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- Title
RETROMUSCULAR MESH PLASTIE OF AN ANTERIOR ABDOMINAL WALL DEFECT, USING THE PERITONEAL FLAPS AND PEROPERATIVE INTRAABDOMINAL PRESSURE MONITORING. CASE PRESENTATION.
- Authors
Muresan, M.; Muresan, Simona; Bara, Tivadar; Neagoe, R.; Popescu, G.; Bara Jr., Tivadar; Sala, Daniela; Brinzaniuc, Klara
- Abstract
Aim: Parietal sutures performed under tension and elevated values of intraabdominal pressure are key elements in the evolution of incisional hernias. The study presents a tension free reconstruction model of the abdominal wall monitored through intraoperative recording of the intraabdominal pressure using the transvesical method. Material and methods: We present the case of a female patient with recurrent gigantic incisional hernia of the midline. A dedicated kit connected to the bladder catheter had been used for recording intraabdominal pressure. The chosen parietal reconstruction method was reconstruction with placement of a polypropylene mesh in a modified inlay position by using two peritoneal flaps prepared from the hernial sac in order to reinforce in the midline the anterior and posterior plates of the abdominal rectus muscles. Intraabdominal pressure values recorded preoperatively and after the patient underwent anesthesia were within range. Parietal reconstruction was performed under intraabdominal pressure monitoring. At the end of the intervention a slight pressure elevation was detected, but without exceeding 12 mmHg. Results: The benefits of the procedure demonstrated to be tension free were as follows: quick resumption of bowel movements, absence of postoperative pain and improvement of respiratory parameters through reestablishment of the abdominal press after the reconstruction has been completed. Conclusions: Intraabdominal pressure monitoring is an objective method of assessing the tension free principle in abdominal wall reconstructions. Observing the tension free principle improves postoperative evolution and respiratory function. Using the flaps prepared from the hernial sac allowed for the tension free closure of the abdominal wall.
- Subjects
INTRA-abdominal infections; INTRAOPERATIVE monitoring; ABDOMINAL wall abnormalities; HERNIA; PHYSIOLOGICAL stress; DIAGNOSIS
- Publication
Romanian Journal of Functional & Clinical, Macro & Microscopical Anatomy & of Anthropology / Revista Româna de Anatomie Functionala si Clinica, Macro si Microscopica si de Antropologie, 2015, Vol 14, Issue 2, p260
- ISSN
1583-4026
- Publication type
Article