Mesh sutured repairs of the abdominal wall

“All high-tension internal surgical closures require that the ultimate tensile strength (UTS) of the repair remains greater than the forces applied. Otherwise, changes at the suture/tissue interface (STI) will lead to acute or chronic suture pull-through and surgical failure. For the abdominal wall, prophylactic flat meshes have been shown to improve outcomes of laparotomy closures and hernia repairs. Unfortunately, flat planar meshes have their own drawbacks, including increased time for placement, increased foreign material, increased tissue dissection, pain, infection, and cost.”

“One hundred and seven patients underwent a mesh sutured abdominal wall closure. Seventy-six patients had preoperative hernias, and the mean hernia width by CT scan for those with scans was 9.1 cm. Forty-nine surgical fields were clean-contaminated, contaminated, or dirty. Five patients had infections within the first 30 days. Only one knot was removed as an office procedure. Mean follow-up at 234 days revealed 4 recurrent hernias.”

Lanier, S. T., et al (2016). Mesh Sutured Repairs of Abdominal Wall Defects. Plastic and reconstructive surgery. Global open, 4(9), e1060. Free Full Text

Evaluation of the utility of placing an intra-abdominal drain in laparoscopic appendectomy for complicated acute appendicitis.

“Complicated appendicitis (CA) may be a risk factor for postoperative intra-abdominal
abscess formation (IAA). In addition, several publications have shown an increased risk of postoperative collection after laparoscopic appendectomy. Most surgeons prefer to place a drain to collect contaminated abdominal fluid to prevent consequent abscess formation. We aimed to evaluate the utility of placing an intra-abdominal drain in laparoscopic appendectomy for complicated acute appendicitis.”

“This study concludes the use of intra-abdominal drain in laparoscopic appendectomy for complicated acute appendicitis does not prevent postoperative complications and may even lengthen hospital stay. Larger and prospective studies are needed to achieve more definitive conclusions.”

Schlottmann F, et al Could an abdominal drainage be avoided in complicated acute appendicitis? Lessons learned after 1300 laparoscopic appendectomies. Int J Surg. 2016 Dec;36(Pt A):40-43 Free Full Text

Antibiotic irrigation for decreasing the incidence of infection from ventral hernia repair.

“Surgical site infections (SSI) are common complications after open ventral hernia repair (OVHR), potentially requiring further intervention. Incidence of surgical site occurrence was significantly lower after G 1 C irrigation (Grp 1, 28.1%; Grp 2, 35.4%; Grp 3, 19.7%; P < 0.001). Incidence of SSI was significantly lower after G 1 C irrigation, but not G
alone (Grp 1, 16.5%; Grp 2, 15.2%; and Grp 3, 5.4%; P < 0.001). Multivariate logistic regression demonstrated significantly increased SSI with contaminated wounds (OR 2.96; 95% confidence interval (CI) 1.39–6.21), dirty wounds (OR 3.84; 95% CI 1.49–9.69), and chronic obstructive pulmonary disease (OR 3.70; 95% CI 2.16–6.38), as expected. Use of G 1 C was an independent predictor of decreased SSI (OR 0.33; 95% CI 0.16–0.67). Irrigation with a combined G 1 C antibiotic irrigation significantly reduces the incidence of surgical site infection after OVHR with mesh.” (Fatula)

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The risk of injury to inferior epigastric artery (IEA) subjects during abdominal procedure

“The anatomical position of the inferior epigastric artery (IEA) subjects it to risk of injury during abdominal procedures that are close to the artery, such as laparoscopic trocar insertion, insertion of intra-abdominal drains, Tenckhoffâ catheter (peritoneal dialysis catheter) and paracentesis. This article aims to raise the awareness of the anatomical variations of the course of the IEA in relation to abdominal landmarks in order to define a safer zone for laparoscopic ancillary trocar placement. Methods of managing the IEA injury as well as techniques to minimise the risk of injury to the IEA are reviewed and discussed.”

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