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Caesarean Section
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Types of caesarean section The caesarean section can be planned, scheduled (elective or pre-labour), or emergency.Lower/upper segment (classical).Transperitoneal/extraperitoneal.
Abdominal and Genitourinary Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Three main anatomical areas are described in the abdomen: the abdominal cavity, the retroperitoneum and the pelvis (Figure 17.1). Further distinctions are made between intra and extraperitoneal areas, the zones of the retroperitoneum, solid organs and hollow viscera.8
Lateral Hernias
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Totally extraperitoneal repair has been described but only for very low Spigelian hernias, well away from the arcuate line, in which case it is essentially the same as for a TEP inguinal hernia repair. Spigelian hernias are generally ideal for a modified TAPP repair, or transperitoneal partially extraperitoneal approach, as outlined for lumbar hernia and described elsewhere.15,16 At transperitoneal laparoscopy, a horizontal incision is made adjacent to the hernia defect and an extraperitoneal pocket is created toward the posterior retroperitoneum, the sac extracted and the defect closed. A double-sided/non-adherent mesh is inserted, with the lower half tucked into the peritoneal pocket and the upper half visible within the peritoneal cavity. Tacks are placed in the visible half of the mesh but none are placed into the posterolateral abdominal wall below the peritoneal incision in order to avoid the possibility of neurovascular injury there (Figure 9.14). Gluing the mesh and peritoneum is an alternative.
Incidental finding of a congenital unilateral absence of the vas deferens during robotic inguinal hernia repair: missing a crucial landmark. A case report
Published in Acta Chirurgica Belgica, 2023
Kim Pauwaert, Filip Muysoms, Maxime Dewulf
During inguinal hernia repair a clear understanding of the anatomy, including the identification of the vas deferens (VD), is a crucial step to perform a safe dissection and obtain a critical view of the myopectineal orifice (MPO) (Figure 1) [1]. A congenital absence of the vas deferens (CAVD) is a rare condition, and has been described in up to 1% of the inguinal hernia repairs in children [2]. To our knowledge, this has only recently been described once as a finding during totally extraperitoneal preperitoneal (TEP) inguinal hernia repair in an adult patient [3]. We report on a second case of congenital unilateral atresia of the vas deferens (CUAVD) encountered during a robotic-assisted transabdominal preperitoneal (TAPP) inguinal hernia repair. Furthermore, we aim to provide a clear overview of relevant literature stressing its clinical relevance, and make recommendations on further investigations and management in case of an incidental finding of CAVD during inguinal hernia repair. This case report has been reported in line with the SCARE Criteria [4]. Patients consent was obtained for publications.
Development of rotational intraperitoneal pressurized aerosol chemotherapy to enhance drug delivery into the peritoneum
Published in Drug Delivery, 2021
Soo Jin Park, Eun Ji Lee, Hee Su Lee, Junsik Kim, Sunwoo Park, Jiyeon Ham, Jaehee Mun, Haerin Paik, Hyunji Lim, Aeran Seol, Ga Won Yim, Seung-Hyuk Shim, Beong-Cheol Kang, Suk Joon Chang, Whasun Lim, Gwonhwa Song, Jae-Weon Kim, Nara Lee, Ji Won Park, Jung Chan Lee, Hee Seung Kim
In contrast, we found no penetration of doxorubicin into the peritoneum of the ileal, jejunal, and gastric regions in either RIPAC or PIPAC. Although the penetration depth was highest in the small bowel located directly under the nozzle in a previous study (Khosrawipour et al., 2016c), we found no penetration of doxorubicin into the peritoneum of the ileal region despite being located directly under the nozzle. Although the relevant evidence is not definitive, we hypothesized that differences in the histologic structures between the visceral and parietal peritoneum rather than the position of the nozzle could lead to the concentration distributions. When we consider that the penetration depth of RIPAC may range within 500 µm, we can expect that doxorubicin can penetrate soft extraperitoneal fat tissues beyond the parietal peritoneum (Abrahams et al., 2019), whereas penetration into the dense muscularis layer beyond the visceral peritoneum seems difficult (van Baal et al., 2017; Isaza-Restrepo et al., 2018). Our findings that the tissue concentrations of doxorubicin were lower in the visceral peritoneum than in the parietal peritoneum support this hypothesis, and lower tissue concentrations in the visceral peritoneum seemed to be related to the systemic absorption of doxorubicin in the mucosal layer instead of the direct penetration of doxorubicin into the peritoneum.
A comparison between the mechanical properties of the hepatic round ligament and the portal vein: a clinical implication on surgical reconstruction of the portal and superior mesenteric veins
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2020
Wentao Zhu, Rongqiang Song, Xuefeng Cao, Lei Zhou, Qiang Wei, Haibin Ji, Rongzhan Fu
Hepatic round ligament (HRL), also known as ligamentum teres, is the remnant of the embryonic umbilical vein, which degenerates after birth (Emre et al. 1993). It is located between the umbilicus and the left branch of the portal vein (PV), connecting the left hepatic vein or the inferior vena cava via the venous ligament. Anatomically, it can be divided into intraperitoneal and extraperitoneal segments. Structurally, it is organized into the inner, middle and outer layers and still retains the structural features of the blood vessel wall that is composed of collagen and elastic fibers, as well as smooth muscles. A distinct elastic muscle band enriched with smooth muscle, elastic and collagen fibers exist between the inner and middle layer. Blood supply to the HRL is sufficiently provided by the right hepatic artery and the umbilical vein. Clinically, narrowed or obstructed HRL can be widened to reconnect with the PV (Ikegami et al. 2008).