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Abdominal wall, hernia and umbilicus
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
This may be done by open or laparoscopic surgery. At open surgery, a vertical or transverse incision is made over the swelling and down to the linea alba. Protruding extraperitoneal fat can simply be pushed back through the defect or excised. Often a small vessel is present in the hernia content that can cause troublesome bleeding. The defect in the linea alba is closed with non-absorbable sutures in adults and absorbable sutures in children. In larger hernias and when a peritoneal sac is present, the surgical approach is similar to an umbilical mesh repair.
Anatomical Approaches for Minimally Invasive Spine Surgery
Published in Alexander R. Vaccaro, Christopher M. Bono, Minimally Invasive Spine Surgery, 2007
Donald C. Shields, Larry T. Khoo, Grigory Goldberg, R. Vaccaro Alexander
Anterior approaches to the lumbar spine were designed to provide direct access to ventral pathology, to avoid dissection of lumbar paraspinal musculature, and to place bone grafts in the predominant load-bearing column of the lumbar spine. Minimally invasive anterior lumbar interbody fusion approaches have more recently been developed to achieve these results with minimal distraction of abdominal cavity contents. While the traditional open transperitoneal approach to the lumbar spine is performed through either midline, paramedian, or Pfannensteil incision, minimally invasive techniques employ three or four smaller incisions for placement of laparoscopic channels. An approximately 1- to 3-cm-wide midline incision just above the pubis is utilized for insertion of the interbody components, while small paramedian incisions allow for insertion of working forceps. An umbilical incision is also created for placement of a viewing camera. Midline incisions pierce the linea alba, while paramedian exposures enter the external oblique, internal oblique, and transverse abdominis muscles. Entrance into the abdominal cavity via the transversalis fascia, extraperitoneal fat layer, and peritoneum, respectively, can then be achieved. Abdominal contents can sometimes be mobilized out of the pelvic inlet as the patient is placed into a steep Trendelenburg position. Once bowel segments are moved to allow viewing of the sacral promontory, the posterior portion of the parietal peritoneum can be dissected with electrocautery. In males, a blunt Kittner dissector should be used to avoid injury to the presacral sympathetic plexus, which can result in retrograde ejaculation.
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.
Assessment of complications and short-term outcomes of percutaneous peritoneal dialysis catheter insertion by conventional or modified Seldinger technique
Published in Renal Failure, 2021
Yun Zou, Yibo Ma, Wenying Chao, Hua Zhou, Yin Zong, Min Yang
Abdominal bleeding is also a complication of traditional percutaneous catheter placement. One of the patients in the conventional technique group suffered intra-abdominal hemorrhage due to repeated abdominal wall punctures that damaged mesenteric vessels. Urgent open surgery was undertaken and the bleeding vessels were ligated. The insertion needle supplied in the percutaneous PD insertion kit is sharp, and causes only subtle tactile feedback when penetrating the peritoneum. With blind penetration, it is often nearly impossible to positively determine whether the puncture needle has entered the peritoneal cavity. Repeated punctures increase the risk of bleeding. To reduce this risk, we replaced the kit puncture needles with pneumoperitoneum needles in the modified group. The pneumoperitoneum needle has a spring protection device with a round blunt tip of a needle core. When encountering resistance, the needle core is pushed back into the needle sheath, allowing the sharp sheath to penetrate the peritoneum. Immediately upon penetration of the peritoneum, the resistance is gone, the spring is released and the blunt needle core pops through the sheath, protecting against injury to intraabdominal structures [26,27]. When saline was infused through the needle sheath, a low echogenic area could be observed between the intestines by ultrasound that indicated successful, atraumatic needle penetration. The concomitant applications of the pneumoperitoneum needle and ultrasound guidance could avoid repeated punctures and reduce complications. For one patient in the modified technique group, entry into the peritoneal cavity by a pneumoperitoneum needle was unsuccessful, and the patient was switched to the open surgical approach. The BMI for this patient was 29.2 kg/m2. The perceived sense of breakthrough that the pneumoperitoneum needle was thought to penetrate the peritoneum, was probably a misinterpretation of the needle only traversing the extraperitoneal fat layer, not the peritoneum. Therefore, we recommend usage of the pneumoperitoneum needle in patients with relatively thin abdominal walls and a BMI of 28 kg/m2 or less.