Mapping traction strength of the anterior rectus sheath in cadaver / Mapeamento da força de tração da lâmina anterior do músculo reto do abdome em cadáver

PURPOSE: The tension at the aponeurotic edges of abdominal wall defects is an important factor of dehiscence and incisional hernia formation. The purpose of this study is to map and compare the traction force necessary for medial mobilization in various levels of the anterior rectus sheath in cadavers. METHODS: Twenty four adult male cadavers, raging from 22 to 59 years old, with the abdominal wall intact and without prior preservation techniques, were dissected. A complete excision of the linea alba was performed. Traction loops of 10 mm in diameter were made in the anterior rectus sheath and were placed: 2, 4, 6 and 8 cm below the lower edge of the umbilicus and 3, 6 and 9 cm above the upper edge of the umbilicus. Each loop was mobilized 10 mm in the medial direction, using an analog dynamometer. The values obtained in each level were compared using Friedman's analysis of Variance for p < 0.05. RESULTS: The average traction values obtained at the various levels were compared and there was no statistical significant difference. CONCLUSION: There is no variation in tension along the whole extension of the anterior rectus sheath.

OBJETIVO: A tensão na margem da aponeurose de um defeito da parede abdominal é um importante fator de deiscência e formação da hérnia incisional. O objetivo deste estudo é mapear e comparar a força de tração necessária à mobilização medial em vários níveis da lâmina anterior do músculo reto do abdome em cadáveres. MÉTODOS: Vinte e quatro cadáveres adultos masculinos, com idade entre 22 e 59 anos, com a parede abdominal intacta e sem técnicas prévias de conservação, foram dissecados. Uma excisão completa da linha alba foi realizada. Alças de tração de 10 mm de diâmetro foram realizadas na lamina anterior do músculo reto do abdome e estavam localizadas: 2,4,6 e 8 cm abaixo da margem inferior do umbigo e 3,6 e 9 cm da margem superior do umbigo. Cada alça foi mobilizada 10 mm em direção medial, usando um dinamômetro analógico. Os valores obtidos em cada nível foram comparados usando a analise de variância de Friedman com p < 0,05. RESULTADOS: Os valores de tração obtidos nos vários níveis foram comparados e não apresentaram significância estatística. CONCLUSÃO: Não há variação de tensão por toda lamina anterior do músculo reto do abdome.

A case of herniated gravid uterus through a laparotomy scar.

A 36-year-old manual worker presented in her second pregnancy at 34 weeks of gestation with an unusual bulge of her abdomen. The lower abdominal bulge turned out to be her gravid uterus herniated through an anterior abdominal wall incisional hernia which is a rare but serious obstetric situation with complications such as premature labour, intrauterine growth retardation, strangulation, intrauterine death and rupture of the lower uterine segment been reported. We had a successful outcome by conservative treatment till 38 weeks of gestation followed by an elective lower segment Caesarean section with hernia repair. Incisional hernia is a frequent complication of abdominal wall closure and the management of pregnancy with a large incisional hernia with gravid uterus in its sac is challenging.

Role of biological mesh in surgical treatment of paracolostomy hernias

Hérnias paracolostômicas são complicações freqüentes de estomas intestinais. A correção pode ser realizada através do seu reposicionamento ou mantendo a mesma localização, associada ao reforço da parede abdominal com ou sem o emprego de prótese. MÉTODOS: Os resultados do tratamento cirúrgico de hérnias paracolostômicas são analisados em 22 pacientes em nosso serviço nos últimos 15 anos. Todos os pacientes eram portadores de colostomias terminais após ressecção abdominoperineal do reto. RESULTADOS: Em 15 (68,2%) pacientes, a correção da hérnia foi realizada mantendo-se a colostomia no local original, em 2 (9,1%) deles através de herniorrafia simples e em 13 (59,1%) com reforço da aponeurose com prótese biológica. Nos outros 7 (31,8%) pacientes, a correção foi realizada por reposicionamento da colostomia. O seguimento médio pós-operatório foi de 50,2 meses. Recidiva foi observada em 3 (13,6%) casos (em média 16 meses após correção). CONCLUSÃO: A hérnia paracolostômica continua a ser um desafio cirúrgico devido a sua elevada recidiva. Correção primária com prótese pode ser favorecida, uma vez que freqüentemente se observa fraqueza da aponeurose.

Recidiva da hérnia incisional após o tratamento pela transposição peritonio-aponeurótica longitudinal bilateral / Recidivation of bilateral longitudinal peritoneum-aponeurotic transposition on incisional hernioplasty

OBJETIVO: Conhecer a incidência de recidiva de hernioplastia incisional pela transposição peritônio-aponeurótica longitudinal bilateral. PROCEDIMENTOS: Foi feito um levantamento dos pacientes que foram operados de hérnia incisional pela técnica de transposição peritônio-aponeurótica longitudinal bilateral. Cento e trinta e dois pacientes (80 do Hospital Universitário de Belo Horizonte, MG e 52 da clínica particular) foram acompanhados por período médio de 4 anos e 10 meses. Muitos dos pacientes eram obesos, porém todos tinham hérnias longitudinais de médio a grande volume. Três aspectos precisam ser ressaltados: o método para se alcançar a parede abdominal interna, a incisão aponeurótica posterior e os fios utilizados. RESULTADOS: Recidiva em 7,69 por cento dos pacientes do grupo operado por um cirurgião (clínica particular) e em 18,75 por cento dos pacientes do grupo operado por cirurgiões em treinamento (Hospital Universitário).

Traumatic Abdominal Wall Hernia

A traumatic abdominal wall hernia (TAWH) is a rare type of hernia, which follows blunt trauma to the abdomen, where disruption of the musculature and fascia occurs, with the overlying skin remaining intact. The case of a sixty five year old female that developed a TAWH, following the collapse of the roof of her house, is reported. She underwent a laparotomy for suspected liver injury, followed by repair of the hernia using a fascia lata graft taken from the thigh. The etiology, pathogenesis and management of this rare hernia are discussed.

Incisional hernia after renal transplantation and its repair with propylene mesh

Kidney recipients are susceptible to incisional hernia. We studied predisposing factors for incisional hernia in our patients and the results of its repair with propylene mesh. From 1989 to 2002, 589 patients had undergone kidney transplantation in our hospital. Of these, patients who developed incisional hernia were evaluated in this study. The following data were collected from their records: age, gender, weight, age at graft rejection, surgical complications, treatment method, and the treatment results with propylene mesh. Of 589 recipients, 16 [3%] developed incisional hernia in surgical site. The median interval between kidney transplantation and developing of incisional hernia was 48 [range 12 to 425] days. Predisposing factors were overweight, age over fifty years, and female gender [P<0.005]. In four patients, hernia was small, and the repair was performed without using mesh. Three patients were reluctant to hernia repair, and in 9, due to the large size of hernia, repair was done using propylene mesh. Having these 9 patients treated with propylene mesh, 2 developed serous collection in surgical site, which were managed successfully with multiple punctures. Hernia recurrence or infection was not noted in these patients during 3 to 36 months follow-up periods. Incisional hernia is not a rare entity after kidney transplantation. Predisposing factors, such as overweight, age over 50 years, and female gender have a role in its development. Also, repeated surgeries in kidney recipients can increase the risk of incisional hernia. Managing this complication with propylene mesh is a safe and effective method

External abdominal hernias

To document our experience of external abdominal hernias at Rahim Yar Khan Design: A descriptive study. Place and Duration: This study was conducted in Surgical Unit-II of Sheikh Zayed Hospital, Rahim Yar Khan from May, 2002 to August, 2002. Patients And All patients admitted with the diagnosis of external abdominal hernia were registered for the study. History, Clinical presentation and relevant investigation were recorded. Commonest type of external abdominal hernia was the inguinal hernia [65%]. Second commonest was paraumbilical hernia [16%]. Third in series was incisional hernia [8%]. Remaining varieties, in descending order were umbilical [5%], ventral [3%], epigastric [2%] and fatty hernia of linea alba [1016]. Most of the findings were similar to those found in other parts of the country except that in our study no adult male suffered from ventral, epigastric or umbilical hernia. Complications were very low and no case of femoral hernia was seen

Incisional hernia at the insertion site of the laparoscopic trocar: case report and review of the literature

Laparoscopic operations offer a myriad of advantages resulting in a rapid postoperative recovery. Incisional hernia is an uncommon cause of morbidity in operative procedures performed by laparoscopic access, and the diagnosis may not be easily made. In our service we identified 2 patients with incisional hernia the site of trocar insertion. The records of these 2 cases were reviewed. We report on these 2 cases and present a review of the literature

Hérnia pós-incisäo em cäes e gatos / Post incisional hernia in dogs and cats

A hérnia pós-incisäo foi analisada quanto à prevalência e protocolo terapêutico em nove cäes e seis gatos cadastrados no Hospital Veterinário da Universidade Federal de Santa Maria, RS, Brasil. Os animais apresentaram peritonite localizada que foi tratada com reposiçäo hidroeletrolítica, antibioticoterapia, irrigaçäo abundante da cavidade abdominal e debridamento cirúrgico. Todos tiveram evoluçäo favorável.

Hérnia traumática da parede abdominal / Traumatic abdominal hernia

A rare case of blunt traumatic abdominal hernia is presented in which jejunal loops herniated through the abdominal wall. The patient had a serious motor vehicle accident seven years ago, while wearing the seat belt. He developed a traumatic hernia in the anterior lateral abdominal wall, which was operated, and relapsed after some months. The patient was reoperated and we observed the unattachment of the anterior lateral abdominal musculature from the ilium crest. After the hernial sac treatment, the defect was solved with the use of a polypropylene mesh. The postoperative evolution was good and four months later there were no signs of recurrence. Traumatic abdominal hernia remains a rare clinical entity, despite the increase in blunt abdominal trauma. Traumatic abdominal wall hernia falls into two general categories: small lower quadrant abdominal defects, typically the result of blunt trauma with bicycle handlebars, and larger abdominal wall defects related to motor vehiche accidents. The diagnosis may be often established by the physical examination alone. Conventional radiology and computerized tomography usefulness have been proved. In the vast majority of cases, early repair is recommended. The appropriate treatment is the reduction of the herniated bowel into the abdomen, the debridment of nonviable tissues, and a primary tension-free closure of the defect

Hernias de la pared anterior del abdomen de origen traumático / Anterior abdominal wall hernias of traumatic origin

Desde que Selby, en 1906, publicara el primer caso de hernia abdominal traumática (HAT) no más de otros 40 similares han sido comunicados, no conociendo los autores artículos nacionales al respecto. El objetivo del presente trabajo es dar a conocer la experiencia de nuestro hospital en el manejo de estos lesionados la que está basada en 4 pacientes atendidos entre 1995 y 1996. El diagnóstico de HAT se basa en el conocimiento del mecanismo lesional, los que en común tienen el aumento brusco de la presión intraabdominal y en la presencia de elementos clínicos entre los que destacan una piel contundida, en ocaciones equimóticas, pero en la que no hay penetración junto a masa palpable las más de las veces, hecho que estuvo presente en 3 de los 4 casos. El examen de mayor rendimiento es la tomografía axial computarizada, la cual es capaz de mostrar la brecha músculo aponeurótica y eventualmente las asas intestinales extendiéndose baja la piel, ella fue de ayuda diagnóstica en 3 pacientes en que fue practicada. La laparotomía de urgencia es el tratamiento de elección estando orientada a tratar eventualmente lesiones asociadas, las que estuvieron presentes en los 4 accidentados de la serie, y a realizar la plastia de la pared dañada. La morbimortalidad de las HAT está habitualmente dada por las lesiones concomitantes, tal como aconteció en uno de nuestros enfermos

Eventraciones: tratamiento por videolaparoscopia / Videolaparoscopic repair of incisional abdominal hernias

Antecedentes: Es una técnica novedosa con escasa constancia bibliográfica. Objetivo: Demostrar la factibilidad y utilidad de la técnica. Lugar de aplicación: Hospital de Comunidad. Diseño: Estudio retrospectivo basado en criterios básicos. Población: Está compuesta sobre pacientes seleccionados, excluyendo aquellos con varias operaciones previas y deformaciones estéticas. Método: Se operaron 35 pacientes por vía laparoscópica colocándose en todos material protésico. Resultados: Pueden considerarse buenos al no constatarse recidivas. Las complicaciones fueron escasas y resueltas sin registrarse mortalidad. Conclusiones: Las ventajas de la técnica laparoscópica es aprovechable para el tratamiento de las eventraciones

Incisional hernias: why do they occur?

Over a period of five years 110 cases of incisional hernia were evaluated at teaching hospitals of Dow Medical College and Peoples Medical College, Nawabshah to ascertain their causes. It was found that these hernias were seen more frequently after emergency surgery [87.27%] performed by resident surgeons [89.09%]. About 70% patients had previous history of gynaecological and obstetric operations. Midline incision is more prone to herniation than paramedic and transverse incisions as evidenced by 73.64% patients in this series. Other important causative factors are wound infection [69.09%], chest infection [30.91%], abdominal distension [14.55%] and constipation

Tratamento cirúrgico de grande hérnia paracolostômica / Surgical treatment of large paracolostomy hernia

A case of large paracolostomy hernia, repaired by extra-peritoneal access with the ostomy kept in its original site, is present. The use of Marlex mesh is recommended in the repair of large herniation without changing the ostomy site. It proved to be easy to done with good post-operative results

Hérnia paraostomal / Parastomal hernia

Os autores revisam os tipos de hérnias paracolostômicas , sua incidência, fatores predisponentes, quadro clínico e prevençäo, enfatizando condutas terapêuticas frente as pequenas e grandes eventraçöes. Para o tratamento cirúrgico várias säo as técnicas disponíveis , sendo discutido a mudança ou näo do sítio original do estoma com ou sem o uso da tela de Marlex. É recomendada a manutençäo do local do estoma primitivo, com a utilizaçäo da malha de poliporpileno para as grandes eventraçöes por meio de técnica pessoal

Tratamento cirurgico das eventracoes / Surgical treatment of eventrations

O tratamento cirurgico das eventracoes envolve uma gama de dificuldades que exigem do cirurgiao pleno conhecimento de anatomia e fisiologia da parede abdominal bem como o dominio das multiplas alternativas tecnicas existentes. Os autores reportam-se aos aspectos fisiopatologicos das hernias incisionais, enfatizando a relevancia dos cuidados pre-operatorios, especialmente o pneumoperitoneo como uma medida util no preparo destes pacientes. Relativamente ao tratamento operatorio, analisam com detalhes, alem dos principios de tecnica, os principais procedimentos cirurgicos. Alicercados com experiencia pessoal, recomendam sempre que possivel, as tecnicas que utilizam as proprias estruturas parietais. Quando isso nao for possivel, como ocorre nas grandes eventracoes, preconizam o uso da Tela de Marlex como uma alternativa plenamente eficaz