PREVENTION AND TREATMENT OF INFECTION WOUND COMPLICATIONS AT PROSTHETIC HERNIA REPAIR

Purpose – development of practical recommendations for prevention and treatment of infectious wound complications at prosthetic hernioplasty, based on the peculiarities of blood supply of the front abdominal wall. Materials and methods. 851 surgeries of prosthetic hernioplasty were made in Propaedeutic Surgery Clinic of Samara State Medical University throughout 2010–2013. The most of infectious complications developed after tension-free hernioplasty of big postoperative ventral hernias, with size of hernia orifice of 10 cm and more (W3–W4, Chevrel–Rath, 1999). 118 hernia repairs have been done for such hernias. These surgeries are peculiar by wide mobilization of cutaneous fat flaps and implant contact with the subcutaneous tissue. The imaging of blood vessels in median masses of the anterior abdominal wall was carried out using anatomic material. Results. Very interesting results were obtained with respect to peculiarities of blood supply to the skin and subcutaneous tissues of anterior abdominal wall, upon pumping of zinc sulfide and lead acetate to the epigastric arteries. The infectious wound complications after prosthetic hernioplasty are mostly concerned with the ischemia of cutaneous and subcutaneous flaps, which wide mobilization causes considerable blood supply disturbance and cellular tissue hemorrhages. In cases of hernia orifices size of 10 cm and more, the occurrence rate of infectious wound complications was 13,6 %. Conclusions. In case of wide mobilization of cutaneous fat flaps, the excision of deep layers of subcutaneous cellular tissue is possible and the aspiration drainage is mandatory. The ischemic genesis of complications causes a possibility of restricted surgical activity. Even development of infectious complications does not prevent the implant survival.

Download Full-text

Effect of alpha lipoic acid co-administration on structural and immunohistochemical changes in subcutaneous tissue of anterior abdominal wall of adult male albino rat in response to polypropylene mesh implantation

International Journal of Experimental Pathology ◽

10.1111/iep.12127 ◽

2015 ◽

Vol 96 (3) ◽

pp. 172-182 ◽

Cited By ~ 1

Author(s):

Shireen A. Mazroa ◽

Samar A. Asker ◽

Waleed Asker ◽

Mohamed Abd Ellatif

Keyword(s):

Abdominal Wall ◽

Adult Male ◽

Lipoic Acid ◽

Polypropylene Mesh ◽

Anterior Abdominal Wall ◽

Subcutaneous Tissue ◽

Alpha Lipoic Acid ◽

Albino Rat ◽

Mesh Implantation

Download Full-text

On the features of the preperitoneal space multifascial structure in clinical and anatomical issues

Russian Military Medical Academy Reports ◽

10.17816/rmmar64485 ◽

2021 ◽

Vol 40 (1) ◽

pp. 65-70

Author(s):

Yuliуa A. Boytsova ◽

Nikolay F. Fomin ◽

Viktor V. Shvedyuk

Keyword(s):

Abdominal Wall ◽

Anterior Abdominal Wall ◽

Meta Analysis ◽

Infectious Complications ◽

Preperitoneal Space ◽

Control Groups ◽

Safe Method ◽

Hernia Formation ◽

And Control ◽

Ventral Hernias

AIM: to determine the prospects for the preventive endoprosthetics of the abdominal wall at preventing the development of postoperative ventral hernias. MATERIALS AND METHODS: A meta-analysis of the literature data performed to determine the effectiveness of preventive endoprosthetics for the prevention of ventral hernia formation. Topographical study has been conducted to explore the most promising levels of the mesh location. RESULTS: During the meta-analysis it has been found that performing preventive endoprosthesis of the anterior abdominal wall t in the preperitoneal space reduces the frequency of ventral hernias. There were no significant differences in the frequency of infectious complications and serom in the experimental and control groups according to studied publications. During the preparation it has been distinguished that between the transverse fascia and the peritoneum there is a preperitoneal fascia consisting of two leaves, which is most manifest in the lateral parts. In the umbilical region above linea arcuata the preperitoneal fascia is thinned and represented by separate fibers that are difficult to differentiate as a structure between the transverse fascia and the peritoneum. In the lateral parts of the abdominal wall, the preperitoneal fascia is well expressed. It has been distinguished that the retroperitoneal fascia, formed by the junction of two sheets of the Gerot fascia continues into the fascia between the transverse fascia and the peritoneum. CONCLUSION: Preventive endoprosthesis of the anterior abdominal wall is an effective and safe method of preventing the formation of postoperative ventral hernias. The anterior abdominal wall is characterized by a complex multifascial structure, which is of fundamental importance for various types of surgery. Between the transverse fascia and the peritoneum there is preperitoneal fascia which is represented by two leaflets. Its continuation is the retroperitoneal fascia (5 figures, 2 tables, bibliography: 8 refs).

Download Full-text

Unexpected Abscess Localization of the Anterior Abdominal Wall in an ADPKD Patient Undergoing Hemodialysis

Case Reports in Nephrology ◽

10.1155/2015/982575 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Nikos Sabanis ◽

Eleni Paschou ◽

Eleni Gavriilaki ◽

Maria Mourounoglou ◽

Sotirios Vasileiou

Keyword(s):

Abdominal Wall ◽

Anterior Abdominal Wall ◽

Systemic Disease ◽

Intestinal Barrier ◽

Infectious Complications ◽

Monogenic Disorders ◽

Increased Risk ◽

Autosomal Dominant Polycystic Kidney ◽

Stage Renal Disease ◽

End Stage

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is one of the most common monogenic disorders and the leading inheritable cause of end-stage renal disease worldwide. Cystic and noncystic extrarenal manifestations are correlated with variable clinical presentations so that an inherited disorder is now considered a systemic disease. Kidney and liver cystic infections are the most common infectious complications in ADPKD patients. Furthermore, it is well known that ADPKD is commonly associated with colonic diverticular disease which recently has been reported to be linked to increased risk of infection on hemodialysis patients. Herein, we present a case of anterior abdominal wall abscess caused byEnterococcus faecalisin a patient with ADPKD undergoing hemodialysis. Although the precise pathway of infection remains uncertain, the previous medical history as well as the clinical course of our patient led us to hypothesize an alternative route of infection from the gastrointestinal tract through an aberrant intestinal barrier into the bloodstream and eventually to an atypical location.

Download Full-text

Technique of Midline Abdominal Incision Closure Among Surgical Trainees

Annals of African Surgery ◽

10.4314/aas.v17i2.7 ◽

2020 ◽

Vol 17 (2) ◽

pp. 72-75

Author(s):

Alex Muturi ◽

Kotecha Vihar ◽

Pulei Ann ◽

Maseghe Philip

Keyword(s):

Abdominal Wall ◽

Anterior Abdominal Wall ◽

Tertiary Hospital ◽

Fascial Closure ◽

Wound Complications ◽

Absorbable Suture ◽

Abdominal Wall Closure ◽

Abdominal Incision ◽

Abdominal Closure ◽

Surgical Trainees

Background: Technique of anterior abdominal wall closure (AAWC) determines wound-related surgical complications. Residents in obstetrics and gynecology and surgery departments perform most midline abdominal wall closure; data is lacking on how it is being done. This study identifies abdominal wall closure techniques used. Methods: A descriptive study was carried out from October 2015 to May 2016. Results: 71 (35 surgical, 36 ObGyn) residents completed a self-administered questionnaire. Knowledge of midline abdominal closure was acquired from medical officers (58.6%) or consultants before residency (28.6%). Absorbable suture was preferred for clean wounds by 75% of residents; 70% used size 1 suture for fascial closure. Most residents (95.7%) closed fascia in clean wound by continuous suturing. Interrupted suturing was preferred in contaminated and dirty wounds. Half of the residents in both groups would close skin in contaminated wounds, while 16% of surgery and 9.4% ObGyn will close skin in dirty wounds. Conclusion: Inconsistencies exist in anterior abdominal wall closure between groups of residents despite presence of clear guidelines. It is important to harmonize training on AAWC at the tertiary hospital. Keywords: Abdominal closure, Midline incision, Wound complications

Download Full-text

The results of surgical treatment of patients with large and complex incisional hernias of the anterior abdominal wall in a multidisciplinary hospital

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2018-3-35-44 ◽

2018 ◽

Vol 17 (3) ◽

pp. 35-44 ◽

Cited By ~ 1

Author(s):

E. N. Degovtsov ◽

P. V. Kolyadko ◽

V. P. Kolyadko ◽

A. V. Satinov

Keyword(s):

Surgical Treatment ◽

Incisional Hernia ◽

Hernia Repair ◽

Abdominal Wall ◽

Anterior Abdominal Wall ◽

Incisional Hernia Repair ◽

The Body ◽

Wound Complications ◽

Postoperative Wound ◽

Mesh Reinforcement

Objectives. To evaluate the immediate results of surgical treatment of patients with large incisional hernia of the anterior abdominal wall with the use of the mesh implants.Materials and methods. The data were retrospectively collected and analyzed. The study included patients with a large and / or complex incisional hernia. There were 108 patients who underwent incisional hernia repair with mesh reinforcement in the period from 2012 to 2016. In all cases the repairs were made with mesh implants. The average age of patients was (56.4 ± 10.4) years. The body mass index (BMI) was on average (32.6 ± 6.24) kg/m2. The medial localization of the hernia was 102 (94.44%). The width of the hernia defect averaged (12.2 ± 3.7) cm. Implants were placement in onlay positions – 19 (17.6%), sublay – 49 (45.37%), IPOM (Intraperitoneal onlay mesh) – 30 (27.77%) patients, the component separation technique (CST) with mesh reinforcement was used in 10 (9.25%) patients. Active aspiration drainage was performed in 72 (66.66%) patients.Results. The average time for draining the postoperative wound was (5 ± 2.2) days. The number of wound complications was 23 (21.3%), the number of seromas of the postoperative wound prevailed was 16 (14.8%) patients, of which 2 (1.85%) were chronic abdominal wall seromas, hematoma occurred in 2 patients (1.85%), the number of prolonged serous exudation was 7 (6.5%), necrosis of the wound edges occurred in 4 (3.7%) patients. There was no mortality. Reliably more often wound complications occurred in patients with large hernia defects (p = 0.006), and also with an increase in the duration of surgical intervention (p = 0.01). The hospital-stay in patients with complications was significantly greater (p < 0.001), the need for analgesics also increased (p < 0.001).Conclusion. Prevention of wound complications after large and complex incisional hernia repair with mesh reinforcement is an important direction in improving the results of surgical treatment in this category of patients.

Download Full-text

Pharmacological stimulation of mesh implant engraftment after ventral hernia repair

Kazan medical journal ◽

10.17816/kmj2021-6 ◽

2021 ◽

Vol 102 (1) ◽

pp. 6-11

Author(s):

E E Lukoyanychev ◽

S G Izmaylov ◽

A A Mironov ◽

A G Izmaylov ◽

A A Bodrov ◽

...

Keyword(s):

Abdominal Wall ◽

Protein Level ◽

Anterior Abdominal Wall ◽

Abdominal Wall Hernia ◽

Wound Complications ◽

Control Group ◽

Prosthetic Repair ◽

C Reactive Protein ◽

Reactive Protein ◽

Mesh Implant

Aim. To study the effect of pyrimidine medication hydroxyethyldimethyldihydropyrimidine on the systemic inflammation after prosthetic repair of the anterior abdominal wall hernia. Methods. We prospectively analyzed two groups of patients aged between 18 and 80 years, who underwent prosthetic repair of the aponeurosis defect in the anterior abdominal wall hernia with a standard polypropylene mesh implant. The main group (n=16) was given 0.5 g hydroxyethyldimethyldihydropyrimidine per os 3 times a day before meals for 57 days from the first day after the operation. In the control group (n=16), patients received basic therapy without hydroxyethyldimethyldihydropyrimidine. Results. The postoperative period in patients after elective prosthetic hernioplasty of anterior abdominal wall was associated with an imbalance of the immune system with a tendency to lymphocytopenia (count in blood changed by 27.0%; p=0.20, Wilcoxon criterion) without significant leukocytopenia (count in blood changed by 4.9%; p=1.00, Wilcoxon criterion) and an 82.8% increase in C-reactive protein content (p=0.2, Wilcoxon criterion) compared to baseline values before the surgery. The proposed pharmacological support of prosthetic hernioplasty of the anterior abdominal wall with hydroxyethyldimethyldihydropyrimidine allowed to correct the postoperative lymphocytopenia (p=0.04, U-criterion) and reduce the concentration of C-reactive protein by 223.6% (p=0.03, U-criterion) compared with the control, which was also associated with a decrease in the number of local complications of prosthetic hernioplasty. Conclusion. The use of hydroxyethyldimethyldihydropyrimidine in patients after prosthetic hernioplasty is associated with a significant decrease in the C-reactive protein level, prevention of postoperative lymphocytopenia and a decrease in the number of local wound complications; C-reactive protein level can serve as one of the early and significant indicators of postoperative complications in this category of patients.

Download Full-text

Evaluation of the use of subcutaneous drains to prevent wound complications in abdominal surgeries

International Surgery Journal ◽

10.18203/2349-2902.isj20181112 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1368

Author(s):

G. V. Manoharan ◽

T. Sivakumar ◽

M. Ashok Kumar

Keyword(s):

Hospital Stay ◽

Abdominal Wall ◽

Subcutaneous Tissue ◽

Wound Dehiscence ◽

Wound Complications ◽

Skin Closure ◽

Abdominal Wall Closure ◽

Duration Of Hospital Stay ◽

Group A ◽

Group B

Background: Wound complications like surgical site infections (SSI) and wound dehiscence are common following abdominal surgery for peritonitis. Drains have been used to remove collections from the early days of surgery. The use of drains to remove subcutaneous collections to prevent wound complications needs to be studied.Methods: Sixty patients who underwent surgery for peritonitis were selected for the study. 30 patients underwent conventional abdominal wall closure while the other 30 had suction drains inserted in the subcutaneous tissue. Wounds were observed for complications and time for healing.Results: The incidence of SSI was significantly less in Group A (23%) than in Group B (60%). Similarly, wound dehiscence occurred in 43% of SSI cases in Group A as against 89% of SSI cases in Group B, the difference of which was statistically significant. The mean duration of hospital stay was significantly less when subcutaneous suction drain was placed (9 days).Conclusions: Subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis when compared to conventional primary skin closure as it significantly reduces the incidence of SSI, wound dehiscence, wound secondary suturing and duration of hospital stay.

Download Full-text

Pleural Mesothelioma Presenting as Periumbilical Metastasis: The First Clinical Documentation

Case Reports in Oncological Medicine ◽

10.1155/2013/198729 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

R. F. Falkenstern-Ge ◽

M. Kimmich ◽

S. Bode-Erdmann ◽

G. Friedel ◽

G. Ott ◽

...

Keyword(s):

Abdominal Wall ◽

Systemic Chemotherapy ◽

Clinical Presentation ◽

Pleural Cavity ◽

Anterior Abdominal Wall ◽

Subcutaneous Tissue ◽

Pleural Mesothelioma ◽

Fatty Tissue ◽

Clinical Documentation ◽

Subcutaneous Fatty Tissue

Introduction. Pleural mesothelioma with metastasis to the subcutaneous tissue of the abdominal wall at first diagnosis and without penetration into the peritoneum is an extremely rare clinical presentation.Methods. Patients with pleural mesothelioma have low survival rate. Usually, the disease at presentation is confined to its site of origin (most often the pleural cavity). A 55-year-old man was referred to our center due to increasing dyspnea and a painful periumbilical mass in the anterior abdominal wall. CT scan revealed both advanced mesothelioma of the pleura and a tumor mass confined to the subcutaneous fatty tissue without penetration through the peritoneum.Results. Video-assisted thoracoscopy confirmed the diagnosis of epithelioid pleural mesothelioma, which was also confirmed by a biopsy of the periumbilical mass. Systemic chemotherapy with cisplatin and pemetrexed was initiated. Under the ongoing systemic chemotherapy, the evaluation revealed partial remission of pleura mesothelioma and its subcutaneous manifestation of the abdominal wall.Conclusion. Mesothelioma of the pleura with a simultaneous metastasis to the subcutaneous fatty tissue of the abdominal wall at presentation without penetration of peritoneum is a rare clinical presentation of mesothelioma disease. The knowledge of its natural history is very limited. This is the first ever clinical documentation of a patient with pleura mesothelioma and simultaneous subcutaneous manifestation of abdominal wall.

Download Full-text

eTep-retromuscular Repair for Ventral Hernia; a Technique Closest to Ideal

Lietuvos chirurgija ◽

10.15388/lietchirur.2020.19.35 ◽

2020 ◽

Vol 19 (3-4) ◽

pp. 151-155

Author(s):

Aleksandar Mitevski ◽

Petar Markov

Keyword(s):

Abdominal Wall ◽

Ventral Hernia ◽

Umbilical Hernia ◽

Anterior Abdominal Wall ◽

Abdominal Cavity ◽

Wound Complications ◽

Suture Repair ◽

Complication Rates ◽

Mesh Placement ◽

Umbilical Hernia Repair

Introduction. Ventral hernia represents a problem for the surgeon and patients alike. eTEP repair is a technique that is minimally invasive, provides lower overall complication rates, decreased wound complications and the recurrence rates and shortens the length of stay in the hospital. Case. We present a case of a 48 year old patient who was admitted to our hospital for elective treatment of recurrent umbilical hernia. The patient had umbilical hernia repair 4 years ago, suture repair without mesh placement was performed according to the information given by the patient. On inspection there is visible supraumbillical scar, 12 cm in length with hernia bulging under the scar which is partially reducible on pressure. Discussion. The eTEP technique is closest to ideal because the abdominal cavity is not penetrated, is lessening the risk of visceral lesions and trocar site hernias, allows local or regional anesthesia, gives unsurpassed views of inguinal region and hernias and reproduces the technique of Rives-Stoppa. In favor to overcome the limitations deriving from the limited surgical field and restricted port set up, this technique has been modified based on the normal anatomy of the abdominal wall naming it dependently of the extension of the dissection and the location of the hernia. Conclusion. The extended-TEP (e-TEP) technique is based on the anatomical principle that the extraperitoneal space can be reached from almost anywhere in the anterior abdominal wall. It provides the most of the benefits for the patients but also requires great surgical skill and understanding of the anatomy of the anterior abdominal wall.

Download Full-text