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Wang XJ, Fei T, Xiang XH, Wang Q, Zhou EC. Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty. World J Gastrointest Surg 2024; 16:2202-2210. [PMID: 39087094 PMCID: PMC11287682 DOI: 10.4240/wjgs.v16.i7.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND The totally preperitoneal (TPP) approach is a new concept that was recently introduced. Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages, there is little evidence reflecting the characteristics and feasibility of either approach. AIM To analyze the potential applications of single-incision laparoscopic TPP (SIL-TPP) inguinal hernia hernioplasty for the treatment of inguinal hernias. METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022. A single-port, named Iconport, and standard laparoscopic instruments were used during the operation. Demographic data, intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed. RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1. The average age was 49.5 years (range from 21 to 81 years). The average body mass index was 27.7 kg/m2 (range from 17.7 kg/m2 to 35.6 kg/m2). SIL-TPP were conducted successfully in 147 patients. Three patients were converted to the SIL-transabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience. In 2 patients with incisional hernias, an auxiliary operation hole was added during the SIL-TPP procedure, as required for surgery. The mean operative time was 64.5 minutes (range: 36.0-110.0 minutes) for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias (range: 40.0-150.0 minutes). The mean postoperative hospital stay was 3.4 days. CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair. SIL-TPP has potential benefits for patients with various abdominal wall hernias. Consequently, doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.
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Affiliation(s)
- Xiao-Jun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315020, Zhejiang Province, China
| | - Ting Fei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315020, Zhejiang Province, China
| | - Xiong-Hua Xiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315020, Zhejiang Province, China
| | - Quan Wang
- Ambulatory Surgery Center, Xijing Hospital, Air Force Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - En-Cheng Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Ningbo University, Ningbo 315020, Zhejiang Province, China
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Jin X, Chu Q, Bing H, Li F, Bai J, Lou J, Sun L, Zhang C, Lin L, Li L, Wang H, Zhou Z, Zhang J, Lian H. Preperitoneal pelvic balloon tamponade-an effective intervention to control pelvic injury hemorrhage in a swine model. Front Bioeng Biotechnol 2024; 12:1340765. [PMID: 38737537 PMCID: PMC11082274 DOI: 10.3389/fbioe.2024.1340765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Objective: This study aimed to estimate the effects of the volume of preperitoneal balloon (PPB) on arterial and venous hemorrhage in a swine pelvic fracture model. Methods: Twenty-four swine were randomized into 0-mL, 500-mL, 800-mL, and 1000-mL intra-hematoma PPB groups. They were subjected to open-book pelvic fracture and reproducible injuries in the external iliac artery and vein. The pelvic binder and IH-PPBs with different volumes of fluid were applied to control the active hemorrhage after arterial and venous injuries. The survival time and rate during 60-min observation and digital subtraction angiography (DSA) images were the primary endpoints in this study. Secondary endpoints included survival rate within 70 min, peritoneal pressure, hemodynamics, blood loss, infusion fluid, blood pH, and lactate concentration. Results: Our results indicated that the 800-mL and 1000-mL groups had a higher survival rate (0%, 50%, 100% and 100% for 0, 500, 800, and 1000-mL groups respectively; p < 0.0001) and longer survival time (13.83 ± 2.64, 24.50 ± 6.29, 55.00 ± 6.33, and 60.00 ± 0.00 min for 0, 500, 800, and 1,000 groups respectively; p < 0.0005) than the 0-mL or 500-mL groups during the 60 min observation. Contrastingly, survival rate and time were comparable between 800-mL and 1000-mL groups during the 60-min observation. The IH-PPB volume was associated with an increase in the pressure of the balloon and the preperitoneal pressure but had no effect on the bladder pressure. Lastly, the 1000-mL group had a higher mean arterial pressure and systemic vascular resistance than the 800-mL group. Conclusion: IH-PPB volume-dependently controls vascular bleeding after pelvic fracture in the swine model. IH-PPB with a volume of 800 mL and 1000 mL efficiently managed pelvic fracture-associated arterial and venous hemorrhage and enhanced survival time and rate in the swine model without evidences of visceral injury.
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Affiliation(s)
- Xiaogao Jin
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Qinjun Chu
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Hailong Bing
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Fang Li
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jingyue Bai
- Department of Orthopedics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Junge Lou
- Department of Peripheral Vascular Intervention, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Liwei Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Chenxi Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Lin Lin
- Department of Ultrasound Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Liumei Li
- Department of Anesthesiology, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Haibo Wang
- Department of Orthopedics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Zhanfeng Zhou
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Junfeng Zhang
- Department of Anesthesiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongkai Lian
- Department of Anesthesiology and Perioperative Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
- Department of Ultrasound Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
- Research of Trauma Center, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
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Kwon HJ, Kim YJ, Kim Y, Kim S, Cho H, Lee JH, Kim DH, Jeong SM. Complications and Technical Consideration of Ultrasound-Guided Rectus Sheath Blocks: A Retrospective Analysis of 4033 Patients. Anesth Analg 2023; 136:365-372. [PMID: 36638514 DOI: 10.1213/ane.0000000000006282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although the ultrasound-guided rectus sheath block (RSB) is usually regarded as an easy and safe procedure in clinical settings, there is currently no report on complications incidence. Therefore, the present study investigated complications in a large cohort and described the technical considerations to minimize complications of real-time ultrasound-guided RSBs. METHODS This was a retrospective cohort study of patients who underwent real-time ultrasound-guided RSBs for perioperative pain control in laparoscopic surgery with an umbilical port between February 1, 2017, and February 28, 2021, at the Asan Medical Center in South Korea. All RSBs were performed bilaterally using a 23-gauge Quincke needle, and a bilateral 2-block placement was regarded as 1 RSB. Patient data, including demographics, preoperative laboratory data, preoperative antiplatelet or anticoagulant medication with the duration of discontinuation, and type of surgery, were collected to show the study population characteristics and explore potential factors associated with adverse events such as hematoma. Ultrasound images of patients and adverse events of RSBs, including extrarectus sheath injections, vascular injuries, bowel injury, or local anesthetic systemic toxicity, were also analyzed accordingly. RESULTS A total of 4033 procedures were analyzed. The mean body mass index of the patients was 24.1 (21.8-26.5) kg/m2. The preoperative laboratory data were within normal range in 4028 (99.9%) patients. Preoperative antiplatelets or anticoagulants were administered in 17.3% of the patients. Overall, 96 complications (2.4%) were observed. Among them, extrarectus sheath injection occurred in 88 cases (2.2%), which included preperitoneal injection (0.9%) and intraperitoneal injection (1.3%). Vascular injuries constituted 8 cases (0.2%) and all vascular injuries resulted in hematoma: 7 cases of inferior epigastric artery injury with rectus sheath hematoma and 1 of inferior mesenteric artery injury with retroperitoneal hematoma. Bowel injury or local anesthetic systemic toxicity was not reported. CONCLUSIONS In this study of RSBs performed on 4033 patients using a 23-gauge Quincke needle in patients with low body mass index, there were 8 cases (0.2%) of vascular injury, all of which accompanied hematoma.
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Affiliation(s)
- Hyun-Jung Kwon
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeon Ju Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Youngmu Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seonjin Kim
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Hakmoo Cho
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea
| | - Jong-Hyuk Lee
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Doo-Hwan Kim
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Moon Jeong
- From the Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Zhou E, Qi C, Wang X, Fei T, Huang Q. Single incision laparoscopic totally preperitoneal hernioplasty (SIL-TPP): Lessons learned from 102 procedures and initial experience. Medicine (Baltimore) 2022; 101:e30882. [PMID: 36181025 PMCID: PMC9524943 DOI: 10.1097/md.0000000000030882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The abdominal wall in groin area is conventionally considered that it was comprised by 9 layers. Single incision laparoscopy totally extraperitoneal hernioplasty (SIL-TEP) reported before were operated through the front of the posterior rectus sheath. METHOD 102 SIL-TPP were conducted from October 2018 to October 2020 at The Affiliated Hospital of Medical School of Ningbo University using a self-made single-port device and standard laparoscopic instruments. Clinical data, demographic and intraoperative findings, and short-term postoperative outcomes were analyzed. RESULTS Of the 102 hernias treated, 46 were right inguinal hernias, 33 were left inguinal hernias and 23 were double-side inguinal hernias. All patients received the SIL-TPP and no conversion happened. The mean left-side and right-side hernia operative time was almost same. The left-side and right-side operative time were 75.48 ± 26.95 and 76.24 ± 26.09 minutes, respectively. The mean operative time was 75.92 ± 26.45 (range, 29-170 minutes) in unilateral inguinal hernia. Mean operative time was 104.17 ± 28.58 minutes (range, 67-180 minutes) in double-side inguinal hernia. The intraoperative complications rate was 21.57 (22/102) and all the complications were Peritoneum or sac tearing. Postoperative complications occurred in 3 cases (1 case wound seroma, 1 case urinary retension and 1 case upper respiratory infection) and were successfully treated conservatively. The mean hospital stay was 2.8646 ± 1.38 days. The 24 hours Visual analogue scale score was 2.28 ± 0.77. During follow-up to June 2022, no recurrence case occurred. CONCLUSION SIL-TPP is safe and feasible. SIL-TPP has its unique skills and advantages to treat inguinal hernia. Large-scale randomized controlled trials comparing SIL-TPP inguinal hernia repair with conventional single port and conventional three port laparoscopic totally extraperitoneal hernioplasty with short-term outcome and long-term recurrence rate are needed to confirm these results.
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Affiliation(s)
- Encheng Zhou
- Department of Gastrointestinal Surgery of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Changlei Qi
- Department of Gastrointestinal Surgery of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Xiaojun Wang
- Department of Gastrointestinal Surgery of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Ting Fei
- Department of Gastrointestinal Surgery of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Qing Huang
- Emergency Department of The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
- *Correspondence: Qing Huang, Emergency Department of The Affiliated Hospital of Medical School, Ningbo University, 247 Renmin Road, Ningbo, Zhejiang 315000, China (e-mail: )
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Gallyamov EA, Agapov MA, Wu Z, Kakotkin VV, Kuznetsova AA, Wang Y, Wang Y, Zhang X, Zhang J. LAPAROSCOPIC APPROACH IN THE TREATMENT OF INGUINAL HERNIAS IN PATIENTS AFTER RADICAL PROSTATECTOMY: COMPARISON OF TARR AND TER RESULTS. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-2-43-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim: To compare and evaluate the immediate and long-term results of performing transabdominal preperitoneal hernioplasty (TAPP) and total extraperitoneal hernioplasty (TEP) for the treatment of inguinal hernias after surgical treatment of prostate cancer;Material and method: the study is a clinical analytical prospective study, with the use of randomization. The study included 88 patients with inguinal hernia, who were randomly divided into two groups (group A (n = 44) and group B (n = 44)). Patients in group A received TEP, those in group B received TAPP. The end points of the study were the results associated with the operation itself and the prognosis of the disease in the two groups.Results: Group A: one patient had a scrotal hematoma, in 2 cases nosocomial pneumonia or infectious complications from the postoperative wound. The overall rate of early postoperative complications was 6.8%. In group B, the following postoperative complications were reported: in one case, intestinal injury, 1 case of acute urinary retention, 2 cases of scrotal hematoma. The overall incidence of early postoperative complications was 9.1%. There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ = 0.009, P > 0.05).Conclusion: During the analysis of the obtained results, no statistically significant difference was found in the duration of hospitalization, the volume of blood loss and the severity of the pain syndrome (P> 0.05); however, the comparison groups differed in the duration of the operation: the operation time in group A was longer than in group B. (P<0.05).
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Affiliation(s)
- E. A. Gallyamov
- Sechenov University; Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | - M. A. Agapov
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
| | | | - V. V. Kakotkin
- Federal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)
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A huge preperitoneal collection following acute necrotizing pancreatitis: A case report and the management approach. Ann Med Surg (Lond) 2022; 78:103843. [PMID: 35734743 PMCID: PMC9207096 DOI: 10.1016/j.amsu.2022.103843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
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Garcia-Urena MÁ, Lopez-Monclus J, de Robin Valle de Lersundi A, Blazquez Hernando LA, Medina Pedrique M, Rial Justo X, Cruz Cidoncha A, Nogueira Sixto M, Munoz-Rodriguez J. Pathways of the preperitoneal plane: from the “fatty triangle” in Rives to the “fatty trident" in extended retromuscular abdominal wall reconstruction. A tribute to Prof. Schumpelick. Hernia 2022; 27:395-407. [PMID: 35426573 DOI: 10.1007/s10029-022-02602-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/08/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE Extended retromuscular dissection performed for abdominal wall reconstruction in complex abdominal wall repair has progressively exposed the anatomy between the peritoneal layer and abdominal wall muscles. This study aimed to assess the morphology and distribution of preperitoneal fat in a cadaveric model and its influence in retromuscular preperitoneal dissections. METHODS Thirty frozen cadaver torsos were dissected by posterior component separation. The shape of the preperitoneal fat was identified, and the dimensions and more significant distances were calculated. RESULTS The results showed that the preperitoneal fat resembles a trident, exists along the midline under the linea alba, and expands in the epigastric area into a rhomboid shape. The fatty triangle was found to be a part of this rhomboid. Caudally, the midline preperitoneal fat widened under the arcuate line to reach the Retzius space. Laterally, the Bogros space communicated the root of the trident with the paracolic gutters, Toldt's fascia, and pararenal fats, forming the lateral prong of the trident. The peritoneum not covered by the preperitoneal fatty trident was easy to break. Three pathways could be tracked following the distribution of this fat that facilitated the dissection of the preperitoneal space to prepare the landing zone of the meshes in hernia repair. CONCLUSION The concept of preperitoneal fatty trident may be of practical assistance to perform various hernia procedures, from the simple ventral hernia repair to the more complex preperitoneal ventral repair or posterior component separation techniques. The consistency of this layer allows us to follow three specific pathways to find our plane between the peritoneum and muscle layers to extend the preperitoneal dissection.
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Affiliation(s)
- M Á Garcia-Urena
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - J Lopez-Monclus
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 2, 28220, Majadahonda, Spain.
| | - A de Robin Valle de Lersundi
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - L A Blazquez Hernando
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, M-607, 9,100, 28034, Madrid, Spain
| | - M Medina Pedrique
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - X Rial Justo
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - A Cruz Cidoncha
- Grupo de Investigación de Pared Abdominal Compleja, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Carretera Pozuelo-Majadahonda km. 1.8, 28223, Pozuelo de Alarcón, Spain
| | - M Nogueira Sixto
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Alvaro Cunqueiro, Estrada de Clara Campoamor 341, 36213, Vigo, Spain
| | - J Munoz-Rodriguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Puerta de Hierro-Majadahonda, Calle Joaquín Rodrigo 2, 28220, Majadahonda, Spain
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Zhou Z, Yan L, Li Y, Zhou J, Ma Y, Tong C. Embryonic developmental process and clinical anatomy of the preperitoneal fascia and its clinical significance. Surg Radiol Anat 2022; 44:1531-1543. [PMID: 36404360 PMCID: PMC9734211 DOI: 10.1007/s00276-022-03046-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Many researchers have different views on the origin and anatomy of the preperitoneal fascia. The purpose of this study is to review studies on the anatomy related to the preperitoneal fascia and to investigate the origin, structure, and clinical significance of the preperitoneal fascia in conjunction with previous anatomical findings of the genitourinary fascia, using the embryogenesis of the genitourinary system as a guide. METHODS Publications on the preperitoneal and genitourinary fascia are reviewed, with emphasis on the anatomy of the preperitoneal fascia and its relationship to the embryonic development of the genitourinary organs. We also describe previous anatomical studies of the genitourinary fascia in the inguinal region through the fixation of formalin-fixed cadavers. RESULTS Published literature on the origin, structure, and distribution of the preperitoneal fascia is sometimes inconsistent. However, studies on the urogenital fascia provide more than sufficient evidence that the formation of the preperitoneal fascia is closely related to the embryonic development of the urogenital fascia and its tegument. Combined with previous anatomical studies of the genitourinary fascia in the inguinal region of formalin-fixed cadavers showed that there is a complete fascial system. This fascial system moves from the retroperitoneum to the anterior peritoneum as the preperitoneal fascia. CONCLUSIONS We can assume that the preperitoneal fascia (PPF) is continuous with the retroperitoneal renal fascia, ureter and its accessory vessels, lymphatic vessels, peritoneum of the bladder, internal spermatic fascia, and other peritoneal and pelvic urogenital organ surfaces, which means that the urogenital fascia (UGF) is a complete fascial system, which migrates into PPF in the preperitoneal space and the internal spermatic fascia in the inguinal canal.
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Affiliation(s)
- Zheqi Zhou
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China ,grid.440747.40000 0001 0473 0092Yan’an University, Yan’an, China
| | - Likun Yan
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Yi Li
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
| | - Jinsong Zhou
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Yanbing Ma
- grid.43169.390000 0001 0599 1243Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Cong Tong
- grid.440288.20000 0004 1758 0451Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 China
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Hori T, Yasukawa D. Fascinating history of groin hernias: Comprehensive recognition of anatomy, classic considerations for herniorrhaphy, and current controversies in hernioplasty. World J Methodol 2021; 11:160-186. [PMID: 34322367 PMCID: PMC8299909 DOI: 10.5662/wjm.v11.i4.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, femoral, obturator, and supravesical hernias. Here, we summarize historical turning points, anatomical recognition and surgical repairs. Groin hernias have a fascinating history in the fields of anatomy and surgery. The concept of tension-free repair is generally accepted among clinicians. Surgical repair with mesh is categorized as hernioplasty, while classic repair without mesh is considered herniorrhaphy. Although various surgical approaches have been developed, the surgical technique should be carefully chosen for each patient. Regarding as interesting history, crucial anatomy and important surgeries in the field of groin hernia, we here summarized them in detail, respectively. Points of debate are also reviewed; important points are shown using illustrations and schemas. We hope this systematic review is surgical guide for general surgeons including residents. Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
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Yasukawa D, Aisu Y, Hori T. Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults. World J Gastrointest Surg 2020; 12:307-325. [PMID: 32821340 PMCID: PMC7407845 DOI: 10.4240/wjgs.v12.i7.307] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of "tension-free repair" is generally accepted, and surgical repairs with mesh are categorized as "hernioplasties". Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.
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Affiliation(s)
- Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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11
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Alcaraz JP, Cinquin P, Martin DK. Tackling the Concept of Symbiotic Implantable Medical Devices with Nanobiotechnologies. Biotechnol J 2018; 13:e1800102. [PMID: 30367543 DOI: 10.1002/biot.201800102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/17/2018] [Indexed: 12/21/2022]
Abstract
This review takes an approach to implanted medical devices that considers whether the intention of the implanted device is to have any communication of energy or materials with the body. The first part describes some specific examples of three different classes of implants, analyzed with regards to the type of signal sent to cells. Through several examples, the authors describe that a one way signaling to the body leads to encapsulation or degradation. In most cases, those phenomena do not lead to major problems. However, encapsulation or degradation are critical for new kinds of medical devices capable of duplex communication, which are defined in this review as symbiotic devices. The concept the authors propose is that implanted medical devices that need to be symbiotic with the body also need to be designed with an intended duplex communication of energy and materials with the body. This extends the definition of a biocompatible system to one that requires stable exchange of materials between the implanted device and the body. Having this novel concept in mind will guide research in a new field between medical implant and regenerative medicine to create actual symbiotic devices.
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Affiliation(s)
- Jean-Pierre Alcaraz
- Univverity Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France.,SyNaBi, Pavillon Taillefer, Domaine de la Merci, La Tronche 38706, Grenoble, France
| | - Philippe Cinquin
- Univverity Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France.,SyNaBi, Pavillon Taillefer, Domaine de la Merci, La Tronche 38706, Grenoble, France
| | - Donald K Martin
- Univverity Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, F-38000 Grenoble, France.,SyNaBi, Pavillon Taillefer, Domaine de la Merci, La Tronche 38706, Grenoble, France
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12
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Quadrelli S, Lloyd T, Medoro L, Coucher J. Unusual case of extraperitoneal gas in the abdomen. J Med Imaging Radiat Oncol 2018; 63:79-81. [PMID: 30353980 DOI: 10.1111/1754-9485.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 09/04/2018] [Indexed: 12/01/2022]
Abstract
The retroperitoneal space is made up of multiple communicating compartments. Here we detail an unusual case of ectopic gas almost exclusively isolated to the properitoneal space, a space in communication with the retroperitoneum. This case is a reminder that when extraperitoneal gas is identified, the retroperitoneal structures should be interrogated carefully to identify a cause.
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Affiliation(s)
- Scott Quadrelli
- Radiology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Thomas Lloyd
- Radiology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Lora Medoro
- Radiology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - John Coucher
- Radiology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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13
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Adlam M, Feehan A, Metaxa V. Prevalence of psychiatric disorders in trauma patients: results from a major trauma unit. Crit Care 2015. [PMCID: PMC4471084 DOI: 10.1186/cc14557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Darwish AM, Mohammad AM. A new era for treating vaginal aplasia using transretropubic balloon vaginoplasty approach. Fertil Steril 2011; 95:1104-8. [PMID: 21227416 DOI: 10.1016/j.fertnstert.2010.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 10/21/2010] [Accepted: 12/13/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To test the efficacy, safety, and tolerability of a novel surgical alternative for formation of a neovagina in patients with vaginal aplasia. DESIGN Technique and instrumentations. SETTING A specialized endoscopic surgery center. PATIENT(S) Four patients with complete vaginal aplasia, three of them without a uterus and one with a functioning uterus. INTERVENTION(S) A silicone Foley catheter sutured to the distal end of a sharp curved needle with a wide eye attached to a plastic handle and passed extraperitoneally into the space of Retzius followed by its inflation and upward traction for 8 days. Clinical and magnetic resonance imaging (MRI) follow-up were done. MAIN OUTCOME MEASURE(S) Operative time, complication rate, tolerability of traction and retraction, reintervention rate, width and length of the newly formed vagina, and postoperative feasibility of intravaginal sexual intercourse for married cases. RESULT(S) The results were satisfactory (normal length and width of neovagina), without complications and with acceptable tolerability and normal sexual life within 8-10 days postoperatively for the married women. CONCLUSION(S) Both clinical and MRI follow-up confirmed that retropubic balloon vaginoplasty is a simple, fast, tolerable, safe, and available extraperitoneal procedure. It can be easily done by any gynecologist having basic knowledge of the anatomy of the retropubic space.
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15
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Percutaneous expansion technique for preperitoneal mesh repair in hernias of the lateral aspect of the anterior abdominal wall by using 2 tip hole needles. Ann Plast Surg 2009; 62:414-6. [PMID: 19325348 DOI: 10.1097/sap.0b013e31817fe490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Preperitoneal mesh repair is associated with good results in hernia repairs of the lateral aspect of the anterior abdominal wall, but this is difficult, and needs much subcutaneous dissection. The percutaneous expansion technique was used to produce well-expanded and fixed mesh at the preperitoneal plane without much dissection. This study included 40 patients who have hernias at the lateral aspect of the anterior abdominal wall. This technique was used to expand and fix the mesh at the preperitoneal plane by helping 2 tip hole needles through multiple small wounds in the anterior abdominal wall. There was no recurrence during the period of follow up. One patient developed subcutaneous seroma collection after 1 month of operation. This percutaneous expansion technique is novel, simple, and easy, and it is associated with good results in the repair of hernias of the lateral aspect of the anterior abdominal wall.
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16
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Lovisetto F, Zonta S, Rota E, Bottero L, Faillace G, Turra G, Fantini A, Longoni M. Laparoscopic transabdominal preperitoneal (TAPP) hernia repair: surgical phases and complications. Surg Endosc 2006; 21:646-52. [PMID: 17103276 DOI: 10.1007/s00464-006-9031-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 03/24/2006] [Accepted: 04/20/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study aimed to determine the nature of complications after transabdominal preperitoneal (TAPP) hernia repair, and to evaluate possible links to intraoperative factors in an effort to reduce the incidence of complications. METHODS The TAPP procedures for inguinal/femoral hernias performed between 1992 and 2004 at a single center were analyzed retrospectively. Complications were categorized according to severity and stage of the surgical procedure at which they occurred. Individual surgeon performances were examined to determine whether the rates of complications were related to surgeon experience. RESULTS A total of 1,973 TAPP procedures were reviewed, and 81% of the patients completed 5 years of follow-up evaluation. The 74 complications (3.7%) reported were categorized as follows: 33 major (1.7%) versus 41 minor (2.0%), 66 hernia-related (3.4%) versus 8 laparoscopy-related (0.5%) complications, and 12 recurrences (0.6%). Risk factors for complications included inguinoscrotal hernia (p < or = 0.001), dissection/reduction of the sac (p = 0.02), and surgeon experience (< 50 TAPP procedures; odds ratio, 7.1; 95% confidence interval, 4.2-11.9). CONCLUSIONS Accuracy in dissection/reduction of the sac improves the outcome of TAPP hernia repair. This effect is related to the experience of the surgeon. Experience performing more than 75 procedures is required for optimal results.
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Affiliation(s)
- F Lovisetto
- Dipartimento di Scienze Chirurgiche, Rianimatorie-Riabilitative e dei Trapianti d'Organo, Facoltà di Medicina, University of Pavia, Pavia, Italy.
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Skandalakis PN, Zoras O, Skandalakis JE, Mirilas P. Transversalis, Endoabdominal, Endothoracic Fascia: Who's Who? Am Surg 2006. [DOI: 10.1177/000313480607200104] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Terminologia Anatomica of 1998, the fasciae of the trunk are listed as parietal, extraserosal, and visceral. Parietal fascia is defined as the fascia located outside the parietal layer of a serosa (e.g., pleura, peritoneum) lining a body wall cavity. The parietal fascia of the thorax is endothoracic fascia, and that of the abdomen is endoabdominal fascia. According to Terminologia Anatomica, endoabdominal fascia comprises: 1) transversalis fascia and 2) investing abdominal fascia: deep, intermediate and superficial. Thus, transversalis fascia is the innermost layer of endoabdominal fascia and, consequently, not synonymous with it. We assert that transversalis fascia is the inner epimysium of transversus abdominis muscle; no separate deep investing fascia exists. Embryologically, deep, intermediate and superficial layers of investing fascia are produced as muscular primordia–originating from somites invading somatopleura–penetrate somatic wall connective tissue, and thus obtain epimysium on either side, which give layers of investing fascia. In the thoracic wall, muscle layers are not separated and no distinct investing fasciae are found on them. Furthermore, in the thorax extraserosal fascia does not exist. Therefore, only endothoracic fascia is found on the inner side of the innermost intercostal muscle, which is deprived of investing fascia, to separate this muscle from pleura.
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Affiliation(s)
- Panagiotis N. Skandalakis
- Centers for Surgical Anatomy & Technique, Emory University School of Medicine, Atlanta, Georgia; the
| | - Odyseas Zoras
- Department of General Surgery, University of Crete Medical School, Heraklion, Crete, Greece; and the
| | - John E. Skandalakis
- Centers for Surgical Anatomy & Technique, Emory University School of Medicine, Atlanta, Georgia; the
| | - Petros Mirilas
- Centers for Surgical Anatomy & Technique, Emory University School of Medicine, Atlanta, Georgia; the
- Department of Anatomy-Embryology, University of Crete Medical School, Heraklion, Crete, Greece
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