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The first 25 slides, exactly as they appear. The full deck has 62 content slides.
General Surgery
Perspective on Hernias (A) Laparoscopic Incisional Hernia
Built from Maingot's Abdominal Operations
What’s inside
8 sections · 62 slides
The problem being solved
What an incisional hernia is, and how the keyhole repair began
- Definition of an incisional hernia
- Burden of incisional hernia in surgical practice
- Terms used in ventral and incisional hernia repair
- First report of laparoscopic incisional hernia repair
- Scope of the term laparoscopic ventral hernia repair
- State of the evidence after two decades
- Minimally invasive operating setup
Rationale for the laparoscopic approach
Why surgeons expected the keyhole route to do better
- Original rationale for the laparoscopic approach
- Patient-related causes of repair failure
- Missed fascial defects as a technical cause of failure
- Causes of incisional hernia repair failure
- Sequence from missed defect to recurrence
- View of the fascial defect from inside the abdomen
- Layers of the anterior abdominal wall
- Incidental findings during peritoneoscopy
- Avoiding dissection through a deeply scarred incision
- Mesh delivery through a clean field after prior wound infection
Drawbacks of the laparoscopic repair
What the keyhole route gives up, and where it can go wrong
- Dead space and seroma formation
- Cosmetic outcome after repair of large defects
- Severe adhesions and hazardous adhesiolysis
- Inadvertent bowel injury and mesh infection
- Sequence from adhesiolysis to mesh infection
- Sites where transfascial fixation is not possible
- Pros and cons of laparoscopic ventral hernia repair
- Balance of advantages against drawbacks
Technique
Mesh choice, fixation and the mistakes that follow the learning curve
- Mesh versus suture repair in open surgery
- Role of mesh in the laparoscopic repair
- Risks of mesh placed in contact with viscera
- Dual-sided mesh prostheses
- Evidence behind adhesion-preventing coatings
- Requirements common to both operations
- What the laparoscopic route substitutes for open dissection
- The invasiveness paradox
- Postoperative pain and quality of life in trials
- Mesh fixation technique and postoperative pain
- Bowel injury rates compared with open surgery
- 1.78%
- The learning curve in laparoscopic repair
- Sizing the mesh with the abdomen deflated
- Transfascial sutures and tacks
- Abdominal binders after repair
- Steps of the laparoscopic repair
Postoperative results
Complications, wound problems, hospital stay and return to work
- Postoperative pain compared with other laparoscopic operations
- Overall postoperative complication rates
- Wound infection and mesh removal
- 31.5% vs 47.9%
- Hospital stay and return to work
- Summary of short-term outcomes
Long-term follow-up
Recurrence, the outcome that decides whether a repair worked
- Recurrence as the key long-term outcome
- Effect of mesh on long-term recurrence in open repair
- 63%
- Recurrence after laparoscopic versus open repair
- Limitations of the long-term evidence
- Surgeon experience and recurrence
Cost and benefit
What the technique adds to the bill, and what is not yet known
- Cost drivers in laparoscopic hernia repair
- State of the cost-effectiveness evidence
Conclusion
Where the laparoscopic repair belongs in practice
- Conclusion of the authors
- Take-home points
- References
- References (continued)
- References (continued)
- Maingot's Abdominal Operations, 12th Edition