Laparoscopic Repair of Diastasis Recti: A Case Report and Literature Review

Diastasis recti is a state with separated aponeurosis between two recti caused by weakening of the intercrossing fibers in the linea alba and it causes abdominal protrusion. Common causes comprised of increased intraabdominal pressure, or congenital weakening of myoaponeurotic layer. We describe a patient who underwent laparoscopic repair of diastasis recti. A 30-year-old woman was referred to our outpatient department for an abdominal mass that had appeared 1 year earlier. Physical examination revealed an abdominal wall defect along the midline and computed tomography showed thinning and stretching of the linea alba. The patient underwent laparoscopic repair for diastasis recti. The stretched linea alba was approximated using interrupted sutures from the epigastrium to the suprapubic area. A dual mesh was applied below the peritoneum to prevent recurrence. The patient was discharged without complications, and was followed up for 1 year without recurrence. Laparoscopic repair could be a considerable is a treatment modality for diastasis recti.

Clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti / 中华消化外科杂志

Objective To investigate the clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti.Methods The retrospective cross-sectional study was conducted.The clinical data of 14 patients with postpartum diastasis recti who were admitted to Ruijin Hospital of Shanghai Jiaotong University School of Medicine between June 2016 and June 2018 were collected.Patients underwent laparoscopic-assisted linea alba reconstruction.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,diastasis recti and umbilical hernia recurrence up to September 2018.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (P25,P75).Results (1) Intra-and post-operative situations:14 patients underwent successful laparoscopic-assisted linea alba reconstruction and 8 complicated with umbilical hernia area of (6± 3) cm2 were sutured and closed.The mesh area,operation time,visual analogue score for pain at the first day after operation,time of postoperative drainage-tube removal and duration of postoperative hospital stay were respectively (214±26) cm2,(74 ± 14) minutes,3.7 ± 0.6,(3.3 ± 0.7) days and (4.1 ± 1.2) days.No patient required administration of analgesics and had postoperative complication.(2) Follow-up:14 patients were followed up for 17 months (5 months,21 months).During the follow-up,1 patient returned visit at postoperative day 10 due to surgical incision drainage and cured after dressing change.The other patients had no complications,without diastasis recti and umbilical hernia recurrence.Conclusion Laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti is safe and effective.

Collagen I and III in women with diastasis recti

OBJECTIVES: Interest in elucidating the etiology of hernias has encouraged countless studies of musculoaponeurotic structures in individuals with and without hernias. Studies of hernia patients have firmly demonstrated a correlation between hernias and collagen alterations in their fascia. Diastasis recti is an increased width of the abdominal midline that is exclusively composed of interlacing aponeurotic expansions of the anterolateral abdominal muscles. The condition is common among women undergoing abdominoplasty, and many factors, not only mechanical, play a role. The goal of this study is to evaluate and compare collagen type I and III levels in the midline fascia of women with and without diastasis recti to report their possible influence on this condition. METHODS: This is a case-control study nested within a surgical cohort of 18 women with diastasis recti and 18 women without the condition (cases and controls, respectively). Fascia from the midline of the abdominal wall was collected and analyzed through immunohistochemistry using polyclonal antibodies to collagen type I and III. RESULTS: Both type I and type III collagen were less abundant in women with diastasis recti than in those without the condition, and the difference was statistically significant (p<0.001). CONCLUSION: Low collagen type I and type III levels in the midline of the abdominal wall may play a key role in the development of diastasis recti.

Consideraciones Anatomo-Quirúrgicas del Ligamento Reflejo / Reflected Ligament: Anatomical and Surgical Considerations

La anatomía de la región inguinal está bien descrita y detallada en la literatura, pero existen algunas controversias vinculadas al ligamento reflejo y a su inserción medial. El objetivo fue analizar la inserción del ligamento inguinal reflejo del músculo oblicuo externo en la línea alba, mediante lo observado en disecciones cadavéricas. Se utilizaron 30 cadáveres formolizados, en los que el ligamento reflejo fue disecado hasta su inserción en la línea alba. Se encontró la presencia del ligamento inguinal reflejo en 25 (83,33%) casos, 16 (64%) hombres y 9 (36%) mujeres, de los cuales sólo en 2 (8%) casos se observó la inserción interdigitada del ligamento inguinal reflejo con el contralateral; y en 5 (16,67%) casos (3 mujeres y 2 hombres), se constató ausencia del mencionado ligamento. El ligamento reflejo fue identificado en la mayoría de nuestros ejemplares. Este ligamento contribuye a la formación de la pared posteromedial del anillo inguinal superficial, siendo importante la necesidad de su conocimiento anatómico para su aplicación en la reparación quirúrgica de hernias inguinales con colocación protésica por vía anterior.

Anatomy of the inguinal region is well described in literature, but there is lack of information related to the reflected ligament and a dichotomy regarding its medial insertion. The aim was to carry out an observational analysis, through dissections, of the insertion of the reflected ligament of the external oblique muscle at the linea alba. We used 30 formolized corpses were, on which the reflected ligament was dissected to its insertion into the linea alba. Of the 30 bodies, we found the reflected ligament in 25 (83.33%), being 16 male (64%) and 9 females (36%), but only in 2 of them (8%) its insertion interdigitated with the contralateral. In 5 (16.67%) cases, 3 female (60%) and 2 male (40%), the absence of that ligament was found. The reflected ligament was identified in most of our specimens. Being part of the posterior limit of the superficial inguinal ring, its anatomical knowledge is important for the surgical repair of inguinal hernias with prosthetic placement, using anterior access.

Schistosomus rellexus en un canino: reporte caso / Schistosomus rellexus in a canine: case report

Durante la realización de una cesárea en el Centro de Medicina Veterinaria y Zootecnia de la Universidad CES se encontró un neonato de la raza Bull Terrier con signos de Schistosomus reflexus, una alteración congénita en la formación de la pared abdominal con exposición de las vísceras. El cachorro del presente reporte nació con vida y se realizó la corrección quirúrgica de la agenesia de la pared abdominal, procedimiento que le permitió su supervivencia por una semana más. El artículo describe el caso clínico de este neonato que según lo reporta la literatura, es el segundo caso de Schistosomus reflexus en un canino.

During the execution of a caesarean section in the 'Centro de Medicina Veterinaria y Zootecnia de la Universidad CES' a Bull terrier neonate with signs of Schistosomus reflexus, a congenital abnormality in the formation of the abdominal wall with exposure of the viscera, was found. The puppy of this report was born alive and the surgical correction of the abdominal agenesis was performed, which allowed its survival for a week. This article describes the clinic case of this puppy which, according to available literature, is the second Schistosomus reflexum case observed in a dog.

Case of Abdominal Compartment Syndrome Treated by using a Bedside Open Linea Alba Fasciotomy

Abdominal compartment syndrome (ACS) is a life-threatening disorder caused by rapidly increasing intraabdominal pressure. ACS can result in multiorgan failure and carries a mortality of 60~70%. The treatment of choice in ACS is surgical decompression. There are very few reports of ACS and experience in Korea. We report 12-year-old male patient who developed an abdominal compartment syndrome due to traffic-accident-induced retroperitoneal hematomas, Which was successfully treated by performing a bedside emergency surgical decompression with open linea alba fasciotomy with intact peritoneum. When patients do not respond to medical therapy, a decompressive laparotomy is the last surgical resort. In patients with severe abdominal compartment syndrome, the use of a linea alba fasciotomy is an effective intervention to lower intra-abdominal hypertension (IAH) without the morbidity of a laparotomy. Use of a linea alba fasciotomy as a first-line intervention before committing to full abdominal decompression in patients with abdominal compartment syndrome improves physiological variables without mortality. Consideration for a linea alba fasciotomy as a bridge before full abdominal decompression needs further evaluation in patients with polytrauma abdominal compartment syndrome.

The effect evaluation of cervical strap muscles longitudinal incision and linea alba cervicalis incision in thyroid surgery / 中国医师进修杂志

Objective To evaluate the advantages and disadvantages of cervical strap muscles longitudinal incision and linea alba cervicalis incision in thyroid surgery.Methods The clinical data of 91 patients with thyroid surgery wefe retrospectively analyzed.They were divided into two groups by random digits table,46 patients with cervical stsap muscles longitudinal incision as the observation group,45patients with linea alba cervicalis incision as the control group,the surgery effect of two groups was compared. Results The operative time,blood loss and postoperative complications between the two groups,the differences were not statistically significant(P>0.05).Compared with control group,the exposure evaluation scores in the upper pole[(3.88±0.32)points vs.(2.15±0.22)points],under pole[(3.68±0.46) points vs.(2.18±0.42) points]and lateral side[(3.55±0.47)points vs.(2.18±0.39)points]of thyroid in observation group were significantly better (P<0.01),but the exposure effect scores in thyroid gorge were signilicantly lower [(2.31±0.39) points vs.(3.48±0.52) points](P<0.01),SF-36 score was better [(77.1±7.3) points vs.(66.4±6.8)points](P<0.05).Conclusion The effects of cervical strap muscles longitudinal incision and linea alba cervicalis incision in thyroid surgery are satisfactory,but the exposure effect of two incision are different,thus it is required to choose the applications according to the conditions ofpatients.

Absence of Linea Alba in Breast Reconstruction with Pedicled TRAM Flap: A Case Report

PURPOSE: The anatomical anomaly of the rectus abdominis muscle and it's fascia is very rare. No case of the absence of the linea alba below the umbilicus has yet been reported. During breast reconstruction with pedicled TRAM flap, we experienced one case of absence of linea alba. METHODS: The patient was a 38-years old female who underwent immediate breast reconstruction with pedicled TRAM flap after Right modified radical mastectomy in June 2010. While the TRAM flap was being elevated, bilateral twitching of the rectus abdominis muscle occurred when electrocautery was applied, and we found the absence of the linea alba below the umbilicus. RESULTS: When the rectus abdominis muscle was exposed, the linea alba below the umbilicus was not observed, and the bilateral rectus abdominis muscle was indistinguishably fused in a gross observation. In addition, bilateral twitching of rectus abdominis muscle was simultaneously observed as one muscle unit when electrocautery was applied. As with both rectus abdominis muscles was bluntly dissected with scissors, the scanty fatty tissues were observed between the both rectus muscles, and the bilateral rectus abdominis muscle was easily separated. The flap was transposed into the corresponding defect to make breast mound. Midline fascia was fixed to the posterior rectus sheath to reconstruct smilar anatomic linea alba. Abdominal defect was reinforced by suturing between remaining anterior rectus sheath. CONCLUSION: As the unexpected anatomical anomaly may affect the operation outcome, surgeons should be careful when they unexpectedly encounter the anatomical anomaly during an operation. Here, we report a rare case of absence of the linea alba seen at the time of pedicled TRAM flap elevation for breast reconstruction.

Avaliação do efeito do extrato hidroalcoólico de Schinus terebinthifolius Raddi (Aroeira) no processo de cicatrização da linea alba de ratos / Evaluation of the hydro-alcoholic Schinus terebinthifolius Raddi (Aroeira) extract in the healing process of the alba linea in rats

OBJETIVO: Avaliar o processo de cicatrização da parede abdominal de ratos após a injeção intraperitoneal do extrato hidroalcóolico de Schinus terebinthifolius Raddi. MÉTODOS: Utilizaram-se 40 ratos da linhagem Wistar, distribuídos em dois grupos de 20 animais, cada um subdividido em dois subgrupos. Estes ratos foram mortos no 3º e 7º dias após a aplicação intraperitoneal do extrato. No grupo experimento, injetou-se uma única dose de extrato hidroalcoólico de Aroeira (100 mg por quilo de peso do animal) e no grupo controle uma única dose de solução salina isotônica a 0.9%. Após a morte dos animais, realizou-se o inventário da cavidade peritoneal à procura de aderências, seguido da ressecção da parede abdominal anterior englobando a ferida operatória para análise. As aderências foram classificadas pelos critérios de adesão de Nair. Realizou-se avaliação tensiométrica da parede abdominal através da medida da carga máxima suportada e da deformação máxima, medidos em máquina universal de ensaios do tipo Tiratest. Por fim, a avaliação histológica foi realizada através da coloração hematoxilina-eosina, com análise dos parâmetros: inflamação aguda, inflamação crônica, necrose isquêmica, reação gigantocelular do tipo corpo estranho, proliferação fibroblástica, fibrose, reepitelização e coaptação das bordas da sutura. RESULTADOS: A avaliacão macroscópica não revelou presença de aderências significativas entre a linha alba e as vísceras intra-abdominais nos grupos de estudo. A tensiometria demonstrou aumento significativo das variáveis carga máxima e deformação máxima (p=0,006 e p=0,000 respectivamente) entre os grupos controle e experimento de sete dias. A avaliação histológica intergrupos (controle e experimento) de três e sete dias não demonstrou alteração significativa para os parâmetros neoformação vascular, necrose, fibrose, reepitelização e coaptação das bordas da sutura. Notou-se diferença...

PURPOSE: To evaluate the healing process in the abdominal wall of rats after the intra-peritoneal injection of the hydro-alcoholic Schinus terebinthifolius Raddi extract. METHODS: Forty Wistar rats were used, distributed in two groups of 20 animals, divided into two subgroups, according to the death day, three or seven, after the intra-peritoneal injection of the extract. The experimental group was injected with only one dose of the hydro-alcoholic Aroeira extract (100mg per animal kilogram); the control group was injected with only one dose of isotonic saline solution at 0.9%. After the animal death, an inventory of the peritoneal cavity was carried out in a careful search for any adhesion, followed by the resection of the anterior abdominal wall encompassing the operating incision in order to examine it for evidence of infection. The adhesions were classified according to the Nair criteria. The tensiometric assessment was performed by means of the measurement of the maximum charge and maximum deformity tolerated, measured in a universal Tiratest type testing machine and, finally, the histological evaluation was performed by means of the hematoxylin-eosine staining in following parameters: severe inflammation, chronic inflammation, ischemic necrosis, gigantocellular reaction of the foreign body type, fibroblastic proliferation, fibrosis, re-epithelization and co-optation of the suture borders. RESULTS: The macroscopic evaluation didn't have any evidence of significant adherence between the alba linea and the intra-abdominal viscera in the study groups. The tensiometry showed significant effect for the Maximum Charge and Maximum Deformity (p=0.006 and p=0.000, respectively) between the 7-day control and experimental groups. The histological 3-day and 7–day control and experimental intergroup evaluation did not show significant alteration for the parameters vascular neoformation, necrosis, fibrosis, re-epithelization and co-aptation. A significant dif...

Análise da cicatrização na Linha Alba com uso de extrato aquoso de Orbignya phalerata (babaçu). Estudo controlado em ratos / Analysis of healing in the Alba Linea with the use of Orbignya phalerata (babassu) water extract. Controlled study in rats

INTRODUÇÃO: O mesocarpo do babaçu (Orbignya phalerata) tem sido utilizado em estudos experimentais para verificar a sua ação antiinflamatória. No Maranhão, é muito utilizado como alimento e como remédio popular para cicatrização de ferimentos. OBJETIVO: Avaliar macroscópica, histológica e tensiometricamente, a ação do extrato de Orbygnia phalerata no processo de cicatrização de laparotomias medianas em ratos. MÉTODOS: Quarenta ratos da linhagem Wistar, adultos, machos, foram utilizados em procedimento experimental que consistiu em uma incisão na linha alba e síntese em plano único com pontos separados de fio de polipropileno 5-0. Após esse procedimento comum, os animais foram distribuídos em dois grupos de 20. Ao grupo chamado controle, foi utilizado injeção intraperitoneal, em dose única de 1mL de soro fisiológico para cada quilo de peso. Ao grupo experimento, utilizou-se solução aquosa de babaçu na dose de 50 mg por quilo de peso. Os animais foram acompanhados e mortos após três e sete dias, procedendo-se, a seguir, à análise tensiométrica e histológica. RESULTADOS: O exame macroscópico não mostrou presença de aderências importantes entre a linha alba e os órgãos intra-abdominais nos grupos de estudo. A avaliação histológica mostrou efeito marginalmente significativo (p=0,086) para inflamação aguda nos grupos controle e experimento de três dias e efeito significativo (p=0,003) para a reação gigantocelular (p=0,003). Diferença significativa (p-=0,023) foi observada para inflamação aguda no grupos controle experimento de sete dias. Na análise intra-grupo (controle três e sete), foi observado efeito marginalmente significativo (p=0,094 e p=0,05) respectivamente para as variáveis inflamação aguda e crônica. Na análise somente entre os grupos experimentos, as variáveis reação gigantocelular (0,002) e colagenização (0,016) apresentaram resultado significativo. A avaliação tensiométrica mostrou diferença significativa em relação ao grupo experimento de sete...

INTRODUCTION: The babassu mesocarp (Orbignya phalerata) has been used in experimental research studies focused on its antiinflammatory action. In state of Maranhão - Brazil it is widely used not only as food, but also as popular medicine in wound healing process. PURPOSE: To evaluate the action of Orbignya phalerata extract in macroscopic, histologicic and tensiometric aspects in the healing process of median laparotomy in rats. METHODS: Forty male adult Wistar rats were submitted to an incision in the alba linea, sutured back in one plan with separated stitches of polypropilene 5-0. After regular procedure, the animals were divided into two groups of 20 rats each. To the group named control an intraperitoneal, dose of 1,0 ml of saline solution per kilogram of body weight was done. To the experimental group, the same thing was also done, but instead of saline solution it was injected water solution of babassu, in a dose of 50 mg/kg. The animals were observed in the following days. All of them were killed within a three and seven day post-operative period schedule, and then a histological and tensiometric analysis was carried out. RESULTS: On macroscopic examination no relevant adherence, between the alba linea and the abdominal organs in the study groups, was found. Histological evaluation presented marginal significant effects (p=0,86) to acute inflammation and significant effects (p=0,003) to giant cell reaction in both control and experimental three days groups. Significant difference was observed to acute inflammation in both seven days control and experimental groups. In the intragroup analysis (control three and seven) some marginal significant effect was in relationship to acute and chronic inflammation. In the interexperimental groups analysis, only the giant cell reactions (0,002) and colagenization had significant results. The tensiometric evaluation showed in the seven day experimental group more resistence then others...