Objective: To evaluate a direct intra-abdominal approach to injection of the ventral transversus abdominis plane (TAP) and compare the dispersion of two volumes of injectate.
Study Design: Prospective anatomic and feasibility study.
Animals: A total of 10 canine cadavers weighing 9 ± 4 kg.
Methods: A ventral incision was made extending through the linea alba, from the umbilicus and extending 5 cm caudally. A single injection of an isovolumic mixture of iopamidol and new methylene blue was performed with a hypodermic needle placed within the TAP of each hemiabdomen, alternating between 0.5 mL kg in low-volume group (LV) and 1 mL kg in high-volume group (HV). Surgical staples marked the incision. Computed tomography and three-dimensional reconstruction of the tomographic images evaluated the dimensions, cranial and caudal spread beyond the incision and the total area of the injectate. Dissection determined the extent of nerve staining within the TAP adjacent to the abdominal incision. Wilcoxon signed rank (stain) or paired t test was used to compare variables between groups. Data are reported as mean ± standard deviation or median (range).
Results: Injectate spread was within the ventral TAP. Length of spread was 2.5 ± 1.6 cm greater in group HV than in group LV. There was a strong positive correlation between the surface area (p = 0.02, r = 0.71) and cranial-caudal spread of injectate (p = 0.041, r = 0.65) with volume. All but two LV injections were associated with staining of all nerves adjacent to the incision. Additional nerves caudal to the incision were stained in group HV (p = 0.02).
Conclusions: This approach to the TAP was easily performed, with volume of injectate positively influencing distribution.
Clinical Relevance: This technique is easily applied and future prospective studies are warranted to determine its analgesic efficacy.
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http://dx.doi.org/10.1016/j.vaa.2021.06.005 | DOI Listing |
Hernia
December 2024
Department of Surgery, Cleveland Clinic Center for Abdominal Core Health Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Purpose: Forceful coughing is assumed to be an uncommon etiology for lateral abdominal wall hernias. The literature regarding this topic is very limited and there is a lack of consensus in management, both operative and non-operative. We aim to report our center's experience in repair of lateral abdominal wall hernias secondary to vigorous coughing.
View Article and Find Full Text PDFJ Laparoendosc Adv Surg Tech A
January 2025
Department of General Surgery, Aulss 5 Polesana, Viale Tre Martiri, Rovigo, Italy.
In the field of abdominal wall hernias, several innovative procedures have been developed, including the extended/enhanced-view totally extraperitoneal (eTEP) hernia repair technique. Initially introduced for laparoscopic hernia repair by J. Daes, it was subsequently applied to ventral hernia repair (VHR) and incisional hernia repair (IVHR) by I.
View Article and Find Full Text PDFSurg Laparosc Endosc Percutan Tech
November 2024
Division of General Surgery, New York University Langone Health, New York, NY.
Background: Posterior component separation with transversus abdominis release (TAR) is a valuable adjunct to address incisional hernia defects. Currently, bilateral docking is a standard technique for robotic TAR. The aim of this study is to describe our technique for extended totally extraperitoneal (eTEP) repair with bilateral TAR through a bottom single-dock robotic approach for hernias at the level of the umbilicus or higher.
View Article and Find Full Text PDFHernia
November 2024
Department of Surgery, BP Koirala Institute of Health Sciences, Dharan, 56700, Nepal.
Background: Primary closure of large ventral hernia is difficult and is usually complicated by postoperative mesh bulge, migration, and higher recurrence. Techniques like component separation and bridging mesh, transversus abdominus release, da Silva triple-layer repair, and peritoneal flap hernioplasty (PFH) are common treatment options.
Objective: To evaluate the early postoperative and long-term outcomes of PFH for large ventral hernias.
Surg Endosc
December 2024
Division of General Surgery, NYU Langone Health, New York, NY, USA.
Aim: Posterior component separation using transversus abdominis release (TAR) is well established as an option for repair of large hernia defects. TAR can be performed robotically (rTAR) or open (oTAR) with limited data to demonstrate benefit and guide decision making. We conducted a systematic review and meta-analysis comparing rTAR and oTAR approaches for ventral hernia repair (VHR).
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