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Caesarean Section
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
In modern-day obstetrics, the caesarean section should be intended and completed as an intraperitoneal lower segment caesarean section. Extraperitoneal caesarean section was encouraged in cases of frank chorioamnionitis to avoid spillage of the infected liquor inside the peritoneal cavity. This technique requires exposing the lower segment by working in the pre-vesical extraperitoneal space. With the advent of antibiotics and advanced management facilities for infected cases, extraperitoneal caesarean section is a forgotten skill.
Urinary diversion
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
A flap of skin is raised superiorly to gain access to the extraperitoneal space via a muscle split. The peritoneum is reflected medially (Figure 71.2b). The ureter is identified by dividing the obliterated umbilical artery. In cases of end ureterostomy, the ureter is detached close to the bladder and the bladder end is oversewn with 4/0 absorbable suture (e.g. polyglactic acid (Vicryl™) or polydioxanone (PDS™)).
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
In the extraperitoneal space – it is difficult, but possible, to develop the plane below the posterior rectus sheath, just outside the peritoneum. Care must be taken to avoid ‘button-holing’ the peritoneum because it is thin and fragile. Mesh can then be tucked into in this space, ensuring a good overlap as before. Ideally, the linea alba is closed over the mesh but, if this is not possible, a flap of peritoneal sac can be used to cover the mesh. This is a good repair, but, if the peritoneum is extensively damaged during the dissection, it will have to be abandoned in favour of an alternative technique.
Complications in robotic urological surgeries and how to avoid them: A systematic review
Published in Arab Journal of Urology, 2018
Rafael Rocha Tourinho-Barbosa, Marcos Tobias-Machado, Adalberto Castro-Alfaro, Gabriel Ogaya-Pinies, Xavier Cathelineau, Rafael Sanchez-Salas
Trans- or extraperitoneal approaches are both safe and depend on surgeon expertise. In order to create extraperitoneal space, balloon dissection is helpful during an extraperitoneal approach [26]. A lower incidence of gastrointestinal complications and shorter hospital stay have been seen in some series of extraperitoneal approach, especially in obese patients [27–29]. Prior abdominal surgery, pregnancy, vascular aneurysms, and abdominal wall hernia require further consideration for access approach choice. In the setting of prior abdominal surgery, extra- or transperitoneal approach are both safe, but adhesiolysis is often required in the latter [30].
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
For the one patient with unsuccessful insertion in the modified technique group, ultrasound examination revealed thickening of the extraperitoneal tissue with saline infusion that suggested the dialysis catheter was placed in the extraperitoneal space. Following several failed attempts of percutaneous catheter insertion, the patient underwent open surgical catheter placement.