19 research outputs found
Robot-assisted repair of complicated inguinal hernia: Advantages in comparison with conventional repair
No full textThe adoption rate of robot-assisted surgery has skyrocketed in recent years, despite limited evidence, an unclear clinical benefit, and an increase in cost. The laparoscopic approach to inguinal hernia repair by either transabdominal or extraperitoneal approach has gradually gained traction owing to distinct advantages over traditional open repairs. Although robotic inguinal hernia repair has been established as a safe alternative to conventional laparoscopy, as of yet no superiority has been proven. We aim to give an overview of certain clinical situations, in which the robot might be advantageous. Specifically, we discuss inguinoscrotal hernia repair, inguinal hernia repair after prostatectomy, and mesh explantation. In our opinion, robotic systems are an invaluable tool in the case of mesh resection or recurrence after previous anterior and posterior repairs. With the increased expansion of the surgical tools and techniques to repair abdominal wall problems, a definitive and clear rule as to which cases should be handled robotically and which should not will be difficult and probably unattainable. We are very much proponents of a tailored approach, where every individual case deserves its surgical plan, bearing in mind all aspects of a patient, with the aim of the best surgical outcome
The open anterior component separation technique for large ventral and incisional abdominal wall reconstruction
No full textLarge defects in the abdominal wall have been a challenge for traditional surgical techniques. Over several decades, the development of what is now known as the anterior component separation technique (CST) has evolved to reduce tension through release of the lateral abdominal wall muscles. Initially, Albanese and later Ramirez described and popularized this technique.In this procedure, the space between the external oblique muscle and the internal oblique muscle is dissected immediately lateral to the rectus compartment, that is, at the level of the linea semilunaris. To reach this area, an extensive dissection of the subcutaneous tissue and bilateral dissection of the aponeurosis of the external oblique muscle is mandatory in an open standard approach. Unfortunately, this extensive dissection comes at the cost of higher wound morbidity rates.Herein, the surgical technique, the indications as well as the complications will be discussed and a short overview of the results of the latest systematic reviews will be presented, comparing the anterior CST with other surgical options to achieve fascial closure in large abdominal wall defects
Botulinum toxin A in abdominal wall reconstruction
No full textReconstruction of large abdominal wall defects is often a challenge for both surgeons and patients. Preoperative conditioning prior to surgery can be crucial for success. Administration of botulinum toxin A (BTA) in the lateral abdominal wall for stretching the musculature seems to provide myofascial advancement and enlargement of the torso diameter. Although the use of BTA has increased since its introduction in 2009, the current evidence on both its safety and efficacy, as well as on its exact role in the treatment algorithm of these types of hernias, remains undetermined. In this chapter, we aim to give a complete overview on the current evidence on the use of BTA in abdominal wall reconstruction
Correction: Cyanoacrylate mesh fxation for laparoscopic inguinal hernia repair: a prospective, multicenter, single‑arm study
No full textCyanoacrylate mesh fixation for laparoscopic inguinal hernia repair : a prospective, multicenter, single-arm study
No full textBackground Inguinal hernia repair is among the most frequently performed surgical procedures. Alternatives to penetrating mesh fixation, such as surgical glue, are being investigated for their potential benefit in reducing chronic pain. The aim of this study was to assess the efficacy of the n-hexyl cyanoacrylate glue Ifabond (TM) for mesh fixation in laparoscopic inguinal hernia repair.Methods This prospective, multicenter, single-arm study collected data from laparoscopic inguinal hernia repairs using Ifabond (TM) (Peters Surgical, Boulogne-Billancourt Cedex, France) and a standard [Promesh (R) SURG ST (Peters Surgical)/Biomesh (R) P1 (Cousin Biotech, Wervicq-Sud, France)] or lightweight [Promesh (R) SURG LI (Peters Surgical)/Premium (R) Implant (Cousin Biotech)] polypropylene mesh. The primary endpoint was postoperative pain [100-scale Visual Analog Scale (VAS)]. Secondary endpoints were complications, hernia recurrences, and quality of life (QoL) (EQ-5D-3L health index and EQ-VAS). Patients were followed up at 5 weeks and 12 months after surgery.Results Six-hundred and thirteen patients underwent laparoscopic inguinal hernia repair. Postoperative pain decreased at 5-week (3.97 +/- 10.04; p < 0.0001) and 12-month (3.83 +/- 11.26; p < 0.0001) follow-up compared with before surgery (26.96 +/- 19.42). One hundred and fifteen patients (13.74%) experienced chronic pain in the groin at 12-month follow-up, of whom 14 (2.67%) required analgesics. There were 6 patients with major morbidities and one patient died of an unrelated cause. Two hernia recurrences occurred within 12-month follow-up. Patients' QoL increased from an EQ-5D-3L index score of 0.82 +/- 0.19 preoperatively to 0.90 +/- 0.15 at 5 weeks (p < 0.0001) and 0.92 +/- 0.15 at 12 months after surgery (p < 0.0001). The EQ-VAS general health scoring increased from 79.03 +/- 12.69 preoperatively to 84.31 +/- 9.97 at 5-week (p < 0.0001) and 84.16 +/- 14.48 at 12-month follow-up (p < 0.0001).Conclusions Ifabond (TM) (Peters Surgical) is a safe, reliable, and feasible fixation method for laparoscopic inguinal hernia repair with a very high surgeon satisfaction score, improved patients' QoL, and comparable risk of developing chronic pain and postoperative complications as described in the literature
Robot-assisted repair of a traumatic hernia after a pelvic fracture : case report and literature review
No full textTraumatic Abdominal Wall Hernias (TAWH) are an uncommon clinical entity, accounting for
less than 0.2% of all blunt trauma injuries. Due to its low incidence and high risk for associated
injuries there is no consensus on their management and best method of repair. We report a case of
a 46-year-old male with a delayed presentation of a traumatic hernia through a defect of the left iliac
wing. To our knowledge, we describe the first robot-assisted transabdominal preperitoneal repair
of a traumatic hernia with a pelvic fracture. We present our operative approach and an overview of
the literatur
Progressive pneumoperitoneum : where do we stand in 2021?
No full textProgressive pneumoperitoneum (PPP) is a technique in which the abdomen is artificially and gradually insufflated over a period of time. The technique was first applied in hernia repair in the 1940s and is now regarded as a useful adjunct in the treatment of complex or giant hernias and those associated with "loss of domain" (LOD). With gradual insufflation, the abdomen becomes progressively distended, promoting soft tissue elongation and preparing it for the post-repair surplus volume of the herniated content. PPP also helps with preoperative pulmonary stabilization and preparation, and it induces pneumatic lysis of intestinal adhesions. In contrast to the longevity of the technique, the heterogeneity in indications and technical variations is remarkable. Indications vary greatly in literature, being either based on clinical judgment or different volumetric cut-off values. Neither is there any consensus on which gas should be used, what volume should be injected, in what frequency, and for how long the pneumoperitoneum should be maintained. There is a clear need for an international consensus concerning LOD hernias and how they are defined. As setting up randomized controlled trials on PPP is not feasible, further research should rely on high-quality observational studies. For reviews and meta-analysis to have any meaningful conclusions, these studies should follow, and adhere to, clear guidelines on the manner of reporting. However, PPP remains a very powerful adjunct in the treatment of large and complex hernias with LOD and has proven its value over time
Robotic repair of large Morgagni hernia in an adolescent girl
No full textIntroduction: Successful robotic repair of Morgagni hernias has been reported a few times, but in these cases the hernia content was rather minimal or unspecified. The goal of this case report is to demonstrate the feasibility of robotic repair of a Morgagni hernia in an adolescent girl, even with massive hernia content. Case report: The case of a15-year-old girl with incidental discovery of a huge Morgagni hernia is presented. The hernia contained the stomach, part of the colon, small intestine and a significant portion of the mesentery. Repair was successfully carried out with the da Vinci Xi Surgical System® (Intuitive Surgical, Sunnyvale, USA. Overall surgery time was 2 h and 10 min, including a 13-min docking time. The procedure was uneventful. Postoperative pain was minimal and oral intake possible on the first day after surgery. Discussion: The advantages of laparoscopic vs open surgery in closing Morgagni hernia's are evident. The main advantage of robotic surgery over laparoscopic surgery in this case was the enhanced maneuverability and view. Conclusion: This case demonstrates that robotic repair of a Morgagni hernia, even with massive hernia content, is feasible in adolescents. However, whether robotic surgery in general, and for Morgagni hernia in particular, is superior to laparoscopy in children, remains to be proven
Robotic-assisted repair of perineal hernia after extralevator abdominoperineal resection
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