The document discusses ventral hernias, including:
- Incidence and risk factors for ventral hernias
- Options for mesh placement during hernia repair surgery
- Types of prosthetic meshes used, including benefits and disadvantages of polypropylene, ePTFE, polyester, and absorbable barrier-coated meshes
- Studies comparing surgical outcomes and complications between different mesh types
Laparoscopic ventral hernia repair involves placing mesh over the hernia defect using laparoscopic techniques. It has advantages over open repair such as lower wound complications, recurrence rates, hospital stay and pain. While more technically challenging, it is effective for primary and recurrent hernias. Outcomes are better in non-obese patients, with obese patients having higher recurrence rates and longer operating times.
Laparoscopic Ventral Hernia Repair Ppt. DR DILIP S.RAJPALdiliprajpal
This document discusses laparoscopic ventral hernia repair (LVHR). It describes the surgical technique for LVHR, including accessing the abdominal cavity through ports, adhesiolysis, measuring and placing the mesh, and fixing it in place. Proper port placement and handling of meshes like Physiomesh and Proceed are emphasized to minimize infection risk. Wide mesh overlap and transfascial sutures are recommended to prevent mesh migration. Fixation techniques like double crowning help reduce seroma formation. Post-operative port site hernias are also mentioned.
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
This document discusses the anatomy and surgical techniques for abdominal wall hernia repair. It covers the layers of the abdominal wall, types of hernias, and various mesh repair techniques including inlay, underlay, and onlay approaches. Component separation is described as a way to gain increased mobility for closure. Post-operative care measures are also outlined.
The document provides details on the anatomy and technique for performing a laparoscopic totally extra-peritoneal (TEP) approach for groin hernia repair. Key steps include: 1) gaining access to the pre-peritoneal space through an infraumbilical incision; 2) inserting additional ports under direct vision; 3) completing dissection of the pre-peritoneal space to expose the hernia; and 4) placing a large piece of mesh without fixation to cover the hernia defect. Important anatomical structures are identified during dissection, including the inferior epigastric vessels and vas deferens, to properly expose direct and indirect hernias.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Laparoscopic ventral hernia repair involves placing mesh over the hernia defect using laparoscopic techniques. It has advantages over open repair such as lower wound complications, recurrence rates, hospital stay and pain. While more technically challenging, it is effective for primary and recurrent hernias. Outcomes are better in non-obese patients, with obese patients having higher recurrence rates and longer operating times.
Laparoscopic Ventral Hernia Repair Ppt. DR DILIP S.RAJPALdiliprajpal
This document discusses laparoscopic ventral hernia repair (LVHR). It describes the surgical technique for LVHR, including accessing the abdominal cavity through ports, adhesiolysis, measuring and placing the mesh, and fixing it in place. Proper port placement and handling of meshes like Physiomesh and Proceed are emphasized to minimize infection risk. Wide mesh overlap and transfascial sutures are recommended to prevent mesh migration. Fixation techniques like double crowning help reduce seroma formation. Post-operative port site hernias are also mentioned.
Component separation technique for a very large abdominal wall herniaSanjiv Haribhakti
Component separation technique is an excellent technique for large ventral central defects which can allow a medial shift of approx. For More information visit at Gisurgery.info
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
This document discusses the anatomy and surgical techniques for abdominal wall hernia repair. It covers the layers of the abdominal wall, types of hernias, and various mesh repair techniques including inlay, underlay, and onlay approaches. Component separation is described as a way to gain increased mobility for closure. Post-operative care measures are also outlined.
The document provides details on the anatomy and technique for performing a laparoscopic totally extra-peritoneal (TEP) approach for groin hernia repair. Key steps include: 1) gaining access to the pre-peritoneal space through an infraumbilical incision; 2) inserting additional ports under direct vision; 3) completing dissection of the pre-peritoneal space to expose the hernia; and 4) placing a large piece of mesh without fixation to cover the hernia defect. Important anatomical structures are identified during dissection, including the inferior epigastric vessels and vas deferens, to properly expose direct and indirect hernias.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
This document discusses the evolution of ventral hernia repair techniques over history. It begins with a definition of ventral hernia and risk factors. It then outlines the early history of hernia repair from ancient times through the 19th century, involving simple suturing and grafting techniques. The introduction of prosthetic mesh in the 1960s decreased recurrence rates compared to suturing. Various mesh placement techniques were developed, with sublay placement showing the lowest recurrence risk. More recent advancements discussed include laparoscopic repair, component separation techniques, and posterior component separation with transversus abdominis release for complex hernias.
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
This document discusses the basic principles of laparoscopy. It describes the key differences between laparoscopic and open surgery for both patients and surgeons. For patients, laparoscopic surgery results in less pain, faster recovery times, and quicker return to normal activities due to smaller incisions. For surgeons, laparoscopy provides a magnified view but with altered tactile response and two-dimensional images. The document outlines the typical laparoscopic setup including the endoscope, light source, camera, monitor, insufflator, trocars and various instruments. It also lists some common laparoscopic procedures that can be used for diagnostic and operative purposes.
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
- Laparoscopic repair of recurrent inguinal hernias has low recurrence rates of 0-1.1% and is associated with less pain and faster recovery compared to open repair.
- TEP repair is an effective procedure for treating direct, indirect, pantaloon, and recurrent hernias through small incisions with early return to normal activities and is a reliable technique for recurrent hernia repair after previous endoscopic herniorrhaphy.
- The learning curve for TEP is longer than for open repair, with some studies suggesting surgeons need to perform more than 100-250 laparoscopic procedures before recurrence rates fall below 5%.
The document discusses strategies for performing safe laparoscopic cholecystectomy, including obtaining the critical view of safety, using intraoperative cholangiography to help identify biliary anatomy, and employing bailout techniques such as partial or subtotal cholecystectomy if the critical view cannot be achieved to avoid potential bile duct injuries. It also describes error traps that can lead to injuries and strategies surgeons should follow to promote a culture of safety in laparoscopic cholecystectomy.
This document announces a one day endoscopy workshop and continuing medical education event taking place on September 1, 2013 at Lotus Hospital in Erode. It will be hosted by the IMA Tamil Nadu State Branch AMS Wing, IMA Erode Branch, and ASI Erode City Chapter. The event will include live endoscopy workshops, lectures, panel discussions, and case scenarios focused on diagnostic and therapeutic endoscopy techniques. Delegates and postgraduates can register for Rs. 1000 and Rs. 500 respectively. The workshop and CME will run from 8am to 6pm and cover topics such as variceal banding, stricture dilation, endoscopic guidelines, and management of corrosive strictures
Laparoscopy involves using small incisions and a camera to perform abdominal surgeries. It was pioneered in the early 1900s and has since been used for procedures like cholecystectomy and appendectomy. Advantages include less pain, scarring and faster recovery compared to open surgeries. Proper patient positioning, insufflation, trocars and energy devices are required. Complications can include injuries from access and cautery. Recent advances include natural orifice translumenal endoscopic surgery and single-incision laparoscopic surgery.
1) Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that uses an endoscope passed through natural openings like the mouth, vagina, or anus to perform internal surgery without external incisions.
2) NOTES was first described in animal models in the early 2000s and the first human transgastric cholecystectomy was reported in 2007.
3) While offering advantages over laparoscopy by avoiding external incisions, NOTES faces challenges of developing improved flexible instruments, closing access sites without leaks, and standardizing safe techniques.
Peritoneal carcinomatosis refers to the spread of cancer to the peritoneal cavity. It has traditionally had a poor prognosis with best supportive care or chemotherapy alone. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC) has emerged as a treatment approach that can provide long-term survival or cure in properly selected patients. Key factors in patient selection include ensuring no distant metastases, thorough staging to determine peritoneal cancer index and completeness of cytoreduction, and histology of primary tumor. The goal of CRS is to remove all visible tumor nodules followed by HIPEC or EPIC to treat any remaining microscopic
This document provides an overview of minimal invasive surgery (MIS), also known as laparoscopic surgery. It discusses the history and development of laparoscopic techniques, advantages like less pain and faster recovery compared to open surgery. Prerequisites for MIS include patient fitness, instruments used like laparoscopes and trocars. Risks include injuries from trocars and potential complications from carbon dioxide insufflation like gas embolism. The document outlines general principles of MIS including visualization, triangulation and sealing blood vessels. Both basic procedures like laparoscopic cholecystectomy and more advanced surgeries are discussed.
This presentation will help u know with the history,present and coming up trends in laparoscopy .Also it is an acquaintance presentation regarding laparoscopy.
The document discusses properties that surgeons should consider when choosing a mesh for hernia repair. Ideal meshes are lightweight, with large pores to reduce foreign body reaction and chronic pain. Monofilament meshes have the lowest risk of infection. For intraperitoneal placement, composite meshes may reduce adhesions by providing an absorbable surface. Overall, lightweight polypropylene or polyester meshes are generally suitable in most contexts by balancing strength, flexibility and biocompatibility.
Ventral hernias occur when abdominal contents protrude through weaknesses in the abdominal wall. There are several types of ventral hernias including umbilical, epigastric, incisional, and parastomal hernias. Incisional hernias occur through surgical scars and are more common with obesity, advanced age, and emergency surgeries. Treatment depends on hernia size but may involve primary repair for small defects or prosthetic mesh placement for larger defects. Laparoscopic repair is preferred when feasible due to benefits like fewer infections and shorter recovery.
Rectal prolapse: Do we really have a perfect surgical solution? pptx copyDr Amit Dangi
Ventral rectopexy has gained worldwide acceptance for surgical correction of rectal prolapse and high-grade internal rectal intussusception. The technique is based on correcting the descent of the posterior and middle compartments combined with reinforcement of the vaginal septum and elevation of the pelvic floor. anterior mobilization of the distal rectum and mesh suspension performed during VR can correct full-thickness rectal prolapse, rectoceles, and internal rec- tal prolapse and can be combined with vaginal prolapse procedures, such as sacrocolpopexy, in patients with multicompartment pelvic floor defects.
Laparoscopy involves using small incisions and a camera to visualize the inside of the abdomen. It has several advantages over open surgery such as less pain, shorter hospital stays, and quicker recovery times. Some of the key equipment used in laparoscopy include rod lens systems and fiber optic cables for optics, trocars for abdominal access, and insufflators to inflate the abdomen with gas. Potential risks include injuries from trocars or pneumoperitoneum as well as effects of the pneumoperitoneum on respiratory and renal systems. Common procedures now performed laparoscopically include cholecystectomy, appendisectomy, hernia repair, and some cancer staging.
This document discusses ergonomics principles for laparoscopic surgery. It notes that laparoscopic surgery provides less painful surgery for patients but is more demanding on surgeons. It covers topics such as instrument triangulation, patient positioning, table height, tactile limitations, port positioning, and ergonomic principles. The concept of ergonomics and problems at laparoscopy like visual axis vs motor axis are assessed. Management of ergonomic problems and who is more ergonomic are discussed.
This document discusses ventral incisional hernia repair and compares the sublay retromuscular technique using lightweight Vypro mesh versus heavier Prolene mesh. It provides background on incisional hernias, risk factors, techniques for open repair including suture repair, inlay, onlay, and sublay/retromuscular approaches. The study aims to evaluate the challenge of the sublay technique with new technical points to reduce recurrence and compare results of Vypro versus Prolene mesh in postoperative complications, chronic pain, and recurrence rates.
This document discusses the management of burst abdomens, also known as abdominal wound dehiscence. It defines abdominal wound dehiscence and provides information on incidence, risk factors, clinical manifestations, and treatment options. Dehiscence occurs when an abdominal wound separates after surgery, with a reported incidence between 0.2-6% and mortality rates of 10-40%. Risk factors include male sex, age under 45, emergency surgery, obesity, and medical conditions like diabetes or renal failure. Treatment depends on the severity but may involve re-suturing the wound with retention sutures or using a prosthetic mesh if the wound cannot be primarily closed.
This document discusses the evolution of ventral hernia repair techniques over history. It begins with a definition of ventral hernia and risk factors. It then outlines the early history of hernia repair from ancient times through the 19th century, involving simple suturing and grafting techniques. The introduction of prosthetic mesh in the 1960s decreased recurrence rates compared to suturing. Various mesh placement techniques were developed, with sublay placement showing the lowest recurrence risk. More recent advancements discussed include laparoscopic repair, component separation techniques, and posterior component separation with transversus abdominis release for complex hernias.
Extended totally extraperitoneal repair (eTEP) is a novel technique that was first introduced by Jorge Daes in 2012 to address difficult inguinal hernias.
This document discusses the basic principles of laparoscopy. It describes the key differences between laparoscopic and open surgery for both patients and surgeons. For patients, laparoscopic surgery results in less pain, faster recovery times, and quicker return to normal activities due to smaller incisions. For surgeons, laparoscopy provides a magnified view but with altered tactile response and two-dimensional images. The document outlines the typical laparoscopic setup including the endoscope, light source, camera, monitor, insufflator, trocars and various instruments. It also lists some common laparoscopic procedures that can be used for diagnostic and operative purposes.
Bile duct injury is a rare but potentially devastating complication of cholecystectomy that can result in biliary peritonitis, sepsis, and cirrhosis. It is most commonly caused by misidentification of structures during laparoscopic cholecystectomy. Management involves controlling infection, delineating biliary anatomy, and reestablishing biliary drainage, usually through surgical hepaticojejunostomy. Prevention relies on identification of anatomical variations, achieving a "critical view of safety" before duct division, and open conversion if needed. Proper management requires a multidisciplinary approach between surgeons, radiologists, and gastroenterologists.
- Laparoscopic repair of recurrent inguinal hernias has low recurrence rates of 0-1.1% and is associated with less pain and faster recovery compared to open repair.
- TEP repair is an effective procedure for treating direct, indirect, pantaloon, and recurrent hernias through small incisions with early return to normal activities and is a reliable technique for recurrent hernia repair after previous endoscopic herniorrhaphy.
- The learning curve for TEP is longer than for open repair, with some studies suggesting surgeons need to perform more than 100-250 laparoscopic procedures before recurrence rates fall below 5%.
The document discusses strategies for performing safe laparoscopic cholecystectomy, including obtaining the critical view of safety, using intraoperative cholangiography to help identify biliary anatomy, and employing bailout techniques such as partial or subtotal cholecystectomy if the critical view cannot be achieved to avoid potential bile duct injuries. It also describes error traps that can lead to injuries and strategies surgeons should follow to promote a culture of safety in laparoscopic cholecystectomy.
This document announces a one day endoscopy workshop and continuing medical education event taking place on September 1, 2013 at Lotus Hospital in Erode. It will be hosted by the IMA Tamil Nadu State Branch AMS Wing, IMA Erode Branch, and ASI Erode City Chapter. The event will include live endoscopy workshops, lectures, panel discussions, and case scenarios focused on diagnostic and therapeutic endoscopy techniques. Delegates and postgraduates can register for Rs. 1000 and Rs. 500 respectively. The workshop and CME will run from 8am to 6pm and cover topics such as variceal banding, stricture dilation, endoscopic guidelines, and management of corrosive strictures
Laparoscopy involves using small incisions and a camera to perform abdominal surgeries. It was pioneered in the early 1900s and has since been used for procedures like cholecystectomy and appendectomy. Advantages include less pain, scarring and faster recovery compared to open surgeries. Proper patient positioning, insufflation, trocars and energy devices are required. Complications can include injuries from access and cautery. Recent advances include natural orifice translumenal endoscopic surgery and single-incision laparoscopic surgery.
1) Natural orifice transluminal endoscopic surgery (NOTES) is a surgical technique that uses an endoscope passed through natural openings like the mouth, vagina, or anus to perform internal surgery without external incisions.
2) NOTES was first described in animal models in the early 2000s and the first human transgastric cholecystectomy was reported in 2007.
3) While offering advantages over laparoscopy by avoiding external incisions, NOTES faces challenges of developing improved flexible instruments, closing access sites without leaks, and standardizing safe techniques.
Peritoneal carcinomatosis refers to the spread of cancer to the peritoneal cavity. It has traditionally had a poor prognosis with best supportive care or chemotherapy alone. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC) has emerged as a treatment approach that can provide long-term survival or cure in properly selected patients. Key factors in patient selection include ensuring no distant metastases, thorough staging to determine peritoneal cancer index and completeness of cytoreduction, and histology of primary tumor. The goal of CRS is to remove all visible tumor nodules followed by HIPEC or EPIC to treat any remaining microscopic
This document provides an overview of minimal invasive surgery (MIS), also known as laparoscopic surgery. It discusses the history and development of laparoscopic techniques, advantages like less pain and faster recovery compared to open surgery. Prerequisites for MIS include patient fitness, instruments used like laparoscopes and trocars. Risks include injuries from trocars and potential complications from carbon dioxide insufflation like gas embolism. The document outlines general principles of MIS including visualization, triangulation and sealing blood vessels. Both basic procedures like laparoscopic cholecystectomy and more advanced surgeries are discussed.
This presentation will help u know with the history,present and coming up trends in laparoscopy .Also it is an acquaintance presentation regarding laparoscopy.
The document discusses properties that surgeons should consider when choosing a mesh for hernia repair. Ideal meshes are lightweight, with large pores to reduce foreign body reaction and chronic pain. Monofilament meshes have the lowest risk of infection. For intraperitoneal placement, composite meshes may reduce adhesions by providing an absorbable surface. Overall, lightweight polypropylene or polyester meshes are generally suitable in most contexts by balancing strength, flexibility and biocompatibility.
Ventral hernias occur when abdominal contents protrude through weaknesses in the abdominal wall. There are several types of ventral hernias including umbilical, epigastric, incisional, and parastomal hernias. Incisional hernias occur through surgical scars and are more common with obesity, advanced age, and emergency surgeries. Treatment depends on hernia size but may involve primary repair for small defects or prosthetic mesh placement for larger defects. Laparoscopic repair is preferred when feasible due to benefits like fewer infections and shorter recovery.
Rectal prolapse: Do we really have a perfect surgical solution? pptx copyDr Amit Dangi
Ventral rectopexy has gained worldwide acceptance for surgical correction of rectal prolapse and high-grade internal rectal intussusception. The technique is based on correcting the descent of the posterior and middle compartments combined with reinforcement of the vaginal septum and elevation of the pelvic floor. anterior mobilization of the distal rectum and mesh suspension performed during VR can correct full-thickness rectal prolapse, rectoceles, and internal rec- tal prolapse and can be combined with vaginal prolapse procedures, such as sacrocolpopexy, in patients with multicompartment pelvic floor defects.
Laparoscopy involves using small incisions and a camera to visualize the inside of the abdomen. It has several advantages over open surgery such as less pain, shorter hospital stays, and quicker recovery times. Some of the key equipment used in laparoscopy include rod lens systems and fiber optic cables for optics, trocars for abdominal access, and insufflators to inflate the abdomen with gas. Potential risks include injuries from trocars or pneumoperitoneum as well as effects of the pneumoperitoneum on respiratory and renal systems. Common procedures now performed laparoscopically include cholecystectomy, appendisectomy, hernia repair, and some cancer staging.
This document discusses ergonomics principles for laparoscopic surgery. It notes that laparoscopic surgery provides less painful surgery for patients but is more demanding on surgeons. It covers topics such as instrument triangulation, patient positioning, table height, tactile limitations, port positioning, and ergonomic principles. The concept of ergonomics and problems at laparoscopy like visual axis vs motor axis are assessed. Management of ergonomic problems and who is more ergonomic are discussed.
This document discusses ventral incisional hernia repair and compares the sublay retromuscular technique using lightweight Vypro mesh versus heavier Prolene mesh. It provides background on incisional hernias, risk factors, techniques for open repair including suture repair, inlay, onlay, and sublay/retromuscular approaches. The study aims to evaluate the challenge of the sublay technique with new technical points to reduce recurrence and compare results of Vypro versus Prolene mesh in postoperative complications, chronic pain, and recurrence rates.
This document discusses the management of burst abdomens, also known as abdominal wound dehiscence. It defines abdominal wound dehiscence and provides information on incidence, risk factors, clinical manifestations, and treatment options. Dehiscence occurs when an abdominal wound separates after surgery, with a reported incidence between 0.2-6% and mortality rates of 10-40%. Risk factors include male sex, age under 45, emergency surgery, obesity, and medical conditions like diabetes or renal failure. Treatment depends on the severity but may involve re-suturing the wound with retention sutures or using a prosthetic mesh if the wound cannot be primarily closed.
Open tibia fractures can range from minor soft tissue wounds to severe injuries with extensive soft tissue damage and bone loss. The goals of treatment are to prevent infection, achieve bone union, and restore function. Management involves thorough debridement and irrigation, temporary stabilization, soft tissue coverage within 7-10 days if possible, and definitive stabilization once the soft tissues have healed sufficiently. Complications include infection, malunion, nonunion, and compartment syndrome, which require additional treatment such as antibiotics, bone grafting, or surgery.
Adhesions are abnormal attachments between tissues and organs that commonly form after abdominal or pelvic surgery as part of the body's healing process. The formation of adhesions involves an inflammatory response to injury where fibrin deposits form bridges between tissues that can develop into fibrous bands unless dissolved. Adhesions cause significant complications like small bowel obstruction, chronic pain, infertility and increase the difficulty of future surgeries. They represent a large economic burden on healthcare systems costing an estimated $1-2 billion per year to treat adhesion-related complications. Efforts to prevent adhesions have focused on reducing inflammation, separating tissues and removing fibrin deposits but with limited success.
Open fractures of the tibial diaphysis are common injuries that require urgent treatment to prevent infection and achieve bone union. The treatment priorities include addressing life threats, administering antibiotics and tetanus prophylaxis, debriding wounds, stabilizing fractures, and covering soft tissue defects. Surgical management often involves external or internal fixation along with soft tissue reconstruction using flaps or grafts. Despite treatment, complications like infection, nonunion, and malunion are common, especially with higher grade open fractures and bone/soft tissue loss. The goals of treatment are to prevent sepsis, achieve bone union, and restore function.
Fixation of the mesh in laparoscopic hernia is an important step .I presented about different meshes used in hernia surgery along with the fixation devices.
Almost all groin hernias should be surgically repaired. When the potential complications as incarceration and strangulation are weighed against the minimal risks of hernia repair (particularly when local anesthesia is used), the early repair of groin hernias is clearly justified. This is especially true in the case of femoral hernias, since the rigid borders of the femoral canal increase the risk of incarceration
This document discusses trocar issues in laparoscopy. It notes that the initial trocar insertion is the most dangerous step and can result in injuries to the bowel or vasculature in over 50% of cases. It recommends inserting the first trocar at the umbilicus as it has minimal intervening tissue. Away from the midline poses risks of injuring major blood vessels. Direct trocar insertion is an alternative that may decrease operative time compared to Veress needle. However, no single technique is proven safest and complications can occur regardless of approach. Immediate conversion to open surgery is needed if a vascular injury is suspected.
Pediatric laryngeal and subglottic stenosis can be graded using the Cotton system. Congenital subglottic stenosis is classified as membranous or cartilaginous based on histopathology. Endoscopic management is effective for early stenosis but open surgery is needed for more advanced cases. Mitomycin C has shown promise in reducing restenosis after laryngotracheal reconstruction surgery. Careful assessment and antimicrobial coverage are important for decannulation and preventing complications.
Management of compound fracture tibia in children with titanium elastic nailsApollo Hospitals
Tibia fractures in the skeletally immature patient can usually be treated without surgery. The purpose of this study was to assess the use of flexible titanium nails in the open fracture tibia that requires operative stabilization.
Tips and Tricks in Laparoscopic Dissection of AdhesionsGeorge S. Ferzli
The document provides information on laparoscopic dissection of adhesions. It discusses the historical perspectives on adhesions, adhesion pathophysiology, prevention of adhesion formation, complications related to adhesions, results of laparoscopic adhesiolysis for small bowel obstruction, operating room set up, laparoscopic management indications and outcomes, laparoscopic approach, peritoneal access and potential trocar injury, optical access trocars, and recommended tools for adhesiolysis.
Dr. Suman Paul provides a historical overview of the treatment of open fractures. Early civilizations like Egyptians recognized the need to cover open fracture wounds to minimize morbidity. Through the 19th century, amputation was often used for treatment after open fractures. Advances in the 20th century included debridement and stabilization principles from World War I, and the introduction of local antibiotics in World War II which reduced wound sepsis rates. The Gustilo classification system, introduced in 1976, provides guidelines for prognosis and treatment of open fractures based on the degree of soft tissue injury. Later classifications like the Bowen system in 2005 incorporated host risk factors to better predict infection risk. Common bacteria associated with open fractures include staph, strep,
This document analyzes complications and implant survival rates in 63 patients who underwent custom megaprosthesis reconstruction for extremity bone tumors at a cancer center in India between 2002-2017. The most common tumors were osteosarcoma (53 cases) and giant cell tumors (8 cases). The most common complications were type I soft tissue failures like joint instability (42% of cases) and wound dehiscence (33.3% of cases). The implant survival rate was high at 96.82%. Limb salvage surgery improves quality of life over amputation for bone tumors.
This document provides a history and overview of open fractures. It defines open fractures as fractures where there is a breach in the soft tissue envelope exposing the fracture. It discusses classifications of open fractures including the Gustilo-Anderson classification. It notes that open fractures often have high rates of infection, delayed healing, and amputation. The document traces historical approaches to treatment and how understanding of microbiology and use of antibiotics has improved outcomes over time.
Negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC) therapy, uses controlled suction to promote wound healing. The study explored using VAC therapy to control orthopedic infections. Patients underwent surgical debridement and VAC application for 5-7 days. Early results showed formation of new granulation tissue and improved healing with continuous therapy at 120 mmHg using standard large pore foam sponges over necrotic soft tissue for 7 days. Further research is still needed to determine the optimal duration of therapy and effects of different dressing types under NPWT.
Evaluation of Stapled versus Hand-Sewn Techniques for Colo- Rectal Anastomosi...Dr./ Ihab Samy
This study compares outcomes of 50 patients who underwent colorectal anastomosis after low anterior resection for mid-rectal cancer using either stapled or hand-sewn techniques. The mean operative and anastomosis times were shorter for the stapled group compared to the hand-sewn group. Post-operative complications like anastomotic leakage, wound infection, and ileus occurred in similar rates between the two groups. The study concluded that colorectal anastomosis after low anterior resection for mid-rectal carcinoma can be performed safely using either stapled or hand-sewn techniques, with no significant differences in short-term outcomes.
Endoscopic Endonasal Excision of Odontoid Processiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Overlapping MAF is a modification of the original MAF technique used in the management of high anal fistulas. This simple modification showed to improve the success rate in 10% more than the original technique.
- Periapical wound healing is the host's programmed immunoinflammatory defense mechanism in response to infection or injury. It involves complex overlapping stages including inflammation, proliferation, and remodeling.
- The primary difference between healing after surgery and nonsurgical root canal treatment is that surgery requires blood clot formation and may result in faster healing dynamics. After successful nonsurgical root canal treatment, periapical inflammatory tissues will be eliminated mainly by phagocytic debridement.
- Healing involves osseous healing of trabecular and cortical bone as well as dentoalveolar healing resulting in repair or regeneration of the apical attachment apparatus. Various factors like age, tooth position, and root canal filling material can
This document provides a history of laparoscopy and key developments in the field. It discusses early developments in the 1800s and 1900s using cystoscopes and insufflation. The first laparoscopy was performed in 1901 by George Kelling. Developments continued through the 1900s including the introduction of trocars and telescopes. Laparoscopic cholecystectomy was first performed in 1985 but was not widely adopted until the late 1980s. The document also discusses current standard laparoscopic procedures and emerging technologies like fluorescent cholangiography and natural orifice transluminal endoscopic surgery (NOTES).
Laparoscopy: Historic, Present and Emerging TrendsGeorge S. Ferzli
The document provides a historical overview of laparoscopy from its origins in ancient Greece and Rome to modern developments. Key events and innovators are discussed, including the first laparoscopic procedures in the early 20th century and developments of critical tools like trocars, insufflators, and improved optics. The document also outlines current standard laparoscopic procedures like cholecystectomy and discusses trends in bariatric surgery like the increasing popularity and safety of laparoscopic Roux-en-Y gastric bypass.
This document describes a study comparing laparoscopic autopsy to needle biopsy and open autopsy. Laparoscopic autopsy was found to have a higher consent rate of 25% compared to needle biopsy. It had a sensitivity of 73% in determining cause of death, compared to 67% for needle biopsy. Laparoscopic autopsy allowed examination of abdominal and thoracic organs in a minimally invasive manner. Several additional diagnoses were made with laparoscopic autopsy that were missed by needle biopsy. The document concludes that laparoscopic autopsy is an effective technique for determining cause of death and has educational benefits for surgical trainees.
This document summarizes endoscopic parathyroid surgery. It discusses the history and discovery of the parathyroid glands and developments in parathyroid surgery techniques. Minimally invasive video-assisted parathyroidectomy has equivalent outcomes to open surgery but offers benefits like less pain and better cosmetic results. Preoperative localization using imaging like sestamibi scans and ultrasound is important to select candidates for minimally invasive approaches.
Common Bile Duct Stones: Leave Them Get Them or Refer ThemGeorge S. Ferzli
The document discusses various approaches for managing common bile duct (CBD) stones, including:
- Preoperative identification using blood tests, ultrasound, ERCP, MRCP, which have varying sensitivity and specificity
- Intraoperative options like cholangiography, laparoscopic ultrasound, and indocyanine green injection
- Postoperative ERCP can be used for diagnostic and therapeutic purposes but has risks of pancreatitis and cholangitis
- The optimal management strategy depends on individual patient risk factors and circumstances.
Laparoscopic Sigmoid Colon Resection: Supine and LateralGeorge S. Ferzli
The document discusses different approaches for performing a laparoscopic sigmoid colon resection surgery. It describes the lateral and anterior patient positioning approaches. For the lateral approach, the patient is positioned on their right side and trocars are placed in a triangular configuration. This approach allows for easy mobilization of the splenic flexure but has disadvantages like poor access to the right side of the rectosigmoid area. The anterior approach involves positioning the patient supine and placing trocars in a semicircular configuration above the sigmoid colon. Both approaches aim to bring the proximal colon through the incision sites to allow for a tension-free anastomosis repair. Data on outcomes from 62 patients undergoing either the lateral or anterior approach are also presented.
Is There a Role for Surgery in the Treatment of DiabetesGeorge S. Ferzli
1. Bariatric surgery has been shown to significantly improve or resolve type 2 diabetes and other obesity-related conditions through mechanisms beyond just weight loss, such as changes in gut hormones.
2. Studies in animal models and humans found that bypassing parts of the small intestine can improve glucose control, independently of weight loss, through changes in hormones like GLP-1, GIP, leptin and others.
3. The mechanisms are not fully understood but likely involve bypassing the duodenum and proximal jejunum to alter gut hormone signaling and glucose metabolism.
Surgery for Obesity Duodeno-Jejunal Bypass forType 2 Diabetes in Non-Obese - ...George S. Ferzli
This document summarizes research on the effects of bariatric surgery procedures like gastric bypass and duodenal switch on type 2 diabetes. It finds that these procedures often dramatically improve blood sugar control and can even cure diabetes in many patients. This is believed to be due both to weight loss effects and hormonal changes from rerouting digestion, which increase levels of gut hormones like GLP-1 that stimulate insulin secretion and improve insulin sensitivity. The document reviews long-term studies finding high rates of diabetes remission following various bariatric procedures.
Urgent early laparoscopy can be used both diagnostically and therapeutically for a variety of acute abdominal conditions including perforated viscus, obstruction, bleeding, and failure of primary procedures. It allows for diagnosis and treatment of conditions like perforated ulcers, adhesions, and anastomotic leaks in a minimally invasive manner. However, it requires an experienced laparoscopist and a low threshold for conversion to open surgery if needed.
Type 2 diabetes can be considered a surgical disease as bariatric surgery procedures like Roux-en-Y gastric bypass and biliopancreatic diversion have been shown to significantly improve and even normalize blood glucose levels and insulin resistance in up to 90-100% of obese patients with diabetes. This glycemic control occurs rapidly within days of surgery, before significant weight loss, suggesting a direct metabolic effect of surgically bypassing parts of the intestines. Studies in animal models provide evidence that bypassing the duodenum through a duodenal-jejunal bypass can improve oral glucose tolerance and lower blood glucose levels through a reduction in the anti-incretin hormone leptin, reducing insulin resistance.
Trocar/Port Placement for the Procedure: General StrategiesGeorge S. Ferzli
The document discusses strategies for correct trocar placement during laparoscopic procedures. It provides guidelines for trocar positioning based on the target organ and surgical procedure. Proper trocar placement should provide direct access and an optimal view while avoiding injury. Placement may need to be modified depending on individual patient anatomy, prior surgery, or if combining multiple procedures. Exceptions include extraperitoneal approaches and some procedures done in non-supine positions.
The document discusses techniques for performing a totally extraperitoneal (TEP) hernia repair for recurrent hernias after a previous TEP procedure. It notes that TEP after TEP is technically challenging due to adhesions and obscured anatomy from the prior mesh placement. The key steps described are blunt dissection, ligation of epigastric vessel branches, and oversizing the repair mesh. While conversion to open surgery may be needed in some cases, the literature suggests TEP can be used to repair recurrent hernias after a previous TEP.
The document discusses the debate around whether mesh should be tacked or not during laparoscopic hernia repair surgery. It summarizes several studies that found: 1) There was no difference in hernia recurrence rates whether the mesh was tacked or not. 2) Patients who did not have their mesh tacked experienced less post-operative pain and required fewer pain medications. 3) Tacking the mesh increased the cost and time of the surgery without providing clinical benefits. Therefore, the document concludes that laparoscopic hernia repair can be performed safely without the routine use of mesh fixation devices.
This document summarizes a study on laparoscopic adhesiolysis for small bowel obstruction. Key points include:
- Laparoscopic adhesiolysis has advantages over open surgery like less pain, quicker recovery, and fewer adhesions.
- Patient selection is important, and factors like bowel diameter >4cm or distal complete obstruction increase risk of conversion.
- The open technique for initial trocar insertion is recommended to avoid injury to adherent bowel.
- Adhesiolysis requires careful sharp dissection and avoidance of cautery to prevent new adhesions.
- Findings like perforated bowel or dense adhesions often require conversion to open surgery.
The document summarizes a study on thyroid surgery performed through a mini-incision approach. An incision of 2-4cm is made along the neck and the thyroid is removed. The study involved 264 surgeries on 256 patients with various thyroid conditions. Most patients were discharged within 23 hours without complications. The mini-incision technique was found to be feasible, safe, and have comparable cosmetic results to endoscopic surgery but with shorter operating times and hospital stays.
The document discusses several studies on the use of laparoscopic (TEP) and open preperitoneal (OPM) approaches for repairing recurrent inguinal hernias. The studies found that both approaches had low recurrence rates of around 2%, with the TEP approach having shorter operating times and hospital stays compared to OPM. Overall, the studies concluded that the preperitoneal approaches, whether open or laparoscopic, are good options for repairing recurrent inguinal hernias when performed by experienced surgeons.
The document discusses the learning curve associated with laparoscopic inguinal hernia repair techniques. It notes that the learning curve for total extraperitoneal (TEP) repair is longer than for other hernia surgeries or transabdominal preperitoneal (TAPP) repair. Several sources suggest it may take 30 to 50 procedures or more to become proficient, and that outcomes like operating time and recurrence rates improve with increased experience.
TAPP and TEP in the Complicated Hernia: Scrotal, Strangulated, and RecurrentGeorge S. Ferzli
This document reviews the literature on the use of TAPP and TEP procedures for complicated hernias such as scrotal, incarcerated, recurrent, and femoral hernias. It provides recommendations on the use of laparoscopic techniques in different clinical scenarios and complication settings. The recommendations are based on evidence levels ranging from I to IV, with level I evidence existing for use of TAPP and TEP in recurrent hernias compared to open repair. Surgeon experience is emphasized as an important factor for many of the more complex cases.
This document summarizes the surgical treatment of morbid obesity. It discusses the prevalence and health risks of obesity, indications for bariatric surgery, the evolution of different surgical procedures like gastric bypass and gastric banding, and results showing significant long-term weight loss and reduction in obesity-related health conditions with bariatric surgery. Laparoscopic bariatric surgery procedures like Roux-en-Y gastric bypass and adjustable gastric banding are now commonly performed and have been shown to be safe and effective options for treating morbid obesity.
1) Standardized trocar placement in a semicircular pattern around the target organ can optimize ergonomics, decrease fatigue, and increase safety during laparoscopic surgery.
2) Trocar placement follows specific quadrants and positions depending on the procedure, such as in the upper right quadrant for cholecystectomy or lower left for sigmoid resection.
3) While standardized trocar positioning is applicable to most intra-abdominal procedures, some exceptions like inguinal hernia repairs or extraperitoneal approaches may require straight-line rather than semicircular placement.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
7. Wound complications related to stitch length Effect of Stitch Length on Wound Complications After Closure of Midline Incisions; A Randomized Controlled Study, Millbourn, D MD; Cengiz, Y MD, PhD; Israelsson, L MD, PhD Arch Surg/vol 144 (No. 11), Nov 2009 www.archsurg.com Stitch length a Fisher exact test. Complication Long Short P Value a Wound dehiscence, No. (%) of patients 1/381 (0.3) 0/356 .99 Surgical site infection No. (%) 35/343 (10.2) 17/326 (5.2) .02 Incisional hernia No. (%) 49/272 (18.0) 14/250 (5.6) .001
8. Significant predictors of surgical site infection and incisional hernia a Effect of Stitch Length on Wound Complications After Closure of Midline Incisions; A Randomized Controlled Study, Millbourn, D MD; Cengiz, Y MD, PhD; Israelsson, L MD, PhD Arch Surg/vol 144 (No. 11), Nov 2009 www.archsurg.com Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); CI, confidence interval; OR odds ratio; SL, suture length; WL wound length A Results of logistic regression analysis. All recorded variables were included in the model and removed by a backward reduction strategy if nonsignificant. Predictor Regression Coefficient (SE) OR (95%CI) Surgical site infection Wound contamination 1.03 (0.48) 2.81 (1.09-7.25) Being diabetic 1.01 (0.38) 2.73 (1.30-5.72) Long stitch length 0.77 (0.31) 2.15 (1.17-3.96) Incisional hernia Male sex 0.76 (0.34) 2.14 (1.10-4.15) Higher BMI 0.05 (0.02) 1.05 (1.01-1.10) Longer operation time 0.005 (0.002) 1.01 (1.002-1.01) Surgical site infection 1.16 (0.40) 3.18 (1.44-7.02) SL to WL ratio <4 1.32 (0.52) 3.73 (1.36-10.26) Long stitch length 1.44 (0.34) 4.24 (2.19-8.23)
9. Conclusions Effect of Stitch Length on Wound Complications After Closure of Midline Incisions; A Randomized Controlled Study, Millbourn, D MD; Cengiz, Y MD, PhD; Israelsson, L MD, PhD Arch Surg/vol 144 (No. 11), Nov 2009 www.archsurg.com When a long stitch length is used, the suture cuts through or compresses soft tissue included in the stitch. This increases the amount of devitalized tissue in the wound and may explain the correlation with infection. This also causes slackening of the suture, which allows the wound edges to separate and increases the risk of incisional hernia. • Surgeons should place stitches 5-8 mm from the wound edge, with minimal tension applied to the suture. • Midline incisions should be closed with a single layer, running monofilament suture and the SL to WL ratio should be at least 4. This ratio should be achieved with several small stitches that incorporate aponeurosis only.
59. Level of Complexity Grade 1 Low risk of infection Low risk of complications Grade 2 Smoker Immunosuppressed Obese Diabetic Grade 4 Active infection Infected mesh Grade 3 Contamination risk Stoma present Violation of bowel wall Previous Wound infection Grade 5 Traumatic fascia loss Extensive fascia loss Percent Performed Open Patients with co-morbid conditions have up to 4x increase in wound-infection rates Open incisional hernias are 10x more likely to have infection than a clean surgical case Infected mesh commonly results in a 2 nd procedure for removal Synthetic Biologic
78. FlexHD Musculo-Skeletal Foundation (MTF) Acellular dermal matrix from Human allograft skin . Alliance between Ethicon and Musculoskeletal transplant Foundation (MTF). Prehydrated with no need for refrigeration .
79.
80. Permacol Supplied sterile, hydrated & ready-to-use Flexible and strong Flat, continuous collagen sheet Easily cut to desired shape
81. Patented Process used to Manufacture Permacol Porcine dermis Extraction of Cells, RNA, DNA Collagen structure maintained Crosslinking for durability Extraction of fat Permacol
91. Grevious MA. Cohen M. Shah SR. Rodriguez P. Structural and functional anatomy of the abdominal wall. Clinics in Plastic Surgery. 33(2):169-79, v, 2006 Apr. External oblique Internal oblique Transversus abdominis Rectus abdominis Components Separation
95. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures Jason H. Ko, MD; Edward C. Wang, PhD; David M. Salvay, MS; Benjamin C. Paul, BA; Gregory A. Dumanian, MD Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Large complex hernias can be reliably repaired using the components separation technique despite the presence of open wounds, the need for bowel surgery and numerous co-morbidities . The long-term strength of the hernia repair is not augmented by acellular cadaveric dermis but seems to be improved with soft polypropylene mesh.
96. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg /vol 144 (No. 11), Nov 2009 www.archsurg.com Figure 1. Modified “components separation” technique using bilateral transverse subcostal incisions to access the external oblique muscle and fascia . A, Using a narrow Deaver retractor and a Bovie cautery with and extender, the external oblique muscle and fascia are divided superiorly (above the rib cage) and inferiorly. B, At the caudal aspect of the midline incision, the cut edge of the external oblique muscle and fascia is delivered using manual traction for complete release.
97. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg /vol 144 (No. 11), Nov 2009 www.archsurg.com • Senior author Gregory Dumanian adapted his surgical technique to perform the external oblique releases through bilateral transverse subcostal incisions to avoid wide undermining, an evolution of the technique of “periumbilical perforator preservation .” Releases take only 15-20 minutes to perform and avoid the setup of endoscopic equipment.
98. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Figure 2 “Components separation” technique with midline approximation of the rectus abdominus muscles. A, No mesh. B, Acellular cadaveric dermis underlay. C, Soft polypropylene mesh underlay.
99. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Figure 3 A 41-year old man with a history of a perforated appendix treated through a midline incision who later developed an incisional hernia. A, Preoperative oblique view after a hernia repair with polypropylene mesh by another surgeon. B, Preoperative computed tomography scan demonstrating the small bowel herniating to the right of the polypropylene mesh, with wide displacement of the rectus abdominus muscles. C, Six-month postoperative oblique view demonstrates restoration of abdominal wall continuity. D, Postoperative anterior view demonstates stable midline closure and bilateral transverse subcostal incision scars.
100. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Figure 4. Predictors of hernia recurrence and major and minor complications using logistic regression controlling for mesh type and follow-up duration. Error bars represent 95% confidence intervals. BMI indicates body mass index.
101. Abbreviation: NA, not applicable. a Includes patients in whom components separation was performed concurrently with panniculectomy or parastomal hernia repair. a Major complications include hematoma, infection that requires incision and drainage, repeated operation for any complication, myocardial infarction, pulmonary embolus and death. c Minor complications include cellulitis, seroma that requires aspiration, skin sloughing and wound breakdown. d Fisher exact test for categorical variables and the F text for continuous variables. e Statistically significant. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Rates of Recurrence and Complications Based on Type of “Component Separation” Repair a Type of Repairs Patients No. Follow-up Mean mo Recurrence No. (%) Time to Recurrence Mean mo Major ComplicationsNo. (%) b Minor Complications No. (%) c No mesh 158 9.6 36 (22.8 ) 14.3 40 (25.3) 30 (19.0) Poly propylene 6 5.4 1 (16.7) 9.9 1 916.7) 2 (33.3) Cadaveric dermis 18 14.7 6 (33.3) 17.8 4 (22.2) 3 (16.7) Soft polypropylene 18 13.8 0 NA 3 (16.7) 3 (16.76) Total 200 10.3 43 (21.5) 14.8 48 (24.0) 38 (19.0) P value d 0.20 0.04 e 0.92 0.92 0.80
102. The components separation technique many be an ideal hernia repair for large defects because it weakens or loosens the contracted sides of the abdominal wall to augment the midline repair. Increased lateral wall compliance may reverse the lateral abdominal wall disuse atrophy and fibrosis seen in animal incisional hernia models. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Observations
103. The midline movement of tissue with the components separation technique permits the excision of all scarred and inflamed tissues. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Observations
104. • The hernia recurrence rate with a cadaveric dermis underlay was even higher than that for primary closure. At the time of repeated operation the cadaveric dermis was often difficult to find and when present, large holes in the material itself, were often noted . • Cadaveric dermis alone does not provide long-lasting or durable results in abdominal wall reconstruction and should therefore, be reserved for contaminated wounds, where a prosthetic mesh is best avoided. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Observations
105. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Conclusions: • A major lesson learned over the years is that handling of the skin is important, especially in patients with an elevated BMI. Wide undermining of the skin to release the oblique musculature disrupts the perforator blood flow to the midline abdominal skin, thereby contributing to wound complications in these patients.
106. Abdominal Wall Reconstruction: Lessons Learned From 200 “Components Separation” Procedures. Ko, J, MD; Wang, E, PhD; Salvay, D, MS; Paul. B, BA; Dumanian, G, MD ArchSurg/vol 144 (No. 11), Nov 2009 www.archsurg.com Conclusions : • Another skin-handling technique is to perform a panniculotomy at the time of the components separation for morbidly obese patients with infraumbilical hernias (repairs of hernias that extend above the umbilicus are generally performed using vertical midline incisions). A third improvement for skin handling is the use of short-term subatomospheric pressure dressings as immediate postoperative dressings in patients with an elevated BMI, gross contamination and large suprapubic dead spaces . This “semi-closed” technique for skin management had led to decreased seroma formation and infections in addition to allowing access to the midline fascial closure in the immediate postoperative period.