A recent study performed by Martínez-Serrano et al. prospectively analyzed morbidity and mortality rates fol- lowing emergency hernia repair . The study popula- tion included 244 patients with complicated abdominalwallhernias requiring surgical repair. In this study, the patients were treated according to standardized proto- cols with detailed actions to be taken during the pre-, intra-, and post-operative periods. Clinical outcomes were compared retroactively to that of 402 patients who had undergone similar procedures before the develop- ment and implementation of the protocols outlined in the study. Results showed higher rates of mortality in patients with acute complication as their first hernia- related symptom and whose treatment was delayed for more than 24 hours. Thus, the authors concluded that early detection of complicated abdominalhernias may be the best means of reducing the rate of mortality .
In 2007, Derici et al. published a retrospective study using univariate and multivariate analyses to investigate factors affecting morbidity and mortality rates in cases of incarcerated abdominalwallhernias . Using the univariate analysis, results showed that symptomatic pe- riods lasting longer than 8 h, the presence of comorbid disease, high American Society of Anesthesiologists (ASA) scores, the use of general anaesthesia, the pres- ence of strangulation, and the presence of necrosis sig- nificantly affect morbidity rates. In contrast, advanced age, the presence of comorbid diseases, high ASA scores, the presence of strangulation, the presence of necrosis, and hernia repair with graft were found to significantly affect mortality rates by univariate analysis; the presence of necrosis, however, was the only factor that appeared to significantly affect mortality rates based on multivari- ate analysis .
found that the biomechanical characteristics of the linea alba are not governed by the number of aponeurotic crossings but by the thickness and density of the fibers, and that the weak type of linea alba aponeurosis may be a predisposing factor for the development of a hernia . About 20% of epigastric hernias are multiple and about 80% are located just off the midline. Fascial defects vary in size from only millimeters to several centimeters. Most epigastric hernias, however, are small and are made up of preperitoneal fat only with no peritoneal sac; these are especially prone to incarceration and strangulation. Frequently, the preperitoneal fat herniating through this small defect grows over time and becomes chronically incarcerated. Larger hernias with a peritoneal sac mostly contain omentum, but also contain any upper intraperitoneal organ such as small bowel, colon, or stomach; these hernias seldom incarcerate or strangulate.
Abstract: Background: Abdominalwall invasion and implantation (AWII) of colorectal cancer leads to complex com- plications and poor prognosis, which has a low efficacious treatment. We present our surgical strategies, which led to a relatively good outcome. Methods: Nineteen cases between February 2006 and July 2018 in our department were enrolled. Operations were divided into extensive resection and palliative resection, which was to eradicate the tumor and to mitigate tumor complications, respectively. The surgical strategies present included reasonable pa- tient enrollment, precise classification of abdominalwall defect and appropriate repair technique for abdominalwall reconstructions. Results: Surgical treatments for AWII of colorectal cancer in our study proved as good methods to mitigate tumor complications and eradicate tumors. The immediate abdominalwall reconstructions were success- ful in all cases using the reinforcement repair technique (14 cases) and the double patch bridging repair technique (5 cases). Patients with type II abdominalwall defects after tumor resection had shorter operation times, shorter hospital stays and fewer postoperative complications than those with type III abdominalwall defects. The follow-up period ranged from 1 to 40 months. Only two patients developed abdominalwallhernias caused by tumor recur- rence. Patients who had undergone extensive resection had a better long term survival time after surgery. Conclu- sion: Appropriate surgical treatment could be a good choice to prolong survival time and improve the quality of life for patients with AWII of colorectal cancer.
Abdominalwallhernias were repaired with the direct suture repair surgical technique when the defect did not exceed 3 cm or in cases of a contaminated/dirty surgical field; otherwise, the mesh-repair technique was adopted with sublay retromuscular positioning of a polyester mesh fixed at the posterior fascia of the rectus abdominis muscle with non-reabsorbable sutures. Indirect inguinal hernias were repaired with the plug- and mesh-mediated technique using a polypropylene plug fixed in the internal inguinal ring at the conjoint tendon and Cooper ligament; the polypropylene mesh was then positioned under the aponeurosis of the external oblique muscle (Trabucco
The wait and see strategy is a rational treatment option in case of desmoid tumors in pregnancy. Depending on the risk factors age, tumor size, and location, the diﬀerent treatment approaches should be considered after successful delivery. The postpartum drop of estrogen level could lead to a tumor regression, which could avoid a mutilating surgery. Regular controls with ultrasound or MRI should show a progression or recurrence of a desmoid tumor before the appearance of symptoms. The surgical intervention has to be the first choice in desmoids close to vitally important organs or very large tumors compressing the uterus. The adjuvant approach with radiation, hormonal therapy, and chemotherapy should be considered individually. A targeted therapy with tyrosin kinase inhibition can be a further treatment option. In case of a tumor of the lower abdominalwall in female patients, the desmoid can be confound with endometriosis. Ultrasound and a fine-needle aspiration cytology can help to find the presurgical diagnosis and to avoid surprising results.
After the resection of abdominal desmoid tumor, the problem is reconstruction of the abdominalwall defect. Regarding the method of reconstruction of the abdominalwall, besides performing primary closure or using arti ﬁ cial materials such as mesh, reconstruction via transplantation of ﬂ ap or autologous fascia is selected. The materials used for fascia include anterior layer of rectus sheath, aponeuro- sis of external oblique muscle, and fascia lata patch. The fascia lata patch is generally preferred because we can easily get resilient and large fascia. 8 Yamamoto studied cases using fascia lata patch as an onlay mesh to reinforce fascial closure when they overlapped with the defect in the anterior rectus fascia. They found no evidence of recur- rence in the median follow-up time of 16.1 months. 9 Stecco et al described that the fascia lata could be used alone as a mesh and that it is more easily integrated into the new site than an arti ﬁ cial mesh. 10 Hamilton microsco- pically observed a piece of a patient ’ s fascia lata patch that was removed 2 years after insertion. They con ﬁ rmed the presence of dense wavy layers of collagen and numerous
Another promising technique is the Rives-stoppa procedure developed for the repair of incisional hernias. Prosthetic material is used to close the defect in a so called sublay technique. The prosthesis is placed between the rectus abdominis muscle and posterior sheath. Above the umbilicus, dissection is performed above the posterior rectus fascia and underneath the rectus muscle. Below the umbilicus, the lack of a posterior rectus fascia necessitates dissection in the preperitoneal space. A large piece of polypropylene mesh is placed in the space created, and fixed to muscle layer above with full or partial thickness suture. The recurrence rate with this repair have been stated to be less than 10%.
The pore pressure distribution during one cardiac cycle can be seen in Figure 4. It should be emphasized that the local pore pressure does not depend only on the dis- tance from lumen but on the local geometry of AAA as well. (See neck areas in Figure 4). Finally, it is emphasized that the tensile stress in the wall during the systolic phase of the cardiac cycle is significantly reduced by the presence of the ILT, in com- parison with the simulation neglecting the ILT as shown in Table 2. Table 2 shows that neither the material model of the ILT nor the prescribed BC affect resulting stresses. On the other hand, considering the ILT reduces stresses (PWS, maximum principal stress, local von Mises) significantly. The reduction is from 45% for AAA60 up to more than 60% for AAA80.
Blunt trauma to the lateral abdominalwall leading to a rapidly expanding haematoma is an uncommon but well-described phenomenon. The potential foci of bleeding include any vessels that supply the lateral abdominalwall, such as the deep circumflex iliac artery, the deep inferior epigastric artery, the deep superior epigastric artery, the lower two to four posterior intercostal arteries and the lumbar arteries  .
Metastases in the thyroid gland are very rare. Even the rarer are sarcoma metastases. A 52-year-old woman was referred to our department for evaluation of a nodule in the right lobe of the thyroid gland. She had a history dermatosarcoma of the abdominalwall with known metastasis in the lung. Clinically she had neck pain and worsened swallowing. Objective assessment (ultrasound, computed tomography, and magnetic resonance) indicated a voluminous right lobe nodule with mechanical syndrome, and a fine-needle aspiration biopsy revealed a very suspicious malignant finding. After surgery, the diagnosis was metastasis of dermatofibrosarcoma protuberans. Subsequent treatment was radio- and chemotherapy.
histochemical findings were diagnostic for Dermatofibrosarcoma protuberans (DFSP) over the anterior abdominalwall. The patient was having a history of resection of similar growth from the same site, which shows the recurrence of the DFSP and managed by resection. She had an uneventful post operative period and is still being followed up in the outpatient clinic for local recurrence (Figure 4).
Our finding that midline incisions are the most frequently applied access in open abdominal surgery is in accordance with previous reports . While the abdominal access may to some degree depend on the target organ it was our aim to assess the overall frequency of midline incisions that would support the rationale of the INSECT-Trial. However, it appears valuable to perform further studies to evaluate the relative frequency of midline and transverse incisions in well-defined patient populations. The urgency of the intervention (i.e. elective vs. emergency laparotomy) as well as the target organ are critical factors to be considered for determination of the population under study. A recent Cochrane review indicated that transverse incisions are potentially less painful and less frequently associated with pulmonary complications, but failed to show a clear advantage for a reduction of inci- sional hernias  when compared to midline incisions. Further data analyzing the patient's perspective (i.e. post- operative pain) in a blinded randomized fashion are needed for evidence-based surgical decision making. Cur- rently, both incision types may be used in daily practice of elective surgery depending on the surgeons preference. The lack of consensus for abdominalwall closure strate- gies after midline incisions demonstrates persistent uncer- tainty within the surgical community. Several RCTs [4-8] and meta-analyses [9-12] were published comparing dif- ferent closure methods of midline abdominal incisions. In a critical appraisal of meta-analyses in the surgical liter- ature  two of these meta-analyses have been found to
Long-term results of surgical treatment were studied in all patients of the research groups in 1 year after surgery by repeated examinations. Recurrences of postoperative ventral hernias were found in 3 (16.7%) patients of the comparison group who were undergone the traditional method of allohernioplasty. There were no primary patients with postoperative recurrence of ventral hernia who were undergone surgical treatment according to the developed method of alloheneic plastic (p = 0.04). Patients with postoperative recurrence of ventral hernia were re-operated according to the developed method of open allohernioplasty with supramuscular arrangement of the mesh implant. 1 (5.6%) patient of the comparison group on the 47 th day after traditional allogeneic plasticity had an intestinal obstruction, which was caused by the formation of multiple adhesions between the conglomerate of the small intestine and the area of the anterior abdominalwall, where alloheronioplasty was performed. Thus, significantly better results of surgical treatment of postoperative ventral hernias after multi-stage surgical treatment of open gunshot wounds of the abdomen are observed in patients of the main group.
N is the number of harmonics used to reproduce the in vivo measurements of luminal velocity (N = 18), u(t), and pressure (N = 7), p(t), respectively. These waveforms are triphasic pulses appropriate for normal hemodynamics conditions in the infrarenal segment of the human abdominal aorta first reported by Mills et al . The use of an input transient velocity based on normal physiology is justified by the fact that the inlet boundary condition is applied above the proximal neck of the aneurysm, an undilated segment of the abdominal aorta. For average resting conditions, blood flow in the abdominal aorta is generally laminar [20,21]; flow deceleration achieved after peak systole induces laminar disturbed flow condi- tions and vortex formation even under simulated exercise conditions [22-24]. Inlet peak systolic flow occurs at t = 0.304 seconds and outlet peak pressure at t = 0.4 seconds. The time-average Reynolds number is Re m = 410, which is characteristic of a patient in resting conditions . Re m is calculated as , where is the time-aver- aged, mean inlet velocity and d is the inlet diameter. The Womersley number, , characterizes the flow frequency ω ( ω = 2 π /T and T = 1.0 seconds), the geometry and the fluid viscous properties, and is α = 13.1, a typical value for the human abdominal aorta under rest-
physicians before she consulted me. There was no loss of weight, no vomiting, normal appetite, normal bowel motion and no significant urinary or gynecological problems. On examination, the abdomen was soft, not distended and there was a palpable mass about 7 cm in diameter felt at the right upper quadrant just above the umbilicus, it was mobile slightly transversely but fixed longitudinally with no other significant finding. Her past medical history was uneventful apart from one caesarian section done 6 years ago and one diagnostic laparoscopy 4 years ago for secondary infertility after her last pregnancy (which was negative and inconclusive because of inadequate visualization and abdominal adhesions). The routine biochemical tests, beta human chorionic gonadotropin (β-HCG) and carcinoma antigen (CA-125) were within normal ranges. Ultrasonography revealed a well-defined rounded mass located in the right upper abdomen just below the rectus abdominis muscle, it was non-homogenous, partly cystic with thin wall and internal echogenic content inside and show no vascularity in color Doppler ultrasound. Abdominal CT scan revealed localized tumefaction about 6 by 5 cm above the umbilicus and just to the right of the midline (Figure 1) so surgical treatment was recommended. Operative intervention was done through upper right Para median incision just near the mass, on exploring the peritoneal cavity, there was a dense mass attached to the posterior surface of anterior abdominalwall, attached to rectus muscle just under the scar of a previous laparoscopic port site, with adhesion to the omentum, small bowel and transverse colon. Sharp dissection and separation of adhesion done carefully without injury to small bowel or colon then complete excision of the mass with safety margin done and sent for histopathological examination (Figure 2), the abdomen closed in layers. Serum test for mycobacterial organism was negative. The postoperative period was uneventful and she was discharged the day after surgery. The result of histopathology was confirmative of endometriosis, it revealed hyperplastic
Initially, we used synthetic mesh in 6 patients but more recently, we have chosen to use biologic graft mate- rials in Grade III and Grade IV hernias due to recommen- dations made by the VHWG. Biologic mesh materials have been introduced to the market in an attempt to minimize the complications associated with synthetic materials. Examples of biologic surgical meshes include Peri-Guard® (Synovis), Permacol® (Covidien), AlloDerm® and Strattice® (Life Cell), and Biodesign® (Cook). Peri- Guard, Permacol, Strattice and Biodesign products are manufactured from collagen obtained from animal tissues, while AlloDerm is derived from human dermal tissue. The Peri-Guard and Permacol products have been cross-linked using chemical methods to minimize immunogenicity and to make them more resilient in the face of contamination. The Biodesign, Strattice and AlloDerm surgical mesh products are not cross-linked and are often associated with remodelling of new tissues.
Endometriosis was first described by an Austrian path- ologist, Karl Freiherr von Rokitansky in 1860 who re- ferred to the disease as adenomyoma . Endometriosis is a rare condition in which ectopic endometrial tissue grows outside the uterine cavity and responds to hormo- nal stimuli . Although its prevalence in adult women is not completely known, it is said to occur in 5% – 10% . Although it is more common in pelvic regions such as the ovaries, posterior cul-de-sac, ligaments of the uterus, pelvic peritoneum, and rectovaginal septum , it can also be extrapelvic. The extrapelvic occurrence of endometriosis is rare and it occurs more commonly in abdominalwall followed by umbilicus, vulva, appendix, ileum, hernia sac, and colon . It is known to develop spontaneously  and is usually found near or at the site of scars of surgeries like hysterectomies, caesarean sec- tions, laparoscopies, tubal ligations, and episiotomies [4,7]. These sites propose the “iatrogenic direct implantation
On February 27, 2017, the patient underwent abdominal mass resection with local anesthesia in a local hospital. Gross examination of the mass showed that a piece of skin tissue had eroded on the skin surface, and the mass was under the incision surface of the skin with a size of 2.8 × 2.5 × 1.5 cm; the mass was gray and hard, and the boundary was unclear. Observations by microscopy were as follows: in the subcutaneous tissue, the tumor cells had large nuclei with dark staining; the chromatin was thick, and the nucleoli were obvious; pathological mitosis was shown with less cytoplasm; the tumor cells were arranged in lumps, nests, and glandular tubules in small amounts with necrosis in small amounts (Figure 1). Invasive growth of the tumor tissue was observed, and its boundary was unclear; the infiltration reached the subcutaneous fibrous connec- tive tissue and the superficial skin (Figure 2), invading the vessels and nerves. The pathological diagnosis was grade II infiltrating ductal carcinoma derived from the accessory mammary gland (abdominalwall) with neuroendocrine
A 55-year-old Japanese man presented to our hospital with a complaint of right lower abdominal pain. His medical and family histories were unremarkable. He worked in a factory. He occasionally consumed alcohol and smoked cigarettes. He denied having eaten fish during the previous few days. Three days prior to visit- ing the hospital, he noticed redness of the skin and pain involving his right lower abdomen. A physical examin- ation revealed tenderness, swelling, and redness at the right iliac fossa; however, he was afebrile (36.5 °C). His blood pressure and pulse were 122/80 mmHg and 85 beats per minute (bpm), respectively. A laboratory exam- ination revealed an increased white blood cell (WBC) count of 10.4 × 10 3 cells/μL and C-reactive protein (CRP) level of 10.19 mg/dL. Except for this finding, laboratory testing revealed no abnormal values. Com- puted tomography (CT) showed a 42 × 22 mm low- density area with rim enhancement in his right internal oblique muscle (Fig. 1a), and a 20 mm-long hyperdense, sharply pointed object in the wall of his cecum adjacent to the low-density area (Fig. 1b). Although he was un- aware of having ingested a sharply pointed object such as a fish bone, we suspected that the object was a fish bone because of the shape. Thus, the findings were diag- nosed as abdominalwall abscess due to a foreign body piercing the cecum. The abscess was aspirated, but did not return fluid. A blood culture had no growth.