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Complications of open aortofemoral bypass
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
There are extensive data in the general surgery literature on the avoidance and prevention of hernia. A recent meta-analysis specific to patients undergoing aortic surgery showed decreased hernia formation in those patients who were closed with a suture:wound length ratio of more than 4:1 and in those who underwent closure with mesh. There was no difference between midline and retroperitoneal incision.35 In high-risk patients, particularly those who have previously undergone abdominal wall repair, pre-emptive involvement with a general surgeon skilled in complex repair of abdominal wall defects may be helpful.
Gastroschisis
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Marshall Z. Schwartz, Shaheen J. Timmapuri
An alternative “gentle touch” technique has also been described. This method involves bedside placement of a spring-loaded silo, followed by passive reduction of the herniated contents into the abdomen via gravity. The infant is kept paralyzed or sedated and intubated with assisted ventilation during the passive reduction. The author states that this process typically takes 4–5 days. Subsequently, closure of the abdominal wall defect is performed.
The Scale of the Problem
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
Samuel G. Parker, Xavier Chalhoub, Alastair C.J. Windsor
The consensus meetings agreed that contaminated and dirty wounds should be classified as complex as they have a significantly higher risk of SSO and recurrence; furthermore, situations that degrade the quality of the residual tissues are regarded as complex. Often, this may involve an old laparostomy wound covered with granulation tissue or a skin graft, thus incisional hernia repair after an open abdomen is again classified as complex. More seldom this may involve a full-thickness abdominal wall defect from trauma, tumour resection or necrotising infection. AWR surgeons working in tertiary care units are often referred patients who have had multiple previous abdominal procedures, which have led to the current presenting hernia. The abdominal wall scarring that has occurred as a result of these procedures reduces the strength and integrity of the remaining tissue; AWR is therefore more challenging and complex. This group of conditions recognises the importance of healthy, clean, well-vascularised soft tissue in maintaining the integrity of a hernia repair, and any condition that removes or degrades this implies a more complex undertaking.
Trisomy 18 in a First-Trimester Fetus with Thoraco-Abdominal Ectopia Cordis
Published in Fetal and Pediatric Pathology, 2020
Ricardo Diaz-Serani, Waldo Sepulveda
The ultrasound diagnosis of ectopia cordis is straightforward and can be made even before 10 weeks of gestation [17]. It relies on the demonstration of a pulsating mass representing the heart outside the thoracic cavity and can be further confirmed with color-Doppler ultrasound. This was clearly demonstrated in our case. Indeed, the fetus presented in the first trimester with a large anterior thoraco-abdominal wall defect containing liver and heart, which was seen pulsating in the superior aspect of the defect on real-time ultrasound. However, milder cases of ectopia cordis such as the ones only involving the apex of the heart can often be overlooked. This is especially true when large associated abdominal wall defects are present [15]. A less prominent finding in our case was the detection of a mild increased nuchal translucency thickness, which on its own is a strong first-trimester ultrasound marker of both trisomy 18 [16] and congenital heart defects [18]. However, the concomitant presence of a large anterior thoraco-abdominal defect was crucial for offering prenatal karyotyping and establishing the cytogenetic diagnosis of trisomy 18.
Gestational Outcomes of Pregnancies with Prenatally Detected Gastroschisis and Omphalocele
Published in Fetal and Pediatric Pathology, 2019
Fatih Aktoz, Ozgur Ozyuncu, Atakan Tanacan, Erdem Fadiloglu, Canan Unal, Tutku Soyer, Tolga Celik, Mehmet Sinan Beksac
Abdominal wall defects are congenital defects affecting the development of the abdominal wall, resulting in protrusion of intraabdominal organs. The majority of these diseases consist of gastroschisis and omphalocele with frequencies of 3–4 and 1.86–4.49 per 10,000 livebirths, respectively [1, 2]. Both gastroschisis and omphalocele are associated with various risk factors, including primigravidity, young maternal age, poor diet and cigarette or drug consumption for gastroschisis, and extreme maternal ages (<20 or >40 years of age), black race and maternal obesity for omphalocele [3, 4]. Omphalocele is also associated with chromosomal abnormalities that may be as common as 60%, or various other congenital defects [5]. Gastroschisis is not strictly related to chromosomal abnormalities or other congenital defects and prognosis mostly depends on the gastroschisis itself [6].
Cost comparison of fibrin sealant versus tack screws for mesh fixation in laparoscopic repair of inguinal hernia
Published in Hospital Practice, 2018
Saswat Panda, Mark Connolly, Manuel G. Ramirez
Inguinal hernias are the most frequent types of abdominal wall defects, accounting for 75% of them. They are more prevalent in men than woman with a lifetime risk of 27% compared to 3%, respectively [1]. Inguinal hernias present as a lump in the groin, which can typically be reduced with light pressure causing mild to moderate discomfort, but can become more severe if left untreated. The prevalence of abdominal wall hernias is 4% in patients over 45 years old, and this is the typical age group of those who will eventually require surgical treatment, after exclusion of congenital hernias in children [1,2]. The primary treatment for inguinal hernias is surgical repair of the abdominal wall, which is the most common procedure performed in general surgery, ranging from 10 per 100,000 in the UK to 28 per 100,000 in the US [3].