Gastrosquisis / Gastroschisis

Introducción: La gastrosquisis es un defecto de la pared abdominal anterior, paraumbilical, habitualmente a la derecha con la protrusión de vísceras intraabdominales, las que flotan libremente en el líquido amniótico durante la vida intrauterina, solo recubiertas por su peritoneo visceral. Objetivo: Analizar la entidad a propósito de un caso portador de gastrosquisis compleja. . Caso clínico: Se describe una neonato de 4 días remitido al servicio de urgencias del Hospital Provincial de Cabinda, República de Angola, por presentar deshidratación severa y "evisceración". La paciente fallece 36 horas posteriores al ingreso. Conclusiones: Los neonatos con esta enfermedad se presentan como una emergencia quirúrgica que plantean un reto difícil para el cirujano tratante. Tiene una alta mortalidad aun con el tratamiento apropiado. Técnicas novedosas de tratamiento se acercan a las tasas de sobrevida esperadas para esta entidad(AU)

Introduction: Gastroschisis is a defect of the paraumbilical anterior abdominal wall, usually on the right with protrusion of intraabdominal viscera, which float freely in the amniotic fluid during intrauterine life, only covered by its visceral peritoneum. Objective: To analyze the entity apropos a case of complex gastroschisis. Clinical case: The case is described od a four-day-old neonate referred to the emergency service at Provincial Hospital of Cabinda, Republic of Angola, for presenting severe dehydration and "evisceration." The patient died 36 hours after admission. Conclusions: Neonates with this disease are presented as a surgical emergency that poses a difficult challenge for the treating surgeon. It has a high mortality even with the appropriate treatment. Novel treatment techniques are close to the expected survival rates for this entity(AU)

A Randomized Control Trial Comparing the Efficacy of Polydiaxanone II and Polypropylene Suture Material for Midline Vertical Abdominal Incision Using Interrupted X Sutures in Prevention of Burst Abdomen

Background: Abdominal wound dehiscence is a commoncomplication of emergency laparotomy. Its prevention inimportant to reduce postoperative morbidity and mortality. Theaim of this study to compare the incidence and risk of burstabdomen, wound infection and sinus formation withPolydiaxanone (PDS II) versus Polypropylene (PPL) in midlinelaparotomy wounds.Materials and Methods: 60 patients undergoing laparotomythrough a midline vertical incision were randomized afterinformed consent, to either a Polydiaxanone (PDS II) versusPolypropylene (PPL) suture material. The incidence andrelative risk (RR) of burst abdomen, wound infection and sinusformation using Polypropylene (PPL) group as the referencecategory were calculated.Results: There was 1 burst abdomen (out of 30 cases, 3.3%)in Polypropylene (PPL) group and none (out of 30) inPolydiaxanone (PDS II). The RR of burst could not becalculated because of 0 in one arm. The incidence of woundinfection was 16.6% in Polypropylene (PPL) (5 out of 30 cases)compared to 10% (3 out of 30 cases) in Polydiaxanone (PDSII). The relative risk (RR) of wound infection was 0.60. Theincidence of suture sinus was 10% (3 out of 30 cases) inPolypropylene (PPL) as compared to 3.3% in Polydiaxanone(PDSII) group.Conclusion: The risk of burst abdomen, wound infection &suture sinuses is less with the use of Polydiaxanone (PDS II).

Temporary Abdominal Closure after Surgical Repair of the Iliac Artery Rupture due to Vascular Type Ehlers-Danlos Syndrome / 日本心臓血管外科学会雑誌

A 39-year-old man was found to have left iliac artery rupture, and was transferred to our department. Emergency surgical repair was done, however, his intra- and postoperative condition precluded primary abdominal closure. On the 8th postoperative day, temporary abdominal closure (TAC) was performed using Composix Mesh TM and negative pressure wound therapy (NPWT). On the 19th day after the first surgery, an emergency reoperation was needed because of the rupture of the common hepatic artery aneurysm, of which there was no finding on admission. After the reoperation of the hepatic artery aneurysm, TAC was again performed using new Composix Mesh. On the 43rd day after the first surgery, the abdominal wall reconstruction without Composix Mesh was done using components separation and the anterior rectus abdominis sheath turnover flap method. On the 106th day after the first surgery, he had recovered well and was discharged. The genetic testing revealed COL3A1 mutation, which is specific for vascular type Ehlers-Danlos syndrome. When long-term open abdominal management is necessary after the abdominal aortic surgery, TAC with Composix Mesh and NPWT may be a useful alternative. Artery rupture in young people is a finding that should be considered suspicious for vascular type Ehlers-Danlos syndrome, which is difficult to treat.

Clinical efficacy of allogeneic cross-linked dermal dressing for the treatment of enteroatmospheric fistula in patients with open abdomen / 中华消化外科杂志

Objective To investigate the clinical efficacy of allogeneic cross-linked dermal dressing (ACLD) for the treatment of enteroatmospheric fistula (EAF) in patients with open abdomen (OA).Methods The clinical data of 44 patients with experienced trauma who received OA at Nanjing General Hospital of Nanjing Military Command from January 2011 to January 2014 were retrospectively analyzed.All patients received temporary abdominal closure (TAC) by modified sandwich-vacuum package (MSVP).From January 2011 to December 2012,33 patients with OA received vaseline gauze as abdominal cover layer (VG group),and from January 2013 to January 2014,11 patients with OA received allogeneic cross-linked dermal dressing as abdominal cover layer (ACLD group).Patients were followed up via outpatient examination or telephone interview till October 2014.The incidence of EAF,time for skin-grafting,hematologic indexes in 2 weeks after surgery (white blood cell counts,percentage of neutrophil,the mean value of procalcitonin and C reactive protein),the duration of postoperative hospital stay,hospital expenses and survival rates in the 2 groups were analyzed using t-test,repeated measures analysis of variance and Fisher's exact test.Results The incidence of EAF in the VG group and ACLD group was 42.4％ (14/33) and 0,respectively,with a significant difference between the 2 groups (P ＜ 0.05).The duration of skin-grafting was (15 ±6) days in the VG group and (11 ±3)days in the ACLD group,with a significant difference between the 2 groups (t =2.10,P ＜ 0.05).The mean values of preoperative procalcitonin and postoperative procalcitonin at day 1,3,7,14 in the VG group were (1.20 ± 0.60)pg,/L and (2.50-± 0.90)pg,/L,(1.70 ± 0.30) pg/L,(1.90 ± 0.40) μg/L and (2.70 ± 0.60) μg/L,which were significantly higher than that of (0.90 ± 0.30) μg/L and (1.80 ± 0.60) μg/L,(1.30 ± 0.50) μg/L,(0.60 ± 0.20) μg/L and (0.30 ± 0.07) μg/L in the ACLD group (F =8.50,P ＜ 0.05).The white blood cell counts and percentage of neutrophil and the percentage of C reactive protein between the 2 groups were changed from (13.8 ±2.4) × 109/L,(12.9 ± 2.1) × 109/L,0.90±0.09,0.88 ±0.06,(81 ± 19)mg/L,(136 ±28)mg/L to (16.2 ±3.3) × 109/L,(7.9 ± 3.0) x 109/L,0.85 ±0.12,0.79 ±0.09,(131 ±30)mg/L,(59 ±22)mg/L at postoperative day 14,showing no significant difference between the 2 groups (F =3.10,0.50,1.20,P ＞ 0.05).Duration of hospital stay and hospital expenses in the VG group and ACLD group were (137 ±32)days,(638 831 ± 113 670) yuan and (82 ± 44)days,(474 839 ± 78 543)yuan,respectively,with a significant difference between the 2 groups (t =3.60,4.43,P ＜ 0.05).The time of follow-up and overall survival rate in the VG group and ACLD group were 29 to 38 months and 81.8％ (27/33),and 10 to 20 months and 90.9％ (10/11),respectively,with no significant difference (P ＞ 0.05).Conclusion Allogeneic cross-linked dermal dressing as abdominal cover layer can effectively decrease EAF in patients with open abdomen.

Fechamento sequencial da parede abdominal com tração fascial contínua (mediada por tela ou sutura) e terapia a vácuo / Sequential closure of the abdominal wall with continuous fascia traction (using mesh or suture) and negative pressure therapy

Na última década multiplicaram-se as publicações e a utilização da cirurgia de controle de danos, resultando num número crescente de pacientes deixados com o abdome aberto (ou peritoneostomia). Uma das consequências nefastas do abdome aberto são as hérnias ventrais gigantes que resultam da impossibilidade de se fechar o abdome durante a internação hospitalar do paciente. Para minimizar esta sequela têm surgido na literatura diferentes tipos de abordagem. Para abordar este tópico, a reunião de revista "Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE) optou por não analisar sistemas comerciais de fechamento abdominal dinâmico, com exceção da terapia de pressão negativa ou vácuo. O grupo fez uma avaliação crítica dirigida de três artigos mais relevantes publicados recentemente sobre fechamento sequencial da parede abdominal (com tela ou sutura) mais vácuo. Nesta avaliação foram incluídos dois estudos retrospectivos mais um estudo prospectivo. Baseados na análise crítica desses 3 estudos mais a discussão que contou com a participação de representantes de 6 Universidades e realizada via telemedicina, são feitas as seguintes recomendações: (1) a associação de terapia de pressão negativa com tração fascial constante mediada por tela ou sutura, ajustada periodicamente, parece ser uma ótima estratégia cirúrgica para o tratamento de peritoneostomias. (2) O fechamento abdominal primário dinâmico com sutura e mediada por tela parece ser mais econômico e eficiente do que deixar o paciente com uma hérnia gigante e planejar uma reconstrução complexa tardiamente. Novos estudos com grupos maiores de pacientes separados de acordo com as diferentes apresentações e doenças são necesários para definir qual o melhor método cirúrgico para o tratamento de peritoneostomias.

The last decade was marked by a multiplication in the number of publications on (and usage of) the concept of damage control laparotomy, resulting in a growing number of patients left with an open abdomen (or peritoneostomy). Gigantic hernias are among the dreaded consequences of damage control and the impossibility of closing the abdomen during the initial hospital admission. To minimize this sequela, the literature has proposed many different strategies. In order to explore this topic, the "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT -TACS) conducted a literature review and critically appraised the most relevant articles on the topic. No commercially available systems for the closure of peritoneostomies were analyzed, except for negative pressure therapy. Three relevant and recently published studies on the sequential closure of the abdominal wall (with mesh or sutures) plus negative pressure therapy were appraised. For this appraisal 2 retrospective and one prospective study were included. The EBT-TACS meeting was attended by representatives of 6 Universities and following recommendations were generated: (1) the association of negative pressure therapy and continuous fascia traction with mesh or suture and adjusted periodically appears to be a viable surgical strategy to treat peritoneostomies. (2) the primary dynamic abdominal closure with sutures or mesh appears to be more efficient and economically sound than leaving the patient with a gigantic hernia to undergo complex repair at a later date. New studies including larger number of patients classified according to their different presentations and diseases are needed to better define the best surgical treatment for patients with peritoneostomies.

Reparação da parede abdominal anterior com o omento maior / Repair of the anterior abdominal wall with omental flap

INTRODUÇÃO: As perdas de substância da parede abdominal são substituídas por próteses sintéticas. Acontecem vantagens e desvantagens. O omento maior é uma estrutura totipotente e se aplica, também, à reparação. OBJETIVO: Apresentar possibilidade técnica de fechamento de parede abdominal com omento após ressecção da parte muscular. MÉTODO: Operou-se dois pacientes adultos com adenocarcinoma de colo direito invadindo a parede abdominal. Foi necessária a ressecção da metade direita da parede para fazer parte do monobloco. A metade esquerda do omento maior, remanescente, foi usada para vedar a cavidade abdominal através de sua sutura às bordas da ferida. Pôde-se recobrir com pele mobilizada nos flancos. A evolução foi satisfatória. No pós-operatório tardio formou-se hérnia incisional. CONCLUSÃO: O omento maior é um recurso a mais para reparar a perda parcial de parede abdominal.

INTRODUCTION: The loss of substance of the abdominal wall is usually replaced by synthetic prostheses with advantages and disadvantages. The greater omentum is a totipotent structure and can be applied also to this repair. OBJECTIVE: To present technical possibility of abdominal closure after resection of abdominal wall muscle part with omentum. METHOD: The technic was carried out in two adult patients with colonic adenocarcinoma with invasion of the right abdominal wall. Was required the resection of the right half of the abdominal wall to join the en-bloc resection. The left half of the greater omentum was used to seal the abdominal cavity fixing it with sutures to the edges of the surgical wound. Final closure was done with the skin freed from the flanks. The recovery was satisfactory. In the late postoperative period incisional hernia occurred. CONCLUSION: The greater omentum can be used to repair the partial loss of the abdominal wall.