Objective To summarize the therapeutic experiences of abdominal wall bulge repair with compound patch intraperitoneal placement. Methods From October 2005 to October 2008, intraperitoneal onlay mesh with compound patch applied in 7 patients with abdominal wall bulge, whose clinical data were analyzed retrospectively. Results All the procedures were performed successfully, including 5 open operation and 2 laparoscopic repair. The mean operation time was 85 min (ranged 68 to 130 min). After operation, 1 seroma formation and 1 hemorrhage in the thoracic cavity developed and were cured with the conservative therapy. Mean postoperative hospital stay was 9.5 d (ranged 8 to 16 d). There was no recurrence, infection, or prolonged pain during 1－4 years follow-up. Conclusion Abdominal wall bulge is caused by the weakness of abdominal wall muscle, and the intraperitoneal onlay mesh repair with compound patch is an appropriate therapy.
Objective To analyze the cl inical therapeutic effect of extended Sublay technique via previous incision for repairing flank hernias in comparison with routine Sublay technique. Methods Between May 2004 and May 2009, 41 patients with flank hernia were treated by extended Sublay repair via previous incision (extended Sublay repair group, n=18) and by routine Sublay repair (rountine Sublay repair group, n=23). In extended Sublay repair group, there were 11 males and 7 females with an average age of 45.2 years (range, 32-61 years); flank hernia was cuased by flank incision operation (12 patientswith surgery history of nephrectomy, adrenalectomy, and vascular procedure) and traffic accident (6 patients) with an average disease duration of 14.5 months (range, 8-23 months); and the locations were the left flank region in 11 patients (7 affected superior lumbar triangles and 4 affected inferior lumbar triangles) and the right flank region in 7 patients (5 affected superior lumbar triangles and 2 affected inferior lumbar triangles). In routine Sublay repair group, there were 14 males and 9 females with an average age of 48.7 years (range, 33-64 years); flank hernia was cuased by flank incision operation (15 patients with surgery history of nephrectomy, adrenalectomy, and vascular procedure), traffic accident (6 patients), and fall ing (2 patients) with an average disease duration of 18.2 months (range, 11-27 months); and the locations were the left flank region in 10 patients (5 affected superior lumbar triangles and 5 affected inferior lumbar triangles) and the right flank region in 13 patients (9 affected superior lumbar triangles and 4 affected inferior lumbar triangles). There was no significant difference in general data between 2 groups (P gt; 0.05). Results The mesh size in extended Sublay repair group was significantly larger than that in routine Sublay repair group [(618.2 ± 40.6) cm2 vs. (512.2 ± 36.5) cm2, P lt; 0.05 ]. There was no significant difference in hernia ring size, operation time, and hospital ization day between 2 groups (P gt; 0.05). In extended Sublay repair group, the patients were followed up 17 to 35 months (26.2 months on average) with an early compl ication incidence of 27.8% (hematomas in 2 cases, seroma in 1 case, and chronic pain in 2 cases within 1 month) and a late compl ication incidence of 0 (no hernia recurrence and abdominalwall bulge during follow-up). In routine Sublay repair group, the patients were followed up 14-35 months (24.5 months onaverage) with an early compl ication incidence of 13.0% (seroma in 1 case and chronic pains in 2 cases within 1 month) and a late compl ication incidence of 30.4% (hernia recurrence in 3 cases and abdominal wall bulge in 4 cases at 1-3 months). There was significant difference in the late compl ication incidence between 2 groups (P lt; 0.05). Conclusion Extended Sublay technique is a safe and effective approach for flank hernia repair. Making clear the anatomy of lumbar region, harvesting adequate space for mesh overlap, and effectively-fixing are critical to ideal cl inical outcomes.
ObjectiveTo explore the feasibility and safety of the artificial pneumoperitoneum and gastrointestinal contrast CT imaging, and imaging diagnostic value on abdominal wall adhesion to intestine after operation. MethodsThirtynine patients with adhesive intestinal obstruction after operation relieved by conservative therapy were included from January 2008 to November 2009. After the artificial pneumoperitoneum established by injection of gas into abdominal cavity and gastrointestinal comparison by oral administration low concentration of meglucamine diatrizoate, CT scan imaging was performed and the radiographic results were compared with surgical findings. ResultsFour patients refused surgery and discharged, so enterolysis was performed in the remaining patients. The surgical findings were consistent with radiographic results. It was showed by laparoscopic operation that intestinal obstruction caused by the fibrous adhesions and the intestine did not adhere to the abdominal wall in eight patients with fibrous adhesion diagnosed by CT. Of eighteen patients with the abdominal wall septally adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed “M”type adhesions and omentum adhesions in sixteen patients underwent open operation, and clear fat space was showed in eight patients and close adhesion was found in another eight patients between the intestine and abdominal wall. Of thirteen patients with the abdominal wall tentiformly adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed continuous and tentiform adhesions and omentum adhesions to the intestine in eleven patients. After the followup of 6-18 months (mean 9 months), incomplete intestinal obstruction occurred in one patient and was relieved by conservative treatment. One patient with discontinuous discomfort in abdomen after operation did not receive any treatment. The other patients were cured. ConclusionThe artificial pneumoperitoneum and gastrointestinal contrast CT imaging can accurately show the location, area, and structure composition of the postoperative abdominal wall adhesion to intestine, which is safety, simple, and bly repeatable, and a better imaging method for the diagnosing of abdominal wall adhesion to intestine after operation.
Objective To research the effect of porcine acellular dermal matrix in the reconstruction of abdominal wall defects in rabbits, and to investigate the appl ication feasibil ity of xeno-transplantation of acellular dermal matrix. Methods The porcine acellular dermal matrix was prepared from a health white pig. Twenty-six Japanese white rabbits (weighing 2.2-2.3 kg, female or male) were randomly assigned to 2 groups: the control group (n=6) and the experimental group (n=20). In the control group, the full-thickness abdominal wall defect of 5.0 cm × 0.5 cm was made, and the defect wassutured directly; in the experimental group, the full-thickness abdominal wall defect of 5.0 cm × 2.5 cm was made, and the defect was repaired with porcine acellular dermal matrix patch at the same size as the defect. At 5 weeks after surgery, the incidence of hernia and the intra-abdominal adhesions were observed and the wound breaking strength was compared between the patchfascia interface and the fascia-fascia interface. The graft vascularization was evaluated through histological analysis at 6 months after surgery in the experimental group. Results No hernia occurred in all rabbits of 2 groups. At 5 weeks after surgery, heal ing was observed between patch and the muscularfascia; the vascularization was seen in the porcine acellular dermal matrix patch. There was no significant difference in the adhesion grade (Z= —0.798, P=0.425) between the experimental group (grade 2 in 1 rabbit, grade 1 in 5, and grade 0 in 12) and the control group (grade 1 in 1 and grade 0 in 5). No significant difference was found (t= —0.410, P=0.683) in the breaking strength between the patch-fascia interface in the experimental group [(13.0 ± 5.5) N] and the fascia-fascia interface in control group [(13.6 ± 4.0) N]. In the experimental group, the small vessels and the infiltration of inflammatory cells were observed in the porcine acellular dermal matrix patch after 5 weeks through histological observations. The junctions of the patch-fascia interface healed with fibrous connective tissue. At 6 months after surgery, the inflammation was subsided and the collagen fiber of the patch was reconstructed. Conclusion The porcine acellular dermal matrix patchhas good results in repairing full-thickness abdominal wall defect. The patch-fascia interface has siml iar breaking strength to the fascia-fascia interface. The collagen fibers of the patch are reconstructed.
Objective To investigate the reconstructive methods and effectiveness of modified pedicled anterolateral thigh (ALT) myocutaneous flap for large full-thickness abdominal defect reconstruction. Methods Between January 2016 and June 2018, 5 patients of large full-thickness abdominal defects were reconstructed with modified pedicled ALT myocutaneous flaps. There were 3 males and 2 females with an average age of 43.7 years (range, 32-65 years). Histologic diagnosis included desmoid tumor in 3 cases and sarcoma in 2 cases. The size of abdominal wall defect ranged from 20 cm×12 cm to 23 cm×16 cm. Peritoneum continuity was reconstructed with mesh; lateral vastus muscular flap was used to fill the dead space and rebuild the abdominal wall strength; skin grafting was applied on the muscular flap, the rest abdominal wall soft tissue defects were repaired with pedicled ALT flap. The size of lateral vastus muscular flap ranged from 20 cm×12 cm to 23 cm×16 cm, the size of ALT flap ranged from 20 cm×8 cm to 23 cm×10 cm. The donor site was closed directly. Results All flaps and skin grafts survived totally, and incisions healed by first intention. All patients were followed up 6-36 months (mean, 14.7 months). No tumor recurrence occurred, and abdominal function and appearance were satisfying. No abdominal hernia was noted. Only linear scar left in the donor sites, and the function and appearance were satisfying. Conclusion Modified pedicled ALT myocutaneous flap is efficient for large full-thickness abdominal defect reconstruction, decrease the donor site morbidity, and improve the donor site and recipient site appearance.
Objective To observe the anti-adhesion and repair effect of 3 composite patches which composed of polylactide-co-caprolactone (PLC), hyaluronic acid (HA), collagen, and polypropylene (PP) mesh repairing abdominal wall defectin rats under contaminated environment, and to investigate the characteristics of 3 composite patches and the feasibil ity of onestage repair. Methods Ninety-three adult male Wistar rats (weighing 150-250 g) were randomly divided into 3 groups (n=31): PP/PLC composite patches (group A), PP/HA/PLC composite patches (group B), and PP/collagen/PLC composite patches (group C). One rat was selected from each group to prepare the contaminated homogenate of the small intestine. The abdominal wall defect models (1 cm in diameter) were established in other rats, and the defects were repaired with 3 composite patches (1.5 cm in diameter) according to grouping method. At 30, 60, and 90 days postoperatively, the adhesions was observed, and the patch and adjacent tissue was harvested for histological observation. Results Six rats died at 10-70 days postoperatively (2 in group A, 3 in group B, and 1 in group C). No wound infection, intestinal obstruction, or hernia occurred in 3 groups. Adhesion was observed between abdominal viscera and the patch, especially intestine, epiploon, and l iver. According to the modified Katada criteria, no significant difference in the adhesion score was found among 3 groups at 30 and 60 days (P gt; 0.05); the adhesion score was significantly lower in group C than in groups A and B at 90 days (P lt; 0.05). The histological results showed that inflammatory cell infiltration, fibroblasts, secreted collagen, and the residual absorbable material were observed around the patch at 30 days in 3groups. Decreased inflammatory cell infiltration, increased fibroblasts and residual PLC were observed at 60 days in 3 groups. At 90 days, the fibroblasts became increasingly mature, collagen deposited, the mesothelium formed gradually, and the residual PLC decreased. Conclusion In contaminated environment, PP/collagen/PLC composite patch is superior to PP/PLC and PP/HA/ PLC composite patches in aspect of abdominal adhesion and inflammatory reaction, and it is more applicable to one-stage repair of rat abdominal wall defect. But it is necessary to further study in the long-term efficacy and the security of the composite patch.
1The surgical treatment for the recurrent groin herniasEver since the advent of elective surgical intervention for inguinal hernia recurrences have been observed. Indeed, many of the modern surgical techniques for herniorrhaphy were devised specifically to minimize recurrence rates. For many reasons it has been difficult to actually quantify a true recurrence rate for inguinal hernia repair. Surgeons use a variety of anatomic and “tension free” mesh repairs when fixing a symptomatic groin heria. In general the recurrence rates for each type of repair have been reported and vary from 0.5% to 10% in the current literature. One factor contributing to the broad range of recurrence is the duration 0 follow up. While most recurrences are noted within 2 to 5 years of the original repair, patients often do not seek repair of the recurrence for some 10 to 15 years following the original operation. Longterm follow up is necessary to appreciate the outcome of hernia repair.In the early 1970’s Dr L M Nyhus taught me the preperitoneal approach to the repair of groin hernia. Introduced it into my practice at the time initially restriction its use to to the repair of recurrent groin hernia but eventually enlarged the indications to include high risk patients, patients with incarcerated hernia, femoral hernia and when I felt the surgical resident needed instruction in the anatomy of the groin. I have used the preperitoneal approach for the repair of groin hernia over 3 000 times in general and specifically for the repair of recurrent groin hernia in over 750 patients. The results have been most ratifying. For first time recurrent groin hernia repair the recurrence rate for over 90% of patients followed five years was 1.6%.
OBJECTIVE: To explore an effective method to repair the abdominal wall defect. METHODS: From July 1996 to December 2000, 7 cases with abdominal wall defect were repaired by pedicle graft of intestine seromuscular layer and skin graft, among them, intestinal fistula caused by previous injury during operation in 4 cases, abdominal wall defect caused by infection after primary fistulization of colon tumor in 2 cases, abdominal wall invaded by intestinal tumor in 1 case. Exploratory laparotomy was performed under general anesthesia, the infective and edematous tissue around abdominal wall defect was gotten rid off, and the pathologic intestine was removed. A segment of intestine with mesentery was intercepted, and the intestine along the longitudinal axis offside mesentery was cutted, the mucous layer of intestine was scraped. The intestine seromuscular layer was sutured to the margin of abdominal wall defect, and grafted by intermediate split thickness skin. RESULTS: The abdominal wall wound in 6 cases were healed by first intention, but part of grafted skin was necrosed, and it was healed by second skin graft. No intestinal anastomotic leakage was observed in all cases. Followed up 1 to 2 years, there were no abdominal hernia or abdominal internal hernia. All the cases could normally defecate. The nutriture of all cases were improved remarkably. CONCLUSION: Pedicle graft of intestine seromuscular layer is a reliable method to repair abdominal wall defect with low regional tension, abundant blood supply and high successful rate.
ObjectiveTo explore the effectiveness of pedicled anterolateral thigh myocutaneous flap for full-thickness abdominal wall reconstruction after tumor resection.MethodsBetween September 2010 and December 2017, 18 patients with abdominal wall tumors were collected. There were 11 males and 7 females, with an average age of 45.2 years (range, 29-68 years). Histologic diagnosis included desmoid tumor in 8 cases, sarcomas in 6 cases, malignant teratoma in 2 cases, and colon adenocarcinoma in 2 cases. All abdominal wall defects were full-thickness defects. Peritoneum continuity was reconstructed with mesh; the lateral vastus muscular flaps were used to fill the dead space and rebuild the abdominal wall strength; the abdominal wall soft tissue defects were repaired with pedicled anterolateral thigh flaps. The size of abdominal wall defects ranged from 15 cm×6 cm to 25 cm×22 cm; the size of lateral vastus muscular flap ranged from 10 cm×8 cm to 22 cm×10 cm; the size of anterolateral thigh flap ranged from 14.0 cm×8.0 cm to 21.0 cm×8.5 cm. The bilateral pedicled anterolateral thigh myocutaneous flaps were harvested to repair the extensive abdominal wall defects in 2 cases. All donor sites were sutured directly.ResultsAll wounds healed smoothly and all flaps survived totally. All donor sites healed smoothly. The mean follow-up time was 22.5 months (range, 11-56 months). No tumor recurrence occurred, the abdominal function and appearance were satisfactory, no abdominal hernia was noted. Only linear scar left at the donor sites.ConclusionPedicled anterolateral thigh myocutaneous flap combined with mesh is fit for large full-thickness abdominal defect reconstruction.
Objective To investigate the improvement effects and mechanisms of composite chitosan (CS) hydrogel on traditional polypropylene (PP) mesh for repairing abdominal wall defects. Methods CS hydrogel was prepared via physical cross-linking and then combined with PP mesh to create a CS hydrogel/PP mesh composite. The internal structure and hydrophilicity of the composite were characterized using macroscopic observation, upright metallographic microscope, scanning electron microscopy, and water contact angle measurements. The performance of the composite (experimental group) in resisting cell adhesion and supporting cell infiltration was assessed through fibroblast (NIH-3T3) infiltration experiments and human umbilical vein endothelial cells (HUVECs) tube formation assays, and simple cells were used as control group. Finally, a bilateral abdominal wall defect model (1.5 cm×1.0 cm) was established in 18 Sprague Dawley rats aged 8-10 weeks, with the composite used on one side (experimental group) and PP mesh on the other side (control group). The effects on promoting wound healing, preventing adhesion, angiogenesis, and anti-inflammation were investigated through macroscopic observation, histological staining (HE and Masson staining), and immunohistochemical staining (CD31, CD68). Results The composite appeared as a pale yellow, transparent solid with a thickness of 2-3 mm, with the PP mesh securely encapsulated within the hydrogel. Scanning electron microscopy revealed that the hydrogel contained interconnected pores measuring 100-300 μm, forming a porous structure. Contact angle measurements indicated that CS hydrogel exhibited good hydrophilicity, while PP mesh was highly hydrophobic. In vitro cell culture experiments showed that DAPI staining indicated fewer positive cells in the experimental group after 1 day of culture, while the cells in control group covered the entire well plate. After 3 days of culture, the cells in experimental group were spherical and displayed uneven fluorescence, suggesting that the material could reduce cell adhesion while supporting cell infiltration. HUVECs tube formation experiments demonstrated an increase in cell numbers in experimental group with a trend towards tube formation, while cells in control group were sparsely distributed and showed no migration. In the rat abdominal wall defect repair experiment, results showed that after 1 week post-surgery, the experimental group had tissue and blood vessels infiltrating, and by 4 weeks, the integrity was well restored with significant regeneration of muscle and blood vessels, while the control group exhibited adhesions and incomplete healing. HE staining results indicated weaker cell infiltration in the experimental group, with cell density significantly higher than that of the control group at 2 and 4 weeks post-surgery (P<0.05). Masson staining revealed that collagen fibers in the experimental group were arranged neatly, with significantly increased collagen content at 2 weeks post-surgery (P<0.05), while collagen content was similar in both groups at 4 weeks (P>0.05). Immunohistochemical staining showed that CD31-positive cells were evenly distributed between muscle layers in the experimental group, whereas the control group exhibited notable defects. At 2 weeks after operation, the CD31-positive cell ratio was significantly higher than that in the control group (P<0.05); at 2 and 4 weeks after operation, the CD68-positive cell ratio in the experimental group was significantly lower than that in the control group (P<0.05). Conclusion CS hydrogel has a positive effect on preventing adhesions and promoting wound healing, exhibiting anti-inflammatory and pro-angiogenic properties during the healing process. This provides a promising strategy to address challenges related to abdominal adhesions and reconstruction.
