A Comparative Study of Low Versus Standard Intraperitoneal Pressures in Gynaecological Laparoscopic Surgery

Background: Minimal access surgery in contrast to open surgery has quicker recovery during the postoperative period as well as reduced scores of pain. As a result of increased pressure in the abdominal cavity, laparoscopic surgery has many implications over a range of organ systems as well as their functioning. Laparoscopic surgery due to increased intraabdominal pressure also has many implications on various organ systems and their functioning. To overcome the consequences of increased intrabdominal pressure, a number of trials have been formulated to compare low- versus standard-pressure pneumoperitoneum. Aim: The aim of this study was to assess the effectivity of low intraperitoneal pressures v/s standard intraperitoneal pressure during laparoscopic hysterectomies. Study Design: Experimental study Materials and Methods: 40 cases with uncomplicated symptomatic benign uterine pathologies who were posted for laparoscopic hysterectomy were selected out of which 20-20 cases were randomized into low and standard pneumoperitoneum groups. Results: In patients in whom low pressure pneumoperitoneum is employed are better recovered in terms of pain than standard pressure pneumoperitoneum. This means hospital stay can be shortened in low pressure pneumoperitoneum groups which will be more economical and comfortable for patients. Conclusion: Laparoscopic hysterectomy can be done at 10 mmhg with the benefits of : Optimum visualization with low pressure Reduction in post operative pain helping the patient for early ambulation so that patient will get back to routine work and normal life earlier, it is the main purpose of minimal invasive surgery.

Non-ICU-Based Staged Management of Laparotomy-Related Abdominal Compartment Syndrome in a 23-Year-Old Male

Introduction: Abdominal compartment syndrome (ACS) is a sustained intraabdominal pressure (IAP) of 20 mmHg or higher with new organ dysfunction. Decompression is required when IAP exceeds 25 mmHg even without evidence of organ dysfunction. Common abdominal surgical diseases and operations can be complicated by ACS, and clinicians should have the requisite capacity to detect and intervene early enough. Intensive care unit (ICU) care has traditionally been the mainstay of ACS management. Case Presentation: A 23-year-old male was referred with a combined mesh and Bogota bag anterior abdominal construct after a midline laparotomy 24 hours earlier, following which the abdominal wall could not be closed primarily without tension. This was the result of significant edema of the bowel and retroperitoneum. This patient, after adequate resuscitation, underwent a two-staged procedure, 6 days apart, to achieve skin closure. After an unremarkable skin healing, a mesh repair for the consequent incisional hernia was carried out 15 months later. Conclusions: This patient’s ACS was successfully managed in a non-ICU setting and could demonstrate the possibility of successfully managing selected cases of laparotomy-related ACS in low-resource settings without ICU facilities.

Gestational Potential Space Hypothesis: Evolutionary Explanation of Human Females Body Fat Redistribution

Homo sapiens, as well as other primates, developed the evolutionary advantage of storing excess energy as body fat, primarily in the readily accessible visceral fat compartment when food is plentiful for use during scarcity. However, uniquely to female humans, a second transient dimorphic phenotypic change begins at menarche and is reversed by menopause. It is the diversion of visceral fat stores from the abdominal cavity to the gluteofemoral region. The evolutionary purpose for this remains unclear. The author proposes the gestational potential space (GPS) hypothesis: that such fat diversion is for the reproductive purpose of increasing the potential abdominal space available for gestation and reducing the intraabdominal pressure. This hypothesis is supported by the basic laws of physics and increased rates of maternal and fetal complications experienced by those with visceral adiposity. It is important that the GPS hypothesis and alternative hypotheses are tested by comparing the health (particularly reproductive) outcomes of women with varying fat distributions and their offspring. Lay summary The author proposes that fat shifting from the abdominal cavity to the hips and thighs in women, during the childbearing period, is for beneficial for reducing the intraabdominal contents consequently increasing pregnancy potential space. Secondarily, it prevents intraabdominal pressure elevation and reduces maternal and fetal complications associated with visceral fat in pregnancy.

General views on treatment technologies for patients with incisional ventral hernia

Nowadays, the problem of surgical treatment of incisional ventral hernia (IVH) still remains significant. According to the statistical data, the number of patients with postoperative ventral hernias has increased by more than 9 times over the past 25 years. Experts offer many solutions to this problem every year and the surgeon have to find the best method of postoperative rehabilitation in the flow of information. Academic research databases Google Scholar, CyberLeninka and others were used to search for the relevant literature. The following conclusions were drawn from this review. The etiology of IVH is multifactorial. There is no generally accepted evidence-based gradation of risk factors. There is no unified system for selecting the method of hernia repair of the anterior abdominal wall in patients with IVH. The choice of allotransplant material and the method of hernia repair are often individual. The value of the critical level of intraabdominal pressure have not been specified, however, all authors agree that its monitoring should become routine. The sublay technique remains the "gold standard" of plastic surgery by aponeurotic flap, inlay should be used when sublay is impossible to perform. Onlay should be used as a reserve method. In some situations, combinations of techniques are required. More and more laparoscopy is being introduced in the treatment of IVH as an assistance and in therapy. The introduction of new methods of hernia repair based on the uncontrolled separation of the anatomical structures of the abdominal wall imposes special requirements on surgical technology: plastic material, instrumental and technical support, wound closure and pharmacological support, especially in conditions of increased intra-abdominal pressure and tissue tension. We can use medication of pyrimidine’s row (xymedon) for a better implantation of the mesh implant and to increase the resistance of local tissues.

Stoma location and Parastomal Hernia. A Virtual Simulation Approach.

An ostomy is a surgical procedure by which an artificial opening in the abdominal wall, known as a stoma, is created. We assessthe effects of stoma location on the abdominal wall mechanics. We perform three–dimensional finite element simulations on ananatomy model which was generated on the basis of medical images. Our simulation methodology is entirely based on opensource software. We consider seventeen different locations for the stoma incision (trephine) and we simulate the mechanicalresponse of the abdominal wall when an intraabdominal pressure as high as 20 kPa is applied. We focus on factors relatedto the risk of parastomal hernia development such as the deformation experienced by the abdominal wall, the stress levelssupported by its tissues and the corresponding level of trephine enlargement.No significant dependence was found between stoma location and the levels of abdominal wall deformations or stress supportedby tissues, except for the case with a stoma located on the linea alba. Trephine perimeter and area respectively increased byas much as 44% and 85%. The level of trephine deformation depends on stoma location with considerably higher trephineenlargements found in stomas laterally located with respect to the rectus abdominis muscle.

Laparoscopic cholecystectomy in patients with liver cirrhosis: review of intraoperative measures and recommendations

Symptomatic biliary stones are related with higher morbidity and mortality rates in patients with liver cirrhosis, especially when patients undergo surgery. The difficulty of cholecystectomy is worsened by liver cirrhosis, especially in patients with extensive liver fibrosis and portal hypertension.Laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis. However, it can be challenging in many aspects and poses a greater degree of difficulty and thus should be performed by experienced surgical teams, who follow the recommendations and take in mined the special precautions which requested to increase safety of the operation and avoid or reduce the morbidity and mortality , and also who able to tackle the more frequent intraoperative incidents or complications.In this review, we focus on of the technical difficulties and intraoperative recommendations that could be used to approach laparoscopic cholecystectomy in this patient population (trocar placement, intraabdominal pressure, visualization, gallbladder dissection, adjunct for hemostasis, intraperitoneal drains, and conversion to open surgery), and the alternative which can be used in advanced cases

Clinical Evaluation of Abdominal Wall Hernias

Hernia is defined as protrusion of a viscus or part of a viscus through a weakening or defect in the wall of its containing cavity. Areas of potential anatomical weakness includes inguinal canal, femoral canal, linea alba, umbilical scar, as well as acquired surgical trauma. The weakening/defect may be acquired (like surgical scar) or congenital (like deep inguinal ring). Raised intraabdominal pressure is the most important factor that leads to the development of hernia through the weak areas. Clinically, the hernia usually presents with an abdominal swelling that progresses gradually over time. The sites of hernia are characteristic and usually points towards the diagnosis. While evaluating a hernia clinically, it is important to identify the content of the hernia sac and whether it suffers any complication, as well as the cause of the hernia development. Failing to identify these prior to surgery, will likely result in morbidity as well as recurrence. This chapter will focus on the clinical art of history taking and examination of different abdominal hernias.