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Midline Incision (midline + incision)
Selected AbstractsTHERAPEUTIC FISTULOSCOPY FOR THE MANAGEMENT OF PROLONGED POSTOPERATIVE INTRA-ABDOMINAL ABSCESS CAUSED BY SMALL INTESTINAL PINHOLE PERFORATIONDIGESTIVE ENDOSCOPY, Issue 4 2005Yoshihisa Saida Fistuloscopy is an effective treatment for intractable fistula, a sometimes difficult to manage postoperative intra-abdominal complication. A case of a 69-year-old male with an abdominal abscess after he underwent right hemi-colectomy for cecum cancer with invasions into the ileum and sigmoid colon is reported. A re-operation for lavage and drainage was performed 2 weeks after surgery. However, no obvious origin for the pus was located. Although physiological saline lavage was repeatedly performed, the effusion of pus persisted in the drain at the midline incision about 7 months after surgery. Then, fistuloscopy with an upper gastrointestinal endoscope was performed through the hole of the tube. A pinhole that produced a bubble just below the midline incision was observed. Then, an endoscopic retrograde cholangiopancreatography (ERCP) tube was inserted to obtain images of the small intestine by fluorography and findings suggested a diagnosis of perforation of the small intestine, which appeared to explain why resolution of the abscess was prolonged. After direct drainage to the small intestine with a 40-cm-long 7 Fr percutaneous transhepatic cholangio drainage (PTCD) balloon catheter, pus from the tube notably decreased. After confirming that the abscess cavity had disappeared by abdominal computed tomography scan, the PTCD catheter was extracted about 8 months after primary surgery. Since then, no recurrence of cancer or abscess has been observed. In cases of intractable postoperative intra-abdominal abscess, fistuloscopy using smaller diameter gastrointestinal endoscopy appears to be a valuable diagnostic tool. [source] Our experience with third renal transplantation: Results, surgical techniques and complicationsINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2007Mohammad Hossein Nourbala Background: Despite the popularity of kidney transplantation in the current era, second and third kidney transplantation are not yet widely accepted and practiced. Each center has its own regulations and experiences and there is no accepted protocol for third kidney transplantation. We report here our 15 years of experience with third kidney transplantation. Methods: This is a report of all the third kidney transplantations performed in Baqiyatallah Hospital, Tehran, Iran, between 1991 and 2006. Demographic data, surgical techniques, complications and outcomes are reported. Results: Of the nine third kidney transplant patients, six were male. The median age was 43 years (32,52). All of the patients received kidney from living donors. All operations were performed by a midline incision and the grafts were placed at the midline, in the intraperitoneal space. For arterial anastomosis, we used internal iliac, right common iliac and both the right external iliac and inferior mesenteric artery in 4, 4 and 1 case(s), respectively. For venous anastomosis, we used vena cava, common iliac and external iliac veins in 3, 5 and 1 case(s), respectively. During the follow up period (38 months), 6 grafts (66.6%) were functioning. None of the graft rejections were due to surgical complications. Wound dehiscence occurred in two patients. No other surgical complications including infection, lymphocele or hemorrhage were observed. Conclusion: Third kidney transplantation is a field that has not been fully explored. The rate of complications seems to be not much higher than the first transplantation. Defining a standard protocol seems necessary. [source] Upper midline incision for living donor right hepatectomyLIVER TRANSPLANTATION, Issue 2 2009Seong Hoon Kim Innovations and refinements in the techniques of living donor right hepatectomy (LDRH) have been made over the past decades, but the type and size of abdominal incision have been at a standstill since its inception. We introduce herein the upper midline incision for LDRH using the standard open technique. A prospective case-matched study was conducted on 23 consecutive donors who underwent LDRH under a supraumbilical upper midline incision (I group) from February to May 2008. These donors were matched 1:1 to 23 right liver donors with a conventional J-shaped incision (J group) according to age, gender, and body mass index. Under the mean incision length of 13.5 cm, LDRH was successfully completed in all 23 donors without extension of the incision, with a mean operative time of 232.3 ± 29.2 minutes. No donors required blood transfusion during surgery. There were 2 cases of postoperative bleeding immediately controlled under the same incision and a case of pleural effusion. All donors fully recovered and returned to their previous activities. All grafts have been functioning well. Compared with the J group, the I group had a shorter operative time, a shorter period of analgesic use, and, after discharge, infrequent complaints of wound pain. This upper midline incision, even without laparoscopic assistance, can be used for LDRH with less pain and without impairing safety, reproducibility, or effectivity, allowing the seemingly insufficient incision to be recommended to the transplant centers that are practicing living donor liver transplantation. Liver Transpl 15:193,198, 2009. © 2009 AASLD. [source] Surgical treatment of thoracolumbar fracture through an approach via the paravertebral muscleORTHOPAEDIC SURGERY, Issue 3 2009Wei Pang MD Objective:, To investigate the methods for, and clinical outcome of, the operative treatment of thoracolumbar fractures through an approach via the paravertebral muscle (PVM). Methods:, From June 2005 to August 2006, 62 patients, comprising 48 men and 14 women with an average age of 45.2 years (range, 21,58) with thoracolumbar fractures without neurological involvement underwent surgical treatment. Twenty-one fractures were located at T12, 24 at L1 and 17 at L2. The study comprised 15 compression and 47 burst fractures with an intact posterior column. Thirty-four cases were selected randomly to undergo surgery through the above approach, while the other 28 cases underwent the traditional procedure. After making a posterior midline incision, which not only facilitates insertion of pedicle screws and fusion of the graft bone at facet joints, but spares the attachment of PVM, the interval between the longissimus and multifidus muscles was undermined. Drainage was not routinely needed and the patients became ambulant with a brace earlier post-operatively. Results:, The new approach had statistically significant advantages (P < 0.005) over the traditional one in regard to blood loss, drainage, duration of recumbency and visual analogue scale (VAS), although the time required was almost the same for the two procedures. Till August 2007, 56 patients were successfully followed up for 12 to 26 months (mean, 18.6) and bone fusion was identified in all cases. Neither reduction loss nor loosening or breakage of the fixation occurred. Conclusion:, The technique of operating through an approach between the PVM is recommended for thoracolumbar fractures because it is much less invasive, can reduce blood loss and accelerates rehabilitation. [source] Robotic Transabdominal Kidney Transplantation in a Morbidly Obese PatientAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010P. Giulianotti Kidney transplantation in morbidly obese patients can be technically demanding. Furthermore, morbidly obese patients experience a high rate of wound infections and related complications, which mostly result from the longer length and extent of the incision. These complications can be avoided through minimally invasive surgery; however, conventional laparoscopic instruments are unsuitable for the safe performance of a kidney transplant in morbidly obese patients. Herein, we report the first minimally invasive, total robotic kidney transplant in a morbidly obese patient. A left, deceased donor kidney was transplanted into a 29-year-old woman with a body mass index (BMI) of 41 kg/m2 who had been on hemodialysis for 5 years. The operation was performed intraabdominally using the DaVinci Robotic Surgical System with 4 trocars and a 7 cm midline incision. The operative time was 223 min, and the blood loss was less than 50 cc. The kidney had immediate graft function. No perioperative complications were observed, and the patient was discharged on postoperative day 5 with normal kidney function. Minimally invasive access and robotic technology facilitated the safe performance of a successful kidney transplant in a morbidly obese patient. [source] Fast track surgery: A clinical auditAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Jonathan CARTER Background:, Fast track surgery is a concept that utilises a variety of techniques to reduce the surgical stress response, allowing a shortened length of stay, improved outcomes and decreased time to full recovery. Aims:, To evaluate a peri-operative Fast Track Surgical Protocol (FTSP) in patients referred for abdominal surgery. Methods:, All patients undergoing a laparotomy over a 12-month period were entered prospectively on a clinical database. Data were retrospectively analysed. Results:, Over the study period, 72 patients underwent a laparotomy. Average patient age was 54 years and average weight and BMI were 67.2 kg and 26 respectively. Sixty three (88%) patients had a vertical midline incision (VMI). There were no intraoperative blood transfusions. The median length of stay (LOS) was 3.0 days. Thirty eight patients (53%) were discharged on or before post op day 3, seven (10%) of whom were discharged on postoperative day 2. On stepwise regression analysis, the following were found to be independently associated with reduced LOS: able to tolerate early enteral nutrition, good performance status, use of COX inhibitor and transverse incision. In comparison with colleagues at the SGOG not undertaking FTS for their patients, the authors' LOS was lower and the RANZCOG modified Quality Indicators (QI's) did not demonstrate excess morbidity. Conclusions:, Patients undergoing fast track surgery can be discharged from hospital with a reduced LOS, without an increased readmission rate and with comparative outcomes to non-fast tracked patients. [source] Causative factors, surgical treatment and outcome of incisional hernia after liver transplantationBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2002Dr H. Janßen Background: Little is known about the incidence and causes of herniation, and the results of hernia repair in patients undergoing liver transplantation. Likewise, nothing is known about the best surgical approach for hernia repair. Methods: A retrospective analysis was conducted of the occurrence of incisional hernia in 290 patients who had liver transplantation between 1990 and 2000, and survived more than 6 months. Follow-up data were obtained from medical records and the outpatient service. Patients were evaluated for various clinical and surgical factors. Hernias were analysed with respect to localization, type of surgical repair and recurrence rate. Results: Some 17 per cent of the transplanted patients experienced an incisional hernia. Risk factors were acute rejection with affiliated steroid bolus therapy (P = 0·025), a low platelet count after transplantation (P = 0·048), and a transverse abdominal incision with upper midline approach (P = 0·04). Hernias were mainly located at the junction of the transverse and midline incision (P < 0·001) and the recurrence rate was highest here (P = 0·007). Prosthetic hernia repair achieved the lowest rate of recurrence and did not increase the incidence of infectious complications. Conclusion: Improved immunosuppression should avoid early steroid bolus therapy after transplantation. A low platelet count promotes herniation. Transverse abdominal incision seems to be the best approach for liver transplantation. Prosthetic hernia repair does not increase the complication rate. © 2002 British Journal of Surgery Society Ltd [source] Incision design in implant dentistry based on vascularization of the mucosaCLINICAL ORAL IMPLANTS RESEARCH, Issue 5 2005Johannes Kleinheinz Abstract Objectives: The delivery of an adequate amount of blood to the tissue capillaries for normal functioning of the organ is the primary purpose of the vascular system. Preserving the viability of the soft tissue segment depends on the soft tissue incision being properly designed in order to prevent impairment of the circulation. A knowledge of the course of the vessels as well as of their supply area are crucial to the decision of the incision. The aim of this study was to visualize the course of the arteries using different techniques, to perform macroscopic- and microscopic analyses, and to develop recommendations for incisions in implant dentistry. Material and methods: The vascular systems of seven edentulous human cadavers were flushed out and filled with either red-colored rubber bond or Indian ink and formalin mixture. After fixation a macroscopic preparation was performed to reveal the course, distribution and supply area of the major vessels. In the area of the edentulous alveolar ridge specimens of the mucosa were taken and analyzed microscopically. Results: The analyses revealed the major features of mucosal vascularization. The main course of the supplying arteries is from posterior to anterior, main vessels run parallel to the alveolar ridge in the vestibulum and the crestal area of the edentulous alveolar ridge is covered by a avascular zone with no anastomoses crossing the alveolar ridge. Conclusion: The results suggest midline incisions on the alveolar ridge, marginal incisions in dentated areas, releasing incisions only at the anterior border of the entire incision line, and avoidance of incisions crossing the alveolar ridge. Résumé Fournir une quantité adéquate de sang aux capillaires pour un fonctionnement normal de l'organe est le but premier du système vasculaire. Préserver la viabilité du segment de tissu mou dépend de l'incision du tissu mou qui doit être effectuée de manière précise pour prévenir la détérioration de la circulation. Une connaissance de géographie des vaisseaux ainsi que de leurs aires de réserve sont essentiels pour la décision de l'incision. Le but de cette étude a été de visualiser les artères en utilisant différentes techniques afin d'effectuer des analyses tant macro- que microscopiques et pour developper des recommandations pour les incisions lors de la pose d'implants dentaires. Les systèmes vasculaires de sept cadavres humains édentés ont été vidés et remplis avec soit de l'encre de Chine ou une solution rouge et du formol. Après fixation une préparation macroscopique a été effectuée pour mettre en évidence le cours, la distribution et l'aire de réserve des principaux vaisseaux. Dans la zone du rebord alvéoaire édenté des spécimens des muqueuses ont été prélevés et analysés microscopiquement. Les analyses ont mis en évidence les principaux caractères de la vascularisation de la muqueuse. Le cours principal des artères converge de l'arrière vers l'avant, les vaisseaux principaux courent parallèlement au rebord alvéolaire dans le vestibule et l'aire crestale des rebords alvéolaires édentés et sont couverts par une zone non-vascularisée sans anastomose traversant le rebord alvéolaire. Ces résultats suggèrent donc des incisions au milieu de la ligne du rebord alvéolaire, des incisions marginales dans les zones dentées, des incisions d'accès seulement dans la frontière antérieure de la ligne d'incision générale et l'abstention d'incision traversant la crête alvéolaire. Zusammenfassung Ziele: Das erste Ziel des Gefässsystems ist es, eine adäquate Menge Blut zu den Kapillaren zu führen, um eine normale Funktion des Organs zu gewährleisten. Der Erhalt der Lebensfähigkeit des Weichteilsegments hängt von der Weichgewebsinzision ab, welche sauber gestaltet sein sollte, um die Zirkulation nicht zu beeinträchtigen. Die Kenntnis des Verlaufs und der Versorgungsgebiete der Gefässe ist für die Wahl der Inzision entscheidend. Das Ziel dieser Studie war, den Verlauf der Arterien mittels verschiedener Techniken sichtbar zu machen, um makroskopische und mikroskopische Analysen durchführen zu können und um Empfehlungen für Inzisionen in der oralen Implantatchirurgie zu entwickeln. Material und Methoden: Das Gefässsystem von 7 zahnlosen menschlichen Kadavern wurde ausgespült und entweder mit rot gefärbter Gummiflüssigkeit oder mit indischer Tinte und einer Formalinmixtur aufgefüllt. Nach der Fixierung wurde eine makroskopische Präparation durchgeführt, um den Verlauf, die Verteilung und die Versorgungsgebiete der grossen Gefässe aufzuzeigen. Im Bereich des zahnlosen Alveolarkammes wurden Proben der Mukosa entnommen und mikroskopisch analysiert. Resultate: Die Analysen zeigten die generellen Eigenschaften der Vaskularisation von Schleimhäuten. Die Hauptrichtung der versorgenden Gefässe verläuft von posterior nach anterior, die Hauptgefässe liegen parallel zum Alveolarkamm im Vestibulum und die Kammregion des zahnlosen Alveolarkammes wird durch eine avaskuläre Zone ohne den Alveolarkamm überkreuzende Anastomosen bedeckt. Schlussfolgerung: Aufgrund der Resultate werden Inzisionen im Bereich der Kammmitte des zahnlosen Alveolarkammes und marginale Inzisionen im bezahnten Bereich vorgeschlagen. Entlastungsschnitte sollten nur an der anterioren Grenze der gesamten Inzisionslinie gelegt werden. Inzisionen, welche den Alveolarkamm überkreuzen, sollten vermieden werden. Resumen Objetivos: El suministro de una cantidad adecuada de sangre a los capilares tisulares para el funcionamiento normal de un órgano es el propósito primario del sistema vascular. La preservación de la viabilidad del segmento de tejido blando depende en la incisión del tejido blando que debe estar debidamente diseñada en orden a prevenir mermas en la circulación. Un conocimiento del curso de los vasos al igual que del área de suministro es crucial para la decisión de la incisión. La intención de este estudio fue visualizar el curso de las arterias usando diferentes técnicas, para realizar análisis macro- y microscópicos, y desarrollar recomendaciones para incisiones en odontología de implantes. Material y métodos: Se vaciaron los sistemas vasculares de 7 cadáveres humanos edéntulos y rellenados con pegamento de goma de color rojo o con una mezcla de tinta india y formalina. Tras la fijación se llevó a cabo una preparación macroscópica para revelar el curso, distribución y área de suministro de los vasos principales. En el área de la cresta alveolar edéntula se tomaron especímenes y se analizaron microscópicamente. Resultados: Los análisis revelaron las principales características de la vascularización mucosa. El curso principal de las arterias de suministro as desde posterior a anterior, los vasos principales corren paralelos a la cresta alveolar en el vestíbulo y el área crestal de la cresta alveolar esta cubierta por una zona avascular sin anastomosis que crucen la cresta alveolar. Conclusión: Los resultados sugieren incisiones en la cresta alveolar, incisiones marginales en áreas dentadas, incisiones liberadoras solo en el borde anterior de la línea completa de incisión, y evitar las incisiones que crucen la cresta alveolar. [source] | ||||||||||||||||||||||