Category Archives: Abdominal

Splenic injury grades & management

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“Management of blunt spleen injuries has evolved from mandatory splenectomy to non-operative management (NOM) allowing for splenic salvage. The Eastern Association for the Surgery of Trauma (EAST) practice management guideline for the management of blunt solid organ injury recommends NOM in splenic injury regardless of age, grade, or associated injuries.”

“Splenectomy continues to be the treatment of choice in patients with unstable hemodynamics and a known splenic injury. In the hemodynamically normal patient, current practice is to observe the patient and treat with NOM to save the patients the complications associated with surgery.”

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Retained wound VAC material as complication of abdominoplasty

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With large cavitating wounds, there is a risk of sponge retention that may be all too easily
overlooked, particularly with the surgeons’ habit of cutting the sponge to the desired shape and the use of multiple fragments. We therefore recommend that a count is made of the number of sponges used – as is standard practise for swabs, needles and instruments.

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Prevention of Parastomal Hernia

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“Parastomal hernia, defined as an incisional hernia at the abdominal wall defect resulting from stoma formation, is a frequent complication of enterostomy (ileostomy and jejunostomy), colostomy, and urostomy. A growing body of evidence supports the use of prophylactic mesh at the time of stoma creation to prevent the development of PSH. In particular, the use of permanent mesh has been supported in the creation of an end colostomy, and prophylactic mesh has been studied for use in other types of stoma.”

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Laparoscopic mesh versus suture repair of hiatus hernia

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“Hiatus hernia contributes to the pathophysiology of gastroesophageal reflux disease (GERD). Mesh-augmentation of surgical repair might be associated with a reduced risk of recurrence and GERD. However, recurrence rates, mesh-associated complications and quality of life after mesh versus suture repair are debated. The aim of this meta-analysis was to determine HH recurrence following mesh-augmentation versus suture repair.”

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Comparative study between Graham’s omentopexy and modified-Graham’s omentopexy

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“Peptic ulcer perforation is a frequent cause of hospitalization, which affects 2–10% of patients with peptic ulcer. Omentopexy is commonly used in emergency management of duodenal ulcer perforation. Omentopexy was first described by Cellen Jones in 1929 and was later modified by Graham in 1937. The surgical approaches for omental patching rely on two principles, that is, direct and indirect omentopexy.”

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Anterior versus posterior component separationfor hernia repair in a cadaveric mode

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Component separation via both anterior and posterior approaches provide substantial myofascial advancement.In our model, we noted statistically greater anterior fascial medialization after PCS versus ACS as a whole, and especiallyin the upper and mid-abdomen. We advocate PCS as a reliable and possibly superior alternative for linea alba restoration forreconstructive repairs, especially for large defects in the upper and mid-abdomen.

Majumder

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Component separation index

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“Abdominal wall reconstruction in the ventral hernia patient represents a constant challenge to the general surgeon and plastic and reconstructive surgeon. Current studies lack a predictive value or objective 3-dimensional measurement to assist in the treatment algorithm or to assess and analyze surgical outcomes. On the basis of our current data, we believe the component seperation index, much like other commonly used anthropomorphic measurements, can assist with decisions for reconstructive options preoperatively.”

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