scholarly journals Abdominal Wall Endoscopic Extraperitoneal Reconstruction Technique in Patients with Primary Midline Hernias and Diastasis of the Rectus Abdominis Muscles

2021 ◽  
Vol 14 (1) ◽  
pp. 19-24
Author(s):  
Vladislav Sergeevich Rakintsev ◽  
Anatolii Vladimirovich Yurasov
Keyword(s):  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Rectus Abdominis ◽  
Reconstruction Technique ◽  
Type I ◽  
Anatomical Landmarks ◽  
Confined Space ◽  
Needle Holder ◽  
White Line ◽  
Surgical Department

Introduction. The paper focuses on technical features of endoscopic extraperitoneal reconstruction (EER) of the anterior abdominal wall in patients with primary median hernias combined with diastasis of the rectus abdominis muscles, the nuances of the operating room equipment and preparation of patients for intervention.The aim of the study was to analyze the stages and features of the technique for performing endoscopic extraperitoneal reconstruction of the anterior abdominal wall to ensure safe and qualified implementation of the operation in clinical practice.Materials and methods. This research was a prospective study including 45 clinical cases of patients with primary median hernias of the anterior abdominal wall combined with diastasis of the rectus abdominis muscles, who were exposed to endoscopic extraperitoneal reconstruction. The study was performed in the surgical department of the private healthcare facility "Central Clinical Hospital Russian Railways-Medicine" in 2019-2020. The median follow-up was 14 months (8 - 18 months), there were no complications estimated higher than type I according to the Clavien-Dindo classification and relapses.Results and discussion. Successful EER requires thorough preoperative preparation: to connect a second monitor; to distance anesthetic equipment; to ensure the patient is in an extension position in the lumbar segment of the spinal column; to identify principle anatomical landmarks under ultrasound control. The main two stages of EER - mobilization and reconstruction - are performed extraperitoneally in a confined space, and therefore the localization of the ports must be anatomically validated. The major point at the stage of mobilization is to maintain the integrity of the parietal peritoneum, this solves visualization problems and helps to work in the required layer of the anterior abdominal wall. Adherence to the principles of open surgery, namely, orientation of the needle holder at an angle close to 0 to the suture line (white line), and the needles at a right angle; maintaining working angles between the instruments 30-60, - allows effectively performing the reconstructive stage.Conclusion. Thus, a topographic-anatomically based approach to each stage of the operation and adherence to a set of features of the surgical technique allows safely and effectively applying EER for the treatment of patients with primary midline hernias and diastasis of the rectus abdominis muscles.

Determination of clinical efficiency of deproteinized dialysate from blood of milk-fed calves after endoprosthetics in patients with ventral hernias

2020 ◽  
Vol 28 (3) ◽  
pp. 323-333
Author(s):  
Sergej V. Ivanov ◽  
Ilya S. Ivanov ◽  
Evgenij G. Obyedkov ◽  
Liliya P. Popova
Keyword(s):  
Abdominal Wall ◽  
Inflammatory Reaction ◽  
Inflammatory Process ◽  
Anterior Abdominal Wall ◽  
Dynamic Change ◽  
Main Group ◽  
Control Group ◽  
Surgical Department ◽  
Regeneration Stage

Aim. To study the influence of deproteinized dialysate from blood of milk-fed calves on the type of exudative discharge and dynamics of inflammatory reaction after hernia repair with plastics of the anterior abdominal wall with hernioendoprosthesis of polypropylene. Materials and Methods. The study involved 59 patients being on stationary treatment in the surgical department of Kursk Regional Clinical Hospital. Patients were hospitalized for the herniation of small or medium dimension. The patients were divided to two groups: the main (n=30) and control (n=29) groups. After endoprosthetics, the patients of the control group were given complex conservative treatment. The patients of the main group, besides standard treatment, were administered deproteinized dialysate from blood of milk-fed calves intravenously in drips 10 ml + 200 ml of 0.9% sodium chloride solution within 7 days. For cytological examination and determination of the type of cytograms, the traumatic discharge was collected and analyzed using the method of M.F. Kamaev and M.A. Palthsev. Results. Cytomorphometric examination was conducted on the third, fifth and seventh day after endoprosthetics with the aim of studying dynamic changes. Determination of cell composition and also of its changes characteristic of each studied period, was necessary for obtaining further information characterizing inflammatory process in the region of placement of the endoprosthesis. After endoprosthetics in patients who were administered hemodialysate, the inflammatory reaction was less pronounced than in patients who did not receive the preparation. This was associated with a more dynamic change of stages of the inflammatory process. In patients of the main group who received deproteinized dialysate, regenerative type of inflammation first appeared on the fifth day and made 6.9%; by the seventh day the share of patients with the regenerative type rose to 17.5%, while in the patients of the control group no regeneration stage was observed in both periods. Conclusion. Analysis of the efficiency of influence of hemodialysate on the inflammatory reaction in plastics of the anterior abdominal wall with polypropylene endoprosthesis evidences faster course of all stages of inflammation and reduction of its intensity by 10%.

scholarly journals A case report of aponeurotic origin of rectus abdominis

2014 ◽  
Vol 03 (02) ◽  
pp. 84-86
Author(s):  
Challa Ratna Prabha ◽  
Namburu Bhanu Sudha Parimala
Keyword(s):  
Case Report ◽  
Abdominal Wall ◽  
Andhra Pradesh ◽  
Anterior Abdominal Wall ◽  
Pubic Symphysis ◽  
Rectus Abdominis ◽  
General Surgeon ◽  
Pubic Tubercle ◽  
Middle Aged ◽  
Medical College

AbstractRectus abdominis is a long strap like muscle that extends along the entire length of anterior abdominal wall. Normally the rectus abdominis arises by two tendons. The larger lateral tendon attached to the crest of the pubis, pubic tubercle up to pectineal line. The medial tendon is attached to the pubic symphysis. The fleshy fibers of rectus abdominis replaced by aponeurosis below the umbilicus was found during the routine dissections of a middle aged female cadaver at Dr. Pinnamaneni Siddhartha Medical College, Chinnavutapalli, Andhra Pradesh, India. The knowledge of partial or complete absence of rectus abdominis and other anterior abdominal wall musculature is of immense importance for the General surgeon, Anatomist and the Gastroenterologist.

scholarly journals Assessment of the Spatial Distribution of Mechanical Properties of the Tissue of Anterior Abdominal Wall at Maximum Functional Load

2021 ◽  
Vol 6 (3) ◽  
pp. 175-181
Author(s):  
R. B. Lysenko ◽  
◽  
V. I. Lіakhovskyi ◽  
V. R. Lysenko
Keyword(s):  
Mechanical Properties ◽  
Spatial Distribution ◽  
Abdominal Wall ◽  
Transverse Direction ◽  
Anterior Abdominal Wall ◽  
Longitudinal Direction ◽  
Main Group ◽  
Treatment Center ◽  
Control Group ◽  
White Line

The purpose of the study was to investigate the changes in the mechanical properties of the anterior abdominal wall at maximum functional loads. Materials and methods. The study was conducted on 112 volunteers aged 18 to 49 years old who were examined and treated in the surgical department of the Medical Diagnostic and Treatment Center "Medion" Poltava for the period from June 2020 to May 2021. There were 60 women (53.6 %), and 52 (46.4%) men. Volunteers were divided into 2 groups: the main group (n=58), which underwent the analysis of movement and deformation changes of the anterior abdominal wall during maximal abdominal inflation during the examination, and the control group (n=54), which were operated laparoscopically due to the schedule. Results and discussion. The results of the study showed the following changes in the mechanical properties of the tissues of the anterior abdominal wall: the average deformation in the longitudinal direction was 6% in the main group and 12% in the control one; deformations in the transverse direction were 3% in the main group and 8% in the control group; deformation in the longitudinal direction exceeded the deformation in the transverse by 38-54% (on average by 46%); the area of the anterior abdominal wall in the main group increased by 10%, and in the control one – by 22% (on average by 16%). During the studies, the anterior abdominal wall underwent greater stresses in the transverse orientation than in the longitudinal one (anisotropy coefficient ~2). The Young's modulus of anterior abdominal wall in the sagittal plane is defined as 23.5±2.6 kPa, while in the transverse – 42.5±7.0 kPa. The mechanical properties of human anterior abdominal wall tissues differed along and across the white line of the abdomen: the modulus of elasticity of anterior abdominal wall tissues, with the same force of impact, in the longitudinal direction is less than the transverse average of 44% (p >0.05). That is, the longitudinal stiffness of the anterior abdominal wall is lower than the transverse one. The maximum strength of the anterior abdominal wall is across the white line of the abdomen, and the greatest elasticity – along. The anterior abdominal wall in women showed increased elasticity compared to men, while the stiffness of the anterior abdominal wall tissue in men in both directions was statistically significantly higher than in women (p >0.05). Conclusion. Reconstruction of the spatial distribution of the mechanical properties of anterior abdominal wall tissues according to the nature of their deformation at maximum functional loads provides an additional opportunity to assess the biomechanics of anterior abdominal wall. The mechanical properties of the musculo-aponeurotic structures of anterior abdominal wall in humans differ in the longitudinal and transverse directions. They have the greatest elasticity in the longitudinal direction, and the maximum rigidity and strength in the transverse direction. The strength of the anterior abdominal wall tissue in men is higher, and the elasticity is less than in women. Changes in the mechanical anisotropic characteristics of anterior abdominal wall tissues at maximum functional loads should be taken into account when performing the anterior abdominal wall alloplasty technique

scholarly journals Optimization of the choice of laparoscopic and open alloplastic surgery of postoperative ventral hernias

2020 ◽  
pp. 289-291
Author(s):  
Ya.P. Feleshtynskyi
Keyword(s):  
Wound Infection ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Rectus Abdominis ◽  
Postoperative Treatment ◽  
Abdominal Pressure ◽  
Electrolyte Balance ◽  
Preoperative Preparation ◽  
Diastasis Recti ◽  
Ventral Hernias

Background. Postoperative ventral hernias (PVH) account for 20.4-22 % of all abdominal hernias. The recurrence rate after alloplastic surgery of large and giant PVH is 10-25 %. Adequate selection of alloplastic surgery method in PVH may help to improve treatment outcomes and reduce the frequency of relapses. Objective. To describe the features of laparoscopic and open alloplastic surgery of PVH. Materials and methods. Analysis of literature sources on this topic. Results and discussion. According to the classification, PVH are divided into medial (subxiphoid, epigastric, umbilical, subumbilical, suprapubic) and lateral (subcostal, flank, iliac, lumbar). Autoplastic surgery (according to Sapezhko, Mayo) is used only for small-sized PVH in young and middle-aged people in the absence of diastasis recti and obesity (up to 3.5 %). In 96.5 % of cases alloplastic surgery is used (open – 81.1 %; laparoscopic – 15.4 %). There are about a dozen types of alloplastic interventions. When choosing the optimal intervention, it is necessary to take into account the width of the defect, the width of diastasis or contracture of the rectus abdominis muscles, the level of intra-abdominal pressure. When performing laparoscopic alloplastic intervention, prevention of trocar wound infection is performed using Dekasan solution (“Yuria-Pharm”) by rinsing before suturing. Alloplastic surgeries of giant PVH should be performed in combination with techniques for separating the anatomical components of the anterior abdominal wall and mandatory monitoring of intra-abdominal pressure, as intra-abdominal hypertension is a frequent complication of such procedures. Preoperative preparation and examination of patients before PVH surgery includes laboratory tests (general and biochemical blood tests, coagulation analysis), electro- and echocardiography, ultrasound or computed tomography of the required areas, spirography, consultations with related specialists, slag-free nutrition and 10-12 days of laxatives (in the outpatient settings), correction of comorbidities, maximum bowel cleansing before surgery, control of intra-abdominal pressure, prevention of infectious complications of the wound and prevention of thromboembolic complications. Contraindications to elective surgery include ineffective preoperative preparation, impaired cardiopulmonary activity, increased intra-abdominal pressure >12 mm H2O using bandage compression, reduction of breathing function <60 % of normal. To prevent postoperative wound infection during surgery at the stages of separation of the anatomical components of the anterior abdominal wall, fixation of the mesh and before drainage and suturing the wound, Decasan washing is used (400-800 ml depending on the wound surface area). Postoperative treatment includes analgesia (paracetamol – Infulgan, “Yuria-Pharm”), oxygen therapy, abdominal bandaging, monitoring of intra-abdominal pressure, stimulation of intestinal function (metoclopramide – Reosorbilact, “Yuria-Pharm”), antibacterial treatment, correction of electrolyte balance, nonsteroidal anti-inflammatory drugs. Removal of drainages from the mesh implant is performed in 3-4 days, from the subcutaneous wound – in 5-6 days. Conclusions. 1. The choice of PVH alloplastic surgery type should be made taking into account the size of the defects, the width of the diastasis recti and intra-abdominal pressure. 2. Optimization of the choice of treatment procedure for giant PVH can be achieved by determining the intra-abdominal pressure during surgery during contact of the rectus abdominis muscles. 3. Decasan lavage is used to prevent infection of trocar and surgical wounds.

To surgical methods of treating discrepancies of the rectus abdominis muscles

1926 ◽  
Vol 22 (1) ◽  
pp. 46-49
Author(s):  
V. L. Bogolyubov
Keyword(s):  
Inguinal Hernia ◽  
Abdominal Wall ◽  
The Elderly ◽  
Rectus Abdominis ◽  
Frequent Occurrence ◽  
White Line ◽  
Inguinal Hernias ◽  
Surgical Methods ◽  
Multiparous Women ◽  
Young Subjects

The divergence of the rectus abdominis muscles is a frequent occurrence that the surgeon has to meet and which has to be eliminated in one way or another by surgery. A similar diastasis of the rectus muscles we meet primarily not only in adults and the elderly. especially in multiparous women, but also in young subjects and even children. If you pay systematically attention to the condition of the rectus muscles in carriers of inguinal hernias, then it is not so rare to find in them, along with the inguinal hernia, also the divergence of the rectus abdominis muscles. Although such a discrepancy does not essentially represent a hernia, it is an expression of a weakening of the abdominal wall and must be corrected by surgery. In addition to the cases mentioned, as is known, we often meet cases of divergence of the rectus muscles, combined with hernias of the white line, incisional and umbilical hernias.

scholarly journals Skin biopsy as a method for determining indications for preventive endoprosthetics of the anterior abdominal wall

2020 ◽  
pp. 46-53
Author(s):  
Viktor A. Lazarenko ◽  
Sergey V. Ivanov ◽  
Ilya S. Ivanov ◽  
Evgeny G. Ob’edkov ◽  
Nikolay N. Grigor'ev ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Skin Biopsy ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Polarized Light ◽  
Structural Features ◽  
Collagen Fibers ◽  
Type Iii Collagen ◽  
Type I ◽  
Connective Tissue Dysplasia

The aim is to examine the effectiveness of preoperative skin biopsy method to determine indications for preventive endoprosthesis implantation of the anterior abdominal wall based on structural features of connective tissue. Materials and methods. The study included 17 patients who had been planned to undergo a scheduled surgery such as video laparoscopic cholecystectomy. The histological material was collected with DERMO PUNCH biopsy needles in an outpatient clinic. Using polarized light microscopy we inspected histological slices coloured with Sirius red. After that we analyzed histological sections including the ratio of collagen fibers, the density of connective tissue and the number of interfibrous spaces. Results. All the studied features of connective tissue dysplasia had been registered among 18% of patients; significant differences (p ≤0.05) had been identified among other 24% of patients. In patients with identified signs of connective tissue dysplasia, an increase in type III collagen fibers and a decrease in type I fibers were revealed, which directly resulted in a decrease in their ratio. In addition, this category of patients noted a decrease in the density of connective tissue and a significant number of interfibrous spaces. Conclusion. Skin biopsy is a safe and informative method to reveal patients with predisposition to the formation of hernias of the anterior abdominal wall based on structural features of connective tissue and to determine indications for preventive endoprosthetic implantation. This method will reduce the frequency of postoperative ventral hernias, so the effectiveness of the treatment will definitely increase.

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