of abdominal wall deformities presented by excess skin and subcutaneous fat, pathological postoperative scars, as well as defects of the muscular aponeurotic layer in abdominal area. There are several abdominoplasty techniques. The purpose of this work is to determine the efficacy of the modified abdominoplasty in the surgical treatment of complex abdominal wall defects. Materials and methods. The study involved 360 patients with complex abdominal wall defects operated on at the surgical department of the Poltava Municipal Hospital №1 in for the last 10 years. Various deformities of the abdominal wall were detected in 289 patients (80,3%). Localization of the defects can be described as following: M – 306 (85%), L – 31 (8,6%), ML – 23 (6,4%). The size of the defects: W1 – 103 (28,6%), W2 – 188 (52,2%), W3 – 69 (19,2%). Additional diastase rectus muscles were detected in 179 patients (49,7%). The combined surgical diseases were found in 332 patients (92,2%); 18,1% of them were diagnosed to have intra-abdominal pathology. Results and discussion. The following types of dermatolipectomy were used: longitudinal - 77 cases (28,1%), by Babcock - 114 cases (41,6%), by Kelly - 6 cases (2,2%), by Fernandes - 63 cases (22,9%), modified Fernandez - 7 cases (2,5%), by Berson - 3 cases (1,1%), by Torek - 2 cases (0,8%), by Hrazer – 2 cases (0,8%). Simultaneous operations were performed on in 65 patients (18,1%). Types of alloplasty used: «onlay» - 3 cases (0,8%), «sublay» - 289 cases (80,3%), «sublay-inlay» - 38 cases (10,6%), «inlay» - 3 cases (0,8%), Ramirez – 4 cases (1,1%), intra-abdominal - 2 cases (0,6%), combine – 21 (5,8%). Conclusions. The term abdominoplasty has a broader definition than it was considered previously. Differentiated surgical tactics for patients with complex abdominal wall defects improves the abdominoplasty outcomes.

scholarly journals RESULTS OF SURGICAL TREATMENT OF NEWBORNS WITH ANTERIOR ABDOMINAL WALL MALFORMATIONS

2020 ◽  
Vol 24 (1) ◽  
pp. 5-10
Author(s):  
A. A. Shchukina ◽  
O. G. Mokrushina ◽  
A. S. Gurskaya ◽  
E. Yu. Dyakonova ◽  
O. N. Nakovkin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Functional Results ◽  
Abdominal Wall Defects ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Satisfactory Condition ◽  
National Medical ◽  
Increased Risk

Introduction. Malformations of the anterior abdominal wall in newborns is one of the actual problems in neonatal surgery. Antenatal diagnostics of such defects as omphalocele and gastroschisis allows to diagnose and perform necessary surgical interventions in time. Often, outcomes of treatment of newborns with embryonic hernia depend not only on the form of the defect, but also on the accompanying abnomalies. Purpose. To present outcomes of surgical treatment of newborns with anterior abdominal wall malformations. Material and methods. From December 2017 till May 2019, 34 pregnant women with fetal anterior abdominal wall malformations were consulted; 17 out of them with omphalocele and gastroschisis were treated. Results. In December 2017, the surgical department for newborns and infants at the National Medical Research Center for Children’s Health successfully helped children with malformations of the anterior abdominal wall. 16 children were discharged home in a satisfactory condition; there was one unsatisfactory outcome. 11 patients were treated for gastroschisis; 6 patients were treated for omphalocele. 3 patients had repeated surgeries for concomitant pathologies. There were no any adhesive processes and commissural intestinal obstruction. Conclusions. In Russia, there are two groups of newborns with anterior abdominal wall defects: children with isolated defects and children with concomitant pathologies who have an increased risk of unsatisfactory outcomes. The technique developed by us for treating newborns with anterior abdominal wall malformations and concomitant pathologies has very good cosmetic and functional results and reduces the number of postoperative complications and unsatisfactory outcomes.

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