Search results for: incisional-hernia

Incisional Hernia

Author : Feliciano Crovella
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Incisional hernia surgery has witnessed important advances over recent years, not only as far as the pathophysiological and etiopathogenetic aspects are concerned, but also from a technical point of view. This book provides an update on incisional hernia surgical techniques. It includes chapters on synthetic prostheses, biomaterials and robotics. Surgeons, surgical residents, and medical students will find the information in this volume very useful in their daily practice.

Incisional Hernia

Author : Volker Schumpelick
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All general surgeons, and especially hernia surgeons, will benefit from this book. It contains a complete update on the research and pathogenesis of the incisional hernia. The volume describes all important diagnostic and therapeutic procedures and evaluates the appropriate use of each procedure for each particular case. Pitfalls and unresolved issues are discussed in depth, and experts of international standing weigh in on each topic.

Laparoscopic and Robotic Incisional Hernia Repair

Author : Karl A. LeBlanc
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The field of hernia repair, in general, has evolved over the last 25 years. The changes that have followed the introduction of this technique have continued and have even increased in the last few years. There is a need to inform the practicing general surgeon about these advances. This text will seek to present the most up to date and important considerations to date. The book will open with a brief history and evolution of the technology surrounding the repair of incisional and ventral hernias laparoscopically and include the introduction of the robotic technology. Prosthetic biomaterials are an integral part of the successful repair of hernias and a comprehensive presentation of these products will be presented. Preoperative preparation of the patient has now been recognized as a method to improve outcomes in these patients and will be addressed.Technical aspects of the repair of these hernias will then follow in an orderly fashion to include the general considerations of the methodology. The “best practices” of these methods will be presented with appropriate figures and illustrations. The management of difficult situations as well as expected outcomes will be discussed. It is the intent of this text that any surgeon interested in the use of the minimally invasive techniques to repair the incisional and ventral hernias of the abdominal wall will have this resource presenting current opinions and methods. The “thought leaders” in these methods will be the authors of these chapters. This title differs from the Springer related title Novitsky, Hernia Surgery. The Novinsky is more comprehensive at 530 pages. It contains many more illustrations and video. The LeBlanc focuses on Laparoscopic and Robotic Hernia surgery with an estimated page count of 300-350. The LeBlanc presents current opinions of the thought leaders. Therefore, the subtitle: Current Considerations.

Hernia Repair Sequelae

Author : Volker Schumpelick
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Even the best hernia repair can result in postoperative difficulties for the patient caused by repair sequelae as for example pain, infertility, infection, adhesion and dislocation of the protheses. That can happen many years later and now, where the general principle of hernia repair is well understood all over the world, these sequelae are noticed more and more. To define them, to evaluate the absolute and relative risk of these sequelaes and to describe the ways of their prevention, diagnosis and treatment, the 5th Suvretta meeting had focussed on this subject. We discussed if there’s a principle risk by technique, material or both. The results of these discussions and the future handling and evaluation of this problem was the aim of this meeting. Even the best method can be made better by optimization of its single components. Even the best hernia repair can result in postoperative difficulties for the patient caused by repair sequelae such as pain, infertility, infection, adhesion and dislocation of the prostheses. This can happen many years later, and now that the general principle of hernia repair is broadly understood all over the world, these sequelae are being noticed more and more. The 5th Suvretta meeting was held in order to define these sequelae, to evaluate the absolute and relative risks they pose, and to discuss the methods of their prevention, diagnosis and treatment. We discussed whether the principal risk was related to technique, material or both. This discussion and the future approach to and evaluation of this problem were the aims of the meeting, working on the premise that even the best method can be made better by optimizing its individual components.

Recurrent Hernia

Author : Volker Schumpelick
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Recurrence is a significant public health problem. So, this fourth Suvretta meeting, held in February 2006 is intended to concentrate on this problem. Technical nuances of the various operations have been discussed to pursue consensus concerning the best techniques. Methods were explored to improve surgeons' education and look into the multifactorial etiologies to understand the biology of hernia recurrence better.

Outcomes After Incisional Hernia Repair Does Mesh Type Matter

Author : Jennifer Koichopolos
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Outcomes after incisional hernia repair: does mesh type matter?Dr. Jennifer Koichopolos, Dr. Kenneth Leslie, Dr. Robert Leeper, Dr. Kelly Vogt, Dr. Neil ParryThe rate of incisional hernia occurrence post-laparotomy is as high as 30% with many patients undergoing subsequent repairs. This study assesses hernia recurrence rates with synthetic mesh vs. biologic mesh with or without component separation.tAll incisional hernia repairs at a single centre between 2007-2013 using synthetic mesh (Proceed, Johnson & Johnson) or biologic mesh were included. Data on patient risk factors and hernia characteristics that increase the risk of recurrence were collected. The primary outcome was recurrence rate and the secondary outcome was infection rate. t183 patients were included in the retrospective review. Despite the differing patient complexity (patients with biologic mesh had significantly higher modified hernia grading scores, ostomy presence, ASA scores, bowel resections, and number of previous hernia repairs), the symptomatic recurrence rate was not significantly different with biologic mesh as compared to synthetic mesh (32.3% vs 22.2% p=0.128) nor was rate of re-operation for that recurrence (15.1% and 12.2% p=0.577). The time to recurrence was significantly earlier for biologic mesh as compared to synthetic mesh (20.5 vs 38.0 months, p=0.002) and the rate of infection was significantly higher (37.7 % vs 13.4%, p=0.000). Component separation did not decrease the recurrence rate with biologic mesh (36.2% vs 23.5%, p=0.206). A regression analysis did not identify any factors that significantly increase the risk of recurrence. tThere was no significant difference seen in hernia recurrence or repair rates between biologic or synthetic mesh. Biologic mesh had a higher rate of surgical site infection and a shorter time interval to recurrence. This is likely secondary to the increased surgical complexity that these patients consistently demonstrated. Component separation did not mitigate these factors. Future research should focus on ways to obtain primary fascial closure with synthetic mesh alone to avoid the added cost and increased morbidity when biologic mesh is used.

Laparoscopic Ventral and Incisional Hernia Repair

Author : E. B. Wassenaar
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MP33 Incisional Hernia Post Hand Assisted Laparoscopic Donor Nephrectomy Significant Donor Morbidity

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Incisional Hernia Post Hand Assisted Laparoscopic Donor Nephrectomy: Significant donor morbidityAdnan Taib1, Zia Moinuddin1,2, Alex Shaw1,2, Martyn Stott1, Babatunde Campbell1, Titus Augustine1,2, David van Dellen1,21Department of Renal & Pancreas Transplantation, Manchester University NHS Foundation Trust, Manchester, UK2 Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UKIntroduction:Hand Assisted Laparoscopic Donor Nephrectomy (HALDN) has evolved to allow safe minimally-invasive kidney donation, via a hand port incision, whilst ensuring the post-operative benefits of laparoscopic surgery. Morbidity in this group of patients is undesirable. However, the reported incidence of significant long-term surgical complications in this cohort, including incisional hernia (IH), remains variable. This study aimed to investigate the incidence and potential risk factors in the IH development post HALDN.Methods:A retrospective analysis of a contemporaneously maintained database and electronic records of patients who underwent intraperitoneal HALDN at a single centre over 10 years (01/2008-11/2018) was performed. Data collected included incidence and time to diagnosis of incisional hernia. Potential patient confounders (demographics, BMI, smoking status, respiratory co-morbidities, previous abdominopelvic surgery, hernia history) and surgical risk factors (hand port site, wound complications, re-operation, post-operative chest infection) were also assessed. Univariate and multivariate logistic regression analysis was performed.Results: There was an IH incidence of 8.9% (n=69) in 771 patients following intraperitoneal HALDN. Median time to hernia diagnosis was 12 months (IQR 5-16). Univariate analysis revealed respiratory co-morbidities (14.5% vs 6%, p=0.019), obesity (BMIu2265 30kg/m2) (35.5% vs 19.7%, p=0.017), wound complications (24.6% vs 9%, p=0.01), re-operation (7.2% vs 2.1%, p=0.027), post-operative chest infection (23.2% vs 10%, p=0.02) as risk factors for incisional hernia occurrence. On multivariate analysis respiratory co-morbidities (OR 2.96, 95% CI 1.21 u2013 7.24), re-operation (OR 3.64, 95% CI 1.04-12.69) and post-operative chest infection (OR 2.46, 95% CI 1.21 u2013 5.02) were significant predictive factors for hernia formation. Discussion:Incisional hernia post HALDN is a major complication with significant morbidity in a previously healthy population. Pre- and post-operative respiratory compromise and re-operation appears to increase risk. Focused prehabilitation and post-operative care (enhanced recovery) may therefore mitigate IH risk. Further studies comparing incisional hernias in total laparoscopic and laparoscopic assisted techniques are also needed to establish if technique refinement may be of benefit.

Management of Abdominal Hernias

Author : Andrew N Kingsnorth
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Hernia repair is one of the commonest operations in general surgery. Open or laparoscopic repair of a primary inguinal hernia is a relatively straightforward operation, but more complex abdominal wall hernias demand greater surgical skill and knowledge. The editors have assembled the world's top herniologists to describe and illustrate numerous surgical techniques in detail. The field of herniology has developed rapidly over the last few years. Since the previous edition of this book, published in 2003, new surgical techniques have been developed and many new prosthetic and biologic materials have been introduced. Management of Abdominal Hernias 4e presents an authoritative, comprehensive and fully updated account of the surgical techniques and the available prosthetic materials for performing repair of abdominal wall hernias. Both open and laparoscopic methods are included. It is aimed at general and specialist surgeons in the practice of clinical surgery, as well as trainee surgeons.

Incisional Hernia a Study of the Causes of Post operative Ventral Hernia and of Operations for Its Cure with a New Procedure

Author : Theo Legate SCHOFIELD
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Outcomes and Costs of Open Incisional Hernia Repair with Retromuscular ProGrip Mesh Placment a Retrospective Case Series

Author : Nawaf AlShahwan
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Introduction:Incisional hernias are a common complication of abdominal surgery, they lead to a spectrum of symptoms ranging from abdominal discomfort and reduced quality of life to bowel incarceration or ischemia. One of the most widely used repair techniques is the open retromuscular repair (i.e. Rives-Stoppa procedure) following posterior component separation. This study examines the feasibility of using a self-fixating mesh (Progrip). The use of this mesh has been proven to be safe, and was reported to have fewer early complications and better outcomes in comparison to other mesh types.Methods: A series of cases (n=33) were performed at the Jewish General Hospital, Montreal, Quebec. Sequential cases done between March 2013 and December 2015 were prospectively entered into the study database; however, some variables were retrospectively collected. Data collected included patients characteristics and perioperative measures. The primary outcome was early recurrence. The secondary outcomes were complication occurrence and treatment cost using Med-GPS data. Follow up included a clinical exam at 1-2 months and to identify complications and early recurrences.Results:Thirty three patients underwent an open incisional hernia repair with retrorectus ProGrip mesh placement during the study period. Table 1 details the patient characteristics. All patients received perioperative antibiotics and DVT prophylaxis. Operative data can be found in table 2. The mean OR date to last clinic follow up visit was 5.52 months, while mean OR date to data review date was 28.74 months. No patient had evidence of recurrence on clinic follow up or on imaging when used.Complications : Postoperative complications occurred in 21.21% of the cohort (n=7), with a median Clavien grade of 2. None of the complications required a reoperation. Four patients had superficial surgical site infections that required antibiotics in addition to packing the wound; one patient had a seroma that was aspirated; one had a superficial hematoma that was treated non-operatively and one patient had urinary retention postoperatively that required a Foley catheter insertionImaging: 33% of the cohort underwent postoperative imaging (CT u00b1 US), none were found to have evidence of recurrence.Costs: A sub-analysis was done on 10 patients to calculate the mean hospital cost was $3,533.87 Canadian dollars (all inclusive, total cost of admission, lab work, medications, anesthesia, surgical equipment and procedure). The mean implant cost was $253.Conclusion:Recent literature shows that the Rives-Stoppa repair with posterior component separation is safe, feasible and favorable for complex incisional hernias. Table 3 compares our outcomes to similar studies in the literature. To the best of our knowledge our study is the largest for open retrorectus incisional hernia repair with ProGrip mesh.

Hybrid Technique for Incisional Hernias

Author : Monika Romanowska
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Hernia is one of the most common complications post any laparotomy. Various techniques are used for the repair of incisional hernias. Hernioplasty with synthetic materials is worldwide standard, and indications to the simple suture methods are rare. Mini-invasive techniques for hernia repair have become popular since 1990 and carry many advantages. Some incisional hernias have a very large hernia sac with large loss of fascia, which makes an exclusive laparoscopic approach challenging. Moreover, some patients are found to have very dense adhesions, which makes laparoscopic approach unsafe, and almost impossible necessitating conversion from laparoscopic to open surgery. Then, the process is carried on until the safe implantation of mesh into abdominal cavity becomes possible. This has led to the birth of what is known as the hybrid technique for incisional hernia repair (laparoscopy, conversion, laparotomy, laparoscopy). Patients with large, complicated, and recurrent incisional hernias should primarily be qualified to hernioplasty with the hybrid technique, which combines the conventional open repairs (safe adhesiolysis, safe placement of laparoscopic tools into the abdominal cavity, closing the defect) with laparoscopic repair (intraperitoneal mesh placing).

Laparoscopic Ventral Hernia Repair

Author : Salvador Morales-Conde
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Primary and incisional ventral hernias are common conditions often encountered in surgical practice. Because of the frequency of this problem it has come to be managed by surgeons in general, regardless of the type of hospital or the conditions dealt with in their daily practice. Laparoscopic surgery has demonstrated to have an important role among the different technique described to repair ventral hernia with less recurrent rate, less morbidity and less overall cost than open conventional repair, with all the advange of the laparoscopic approach. As a result the indications for this surgical technique are currently being debated since the advantages are evident and progressive implementation is ensured. Now is the time to analyze the usefulness, results, technical variants, anatomic, physiologic and scientific basis and implications involved in implementation of laparoscopy as the technique of choice.

OPCS Classifications of Interventions and Procedures

Author : NHS Connecting for Health
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The ability to provide improved clinical information continues to ensure the classification meets the needs of the Government's reform of NHS funding - Payment by Results (PbR). Completed in collaboration with the Department of Health and the Information Centre for health and social care, this title features tabular list of three digit categories.

Epigastric Incisional Hernia

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Hernia Surgery Simplified

Author : Sachin Kuber
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A hernia is where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. Hernias occur in the abdomen and there are several different types, each determined by its location within the abdomen. Hernia Surgery Simplified brings trainees and surgeons fully up to date with the latest techniques for hernia repair. The initial chapters discuss surgical anatomy of hernias, incidence and etiology, diagnosis and anaesthesia. The following sections are each dedicated to a different type of hernia and its surgical management. This comprehensive book places emphasis on the latest mesh products available for use in surgery and includes a DVD demonstrating hernia repair using a prolene mesh implant. Nearly 340 full colour photographs and illustrations assist understanding. Key points Comprehensive guide bringing surgeons up to date with latest hernia repair techniques Detailed coverage of all types of hernia and their surgical management Emphasis placed on latest mesh products Includes DVD featuring hernia repair using prolene mesh implant Nearly 340 full colour photographs and illustrations

Hernia Surgery

Author : Yuri W. Novitsky
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This textbook provides a state-of-the-art reference in the rapidly changing field of hernia surgery. With contributions by key opinion leaders in the field, this book describes the latest trends and detailed technical modifications for both routine and complex hernias. The reader will gain unique insights into robotic and laparoscopic repairs, anterior and posterior component separations, reconstructions in the setting of contamination, enterocutaneous fistulas and loss of abdominal domain. Important contributions from key reconstructive plastic surgeons detail modern trends on how to deal with complex skin and soft tissue challenges. The textbook provides unparalleled step-by-step instructions to perform both routine and complex repairs by incredible illustrations, intra-operative color photographs and a unique video collection of procedures performed by today’s top hernia surgeons. As a comprehensive and most up-to-date reference to modern treatment algorithms, trends in prosthetic science and technique selections, Hernia Surgery: Current Principles will be an invaluable resource to all residents and practicing general, plastic, and trauma surgeons to help them succeed in the field of Hernia surgery.

Shackelford s Surgery of the Alimentary Tract E Book

Author : Charles J. Yeo
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Comprehensive and complete, Shackelford’s Surgery of the Alimentary Tract delivers the definitive, clinically oriented, cutting-edge guidance you need to achieve optimal outcomes managing the entire spectrum of gastrointestinal disorders. Make effective use of the latest endoscopic, robotic, and minimally invasive procedures as well as medical therapies with unbeatable advice from a "who’s who" of international authorities! Find expert answers to any clinical question in gastrointestinal surgery, from the esophagus to the colon. See exactly what to look for and how to proceed from an abundance of beautifully detailed intraoperative and laparoscopic photographs.

Principles of Gynaecological Surgery

Author : Stuart L. Stanton
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For a long time I have felt that the present gynaecological training for registrars lacked familiarisation and understanding of the basic principles of surgery. This is due to several factors. Firstly, the historical separation of gynaecology from general surgery which led to our development as an independent speciality (and which Victor Bonney foretold to our detriment when he opposed the formation of the College of Obstetricians and Gynaecologists as a separate body from the College of Surgeons). Secondly, a vast improvement in medical management of many gynaecological conditions has made surgical practice dull and an unquestioning daily routine with little or no surgical instruction for many junior staff. Thirdly, the arrival of subspecialisation has exacerbated this, as complicated surgery may be referred out by the general gynaecologist. Finally, the trend in further education towards writing an MD rather than taking an FRCS degree. The arguments for and against were set out in an editorial in the British Journal of Obstetrics and Gynaecology (1983), later taken to task in the ensuing correspondence. That editorial. together with the difficulty in finding up-to-date articles on surgical principles in one volume, were the catalysts for this book. With the help of colleagues from other disciplines, I have attempted to present recent advances side-by-side with modern-day gynaecological practice.

Surgery of the Abdominal Wall

Author : Jean P. Chevrel
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The abdominal wall has always been of interest to surgeon-anato mists. It was recognized as a barrier, and volumes have been written demonstrating how to breach this wall. Similarly, great importance has been placed on the methods of repairing the abdominal wall, whether that repair is necessitated by a primary operative wound, a congenital failure, an acquired defect, or the ubiquitous iatrogenic problem, the postoperative abdominal wall hernia. French surgeons have a long tradition of excellence in the field of human anatomy: the names of Pare, Bichat, Cloquet, and Fru chaud readily come to mind. It is not surprising then, that this com prehensive text on the subject of the abdominal wall and its defects emanates from France. Although there are many interesting aspects to this presentation of abdominal wall problems, I find the review of prosthetic material and its use to be most unique. The synthetic meshes available today may well revolutionize our various approaches for repair of hernial defects. Considerable experience has evolved in the use of these prosthetic materials, particularly in the United Kingdom and Eu rope. I have been a proponent of prosthetic mesh for the cure of recurrent groin hernia during the past decade. According to the re sults reported in this book, the use of a prosthetic material in select ed patients needing primary hernia repair seems indicated. I would be remiss if the organization GREPA were not highlighted.