Abdominal Wall Surgery

, Umberto Bracale , Ristovich Lidia1, Lever Michele1 and Giusto Pignata 



(1)
Department of General Surgery, “San Camillo” Hospital, Trento, Italy

(2)
Department of Surgical Specialities and Nephrology, University “Federico II” of Naples, Naples, Italy

 



 

Umberto Bracale



 

Giusto Pignata




Abdominal hernia diseases are the most common cause of hospitalization in Western countries. Moreover, treatment of inguinal hernias is one of the most commonly performed surgical procedures in the world [1]. Some reports have listed specific indications for laparoscopic inguinal hernia repair over open repair, including recurrent hernias, bilateral hernias, sports-oriented patients, associated pathologies, and technique request by patients [2, 3]. We described a transabdominal preperitoneal repair because we believe that this approach gives all the advantages of laparoscopic surgery. Even if TAPP hernia repair is a possible therapeutic option in scrotal and incarcerated hernia, operation time, complication rate, and frequency of recurrences are higher than in normal hernia repair [3]. A number of studies have shown that laparoscopic repair of inguinal hernias has advantages over conventional repair as reduced postoperative pain, diminished requirement for analgesics, and earlier return to work [4, 5].

Laparoscopic incisional and ventral hernia repair is preferred over open repair because of lower recurrence rates (less than 10 %), lower wound morbidity, less pain, and early return to work [6, 7]. The technique of laparoscopic repair of incisional and ventral hernia has almost been standardized, and the issues, such as the access to the abdominal cavity, mesh size, and extent of overlap, have been resolved [810].

Surgical treatment must be performed in an elective setting and, therefore, under ideal clinical conditions. It is essential to perform a preoperative evaluation with a multidisciplinary approach especially in ventral and incisional hernia so as to give a correct indication for surgery centered on the patient.

Every feature of the patient should be considered and then lead to correct surgical approach. For this reason, the position of the patient reported in this book should be considered as a suggestion to the conventional cases of ventral hernia.

Nowadays, it is essential to talk about “tailored surgery.” Already in 2007, Negro et al. [10] emphasized this way. He described a new therapy model based on individualized selective approach tailored to the type of hernia as well as to the characteristics of the patient. It contrasts with the past where it was one for all standard therapy.

Then laparoscopic surgery and the spread of new prosthetic materials did take off the tailored surgery.

So the surgeon plans the individual surgical approach selecting the proper technique and the right mesh for each patient.


3.1 Inguinal Hernia


The bed is placed in Trendelenburg position. The patient lies supine with arms along the body. A shoulder holder is needed. Laparoscopic rack is placed at patient’s feet (Fig. 3.1).

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Fig. 3.1
(ac) Equipment and patient position during TAPP inguinal hernia repair

Specific surgical drapes are used.

Laparotomic Instrument Table Must Be Always Ready for Use


Surgical Steps



1.

Landmark recognition

 

2.

Peritoneal incision

 

3.

Preparation of a wide place for the mesh placement

 

4.

Hernia reduction

 

5.

Mesh placement

 

6.

Mesh fixation

 

7.

Peritoneal suture

 


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Jun 5, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on Abdominal Wall Surgery

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