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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 14 newborns with gastroschisis, fascial closure was effected by muscular suture associated with teflon mesh prosthesis interposition. This was realized either in urgency during neonatal period (9), either secondly (5). Neonatal cases were treated between 0 h 30 and 5 h of age. Pulmonary hyper-pressure risk was very important when primary suture was early employed (card freq: 150 b. min-1. PA syst: 60 cm Hg; pulm pres: 20 cm Hg). When we used a teflon mesh prosthesis, we had 8 good results and only one initial death. 5 complications were represented by cutaneous ischemia which spontaneously disappeared (1), ischemia with infection and partial necrosis (2), important necrosis with teflon mesh prosthesis exteriorization (2). It has been definitely possible to achieve complete fascial in 7 newborns. Only one of them had a little ventral hernia. 5 newborns were early treated by simple skin coverage (Gross) as primary management. They have had teflon mesh prosthesis between 5 and 14 M of age and have undergone excision of the teflon mesh prosthesis and fascial repair without difficulty (5 good results). With teflon mesh prosthesis for treating congenital abdominal defects, abdominal hyper-pressure and pulmonary complications are exceptional. Local complications are very limited because of good vascular conditions. We did not have any adherences because of teflon mesh prosthesis good biological and histological tolerance. Digestive complications (statis, septicemia...) have been few and mild because physiological intra abdominal pressure has been early obtained.
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PMID:[Laparoschisis. Indications for a teflon patch in wall repair]. 214 1

Primary tissue closure of gastroschisis remains controversial. Some surgeons routinely place a silicone rubber sheet silo over the exposed bowel, planning a staged closure. In the past 14 1/2 years, we have cared for 106 newborns with gastroschisis, closing the defect primarily in 80%. The success of this technique depends on enlarging the abdominal cavity and decreasing the volume of bowel that must be replaced in the peritoneal cavity. Thorough preoperative rectal irrigation should evacuate all meconium. After undermining the skin around the abdominal wall defect for only 1 cm, a midline subcutaneous fasciotomy is created from the xiphoid to the pubis. The abdominal wall is then stretched in all quadrants beginning at the flanks. The eviscerated small bowel can often be returned without enlarging the initial skin defect. The skin is closed with subcuticular absorbable sutures reinforced by long skin tapes. The small ventral hernia that results is closed at about 1 year of age. Fascia could be closed primarily in 28% of these patients, and 17% required a prosthetic pouch. The duration of postoperative ileus and length of hospital stay were statistically significantly shorter in the infants who underwent primary closure. Even though more complicated patients were included in the primary closure group, the incidence of mortality and morbidity was not higher than in patients treated with silicone rubber pouches. Deaths were inevitable in five infants with gangrenous bowel, multiple anomalies, and extreme prematurity. Deaths were related to sepsis in three infants and were the result of operative or anesthetic technique in four. Only two preoperative factors were prognostic of morbidity and mortality: gestational age (but not birth weight) and the presence of intestinal ischemia or atresia.
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PMID:Gastroschisis in 106 consecutive newborn infants. 293 43

It has been reported that avoidance of recurrences after laparoscopic ventral hernia repair (LVHR) depends on using sutures to secure the mesh. We developed a successful sutureless LVHR. The "Double Crown" LVHR using ePTFE mesh (overlap, 23 cm) was done in 140 cases. Tacks were placed 1 cm apart at the edge of the mesh. A second crown of tacks was placed at the edge of the defect. Three conversions (2.14%) and five bowel perforations occurred intraoperatively (3.57%). Postoperative complications were prolonged ileus (two cases), hematoma (two cases), seroma requiring drainage (three cases), and reoperation in one case for mesh intolerance, three cases for bowel perforation, and one case for small bowel ischemia. The recurrence rate (mean follow-up of 40 months) was 2.14%. The Double Crown LVHR is a safe alternative to LVHR using sutures, with a similar recurrence rate, less pain, fewer incisions and infections, and a shorter operating time.
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PMID:Laparoscopic ventral hernia repair without sutures--double crown technique: our experience after 140 cases with a mean follow-up of 40 months. 1646 50

Component separation is a technique used to provide adequate coverage for midline abdominal wall defects such as a large ventral hernia. This surgical technique is based on subcutaneous lateral dissection, fasciotomy lateral to the rectus abdominis muscle, and dissection on the plane between external and internal oblique muscles with medial advancement of the block that includes the rectus muscle and its fascia. This release allows for medial advancement of the fascia and closure of up to 20-cm wide defects in the midline area. Since its original description, components separation technique underwent multiple modifications with the ultimate goal to decrease the morbidity associated with the traditional procedure. The extensive subcutaneous lateral dissection had been associated with ischemia of the midline skin edges, wound dehiscence, infection, and seroma. Although the current trend is to proceed with minimally invasive component separation and to reinforce the fascia with mesh, the basic principles of the techniques as described by Ramirez et al in 1990 have not changed over the years. Surgeons who deal with the management of abdominal wall defects are highly encouraged to include this technique in their collection of treatment options.
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PMID:Component separations. 2337 55

In open vascular repair, when prolonged infrarenal aortic clamping can be expected, and collateral perfusion is reduced, the use of a temporary shunt may reduce the risk of ischemic complications. In a patient with Marfan's syndrome and aortic dissection who had developed infrarenal aneurysms, segmental arteries had been occluded by prior aortic surgery and collateral arteries in the anterior torso could have been damaged by previous pectus excavatum, muscle flap, sternotomy, and ventral hernia operations. The axillary artery was dilated. For the prevention of ischemia during open repair with a bifurcated graft, a temporary extracorporeal brachio-femoral vascular prosthesis shunt was constructed. Ischemia was not observed. The use of a temporary extracorporeal brachio-femoral shunt with a vascular prosthesis is a feasible method for ischemia prevention.
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PMID:Temporary extracorporeal brachio-femoral vascular prosthesis shunt for ischemia prevention in an operation for abdominal aortic and iliac aneurysms in a patient with Marfan's syndrome. 2344 1

The success of hernia repair is measured by absence of recurrence, appearance of the surgical scar, and perioperative morbidity. Perioperative surgical site occurrence (SSO), defined as infection, seroma, wound ischemia, and dehiscence, increases the risk of recurrent hernia by at least 3-fold. The surgeon should optimize all measures that promote healing, reduce infection, and enhance early postoperative recovery. In the population with ventral hernia, the most common complication in the immediate perioperative period is surgical site infection. This article reviews several preoperative measures that have been reported to decrease SSOs and shorten length of hospital stay.
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PMID:Preoperative risk reduction: strategies to optimize outcomes. 2403 75

Hernias are routine general surgical problems that may present in any age group, regardless of the patient's socioeconomic status. We present a rare case of a complicated ventral hernia leading to short bowel. This is an unusual case and is very rarely reported in the literature. This current case report describes a 54-year-old gentleman who presented to the hospital with a giant strangulated ventral hernia causing massive bowel ischemia and resulting in a short bowel. The literature on large abdominal wall hernias leading to short bowel is reviewed, and a discussion on short bowel syndrome is also presented.
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PMID:An unusual outcome of a giant ventral hernia. 2621 51

Acute portomesenteric venous thrombosis is a rare but life-threatening complication of laparoscopic surgery that has been described in literature. Prompt diagnosis and early initiation of treatment are vital to prevent life-threatening complications such as mesenteric ischemia and infarction. A 51-year-old lady had laparoscopic small bowel resection and primary anastomosis with ventral hernia repair 4 weeks earlier for partial small bowel obstruction. Her postoperative period was uneventful and she was discharged home. Four weeks after surgery she developed watery diarrhea and generalized abdominal pain for four-day duration. A computed tomography of the abdomen revealed portomesenteric venous thrombosis although a computed tomography of abdomen before surgery 4 weeks back did not show any portomesenteric venous thrombosis. We are reporting a case of acute portomesenteric venous thrombosis as a complication of laparoscopic surgery.
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PMID:Acute Portomesenteric Venous Thrombosis following Laparoscopic Small Bowel Resection and Ventral Hernia Repair. 2629 84