Treatment of abdominal wall eventrations associated with abdominoplasty techniques

Repair of the Severe Muscle Aponeurotic Abdominal Laxity with Alloplastic Mesh in Aesthetic Abdominoplasty

BACKGROUND

Abdominoplasty is the most frequently performed surgical procedure for body contour; in our experience, we have observed some patients with prominent bulging that is difficult to treat and that presents results that are unsatisfactory or have recurrences to conventional treatments. This leads us to carry out an analysis of the elements responsible for the containment and abdominal format. We determined that it may be due to an inability of an important sagging aponeurotic muscle of primary origin to support the abdomen and could be caused by predisposing factors. For these specific cases, we developed a treatment proposing the use of a mesh.

METHODS

We present these cases over a period of 24 years. Fourteen patients were treated with primary and secondary abdominoplasties. The abdominal wall reinforcement was performed by placing polypropylene mesh at the sub-muscular plane, fixed with U-stitches on the fascia transversalis, seeking to strengthen the muscle and the fascia transversalis.

RESULTS

The results were satisfactory after long-term observation, gaining resolution of the abdominal bulges. Only two complications occurred; the presence of localized chronic pain and the appearance of umbilical fistula.

DISCUSSION

We emphasize the importance of avoiding unnecessary interventions in patients with marked bulging, associated with inability of abdominal restraint. We only consider its indications in patients with conventional recurrence treatment, also identifying the predisposing factors, the knowledge of the abdominal anatomy, the muscular dynamics of the abdomen and understanding its indication in these specific cases of difficult treatment.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Diastasis recti associated with midline hernias: Totally subcutaneous video-endoscopic repair

A 63-year-old man with a history of a conventional cholecystectomy was referred to our department for an incisional subcostal hernia and chronic back pain. Physical examination also showed an umbilical hernia and diastasis recti measuring 6 cm that was confirmed with a computed tomography scan. Subcutaneous video-endoscopic repair was done repairing all defects simultaneously.

Plastic surgery: personal recollections, contributions, and some thoughts: the Ohmori lecture: 18th I.S.A.P.S. Congress, Rio De Janeiro--2006

Professor Ivo Pitanguy is Head Professor of the Plastic Surgery Departments of the Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Institute of Postgraduate Medical Studies. He also is a member of the Brazilian Society of Plastic Surgery, the National Academy of Medicine, and the Brazilian Academy of Letters, as well as Visiting Professor of the International Society of Aesthetic Plastic Surgery (ISAPS). He is a Fellow of the American and the International College of Surgeons (FICS, FACS). He also is the Honorary President of the Alumni Association of Professor Ivo Pitanguy, and has recently been declared the Patron of Plastic Surgery in Brazil through a unanimous vote by the Brazilian Society of Plastic Surgery.

Complicações pós-operatórias em pacientes submetidos à abdominoplastia isolada e combinada à outras cirurgias do abdome

OBJETIVO: A realização de abdominoplastias associadas a outras cirurgias da parede ou da cavidade abdominal, embora atrativa, é motivo de controvérsias. O objetivo deste trabalho é avaliar o grau de morbidade e mortalidade destas associações. MÉTODO: Foram estudados retrospectivamente 75 pacientes com indicação de abdominoplastia dos quais 39 submeteram-se a abdominoplastia isoladamente (grupo 1) e 36 à associação de abdominoplastia a outras cirurgias do abdome (grupo 2), como correção de hérnias, histerectomias e colecistectomias. Foram analisados os diversos fatores capazes de interferir na evolução do paciente, como doenças pré-existentes, assim como as complicações pós-operatórias. RESULTADOS: As complicações observadas foram: seroma (grupo 1: 2.6% , grupo 2: 25%,), epidermólise (grupo 1: 12.82% , grupo 2: 5.55%), deiscência de sutura (grupo 1: 5.12% , grupo 2: 5.55%), infecção da ferida operatória (grupo 1: 0%, grupo 2: 8.33%) e hematoma (grupo 1: 0%, grupo 2: 5.55%). Não houve diferença estatisticamente significante entre os dois grupos no que se refere a complicações pós-operatórias, exceto quanto ao seroma (p=0,009). CONCLUSÕES: Concluímos que não houve aumento significativo da morbidade e da mortalidade dos pacientes submetidos a cirurgias combinadas quando comparados aos pacientes submetidos à abdominoplastia isoladamente.

Analysis of 60 cases of simultaneous mammaplasty and abdominoplasty

The authors report 60 cases of simultaneous breast and abdomen reduction and analyze the value of its use. The combined procedure remodels the body contour with excellent results and low morbidity.