Hernia Repair: Measures of Success and Perioperative Considerations

Transcription

1 Current Concepts in Hernia Surgery Foreword Ronald F. Martin xiii Preface Ajita S. Prabhu xvii Hernia Repair: Measures of Success and Perioperative Considerations Epidemiology and Disparities in Care: The Impact of Socioeconomic Status, Gender, and Race on the Presentation, Management, and Outcomes of Patients Undergoing Ventral Hernia Repair 431 Deepa V. Cherla, Benjamin Poulose, and Ajita S. Prabhu More research is needed with regards to gender, race, and socioeconomic status on ventral hernia presentation, management, and outcomes. The role of culture and geography in hernia-related health care remains unknown. Currently existing nationwide registries have thus far yielded at best a modest overview of disparities in hernia care. The significant variation in care relative to gender, race, and socioeconomic status suggests that there is room for improvement in providing consistent care for patients with hernias. Quality Measures in Hernia Surgery 441 Michael J. Rosen With growing pressures to formulate easily interpreted quality metrics, potential pitfalls exist that deleteriously affect the ultimate outcome of patients. This article defines what quality means in hernia surgery, how it is measured, who measures it, and how it is reported. Key governmental organizations responsible are highlighted. Although striving for high quality seems relatively straightforward, it is a challenge to account for all variables. Most definitions of quality are based on products and derived from minimum standards. This transition to basing it on health care delivery is ongoing, challenging, and incredibly important for the future of patients. Establishing a Hernia Program 457 David M. Krpata Hernia repair is one of the most common operations performed by surgeons; however, there is neither consistency in practice nor broadly accepted guidelines to advise best practices. Hernia programs can help shape guidelines through voluntary participation, inclusion, continuous quality improvement, education, and research by all stakeholders involved in hernia surgery at the institution. Once established, a hernia

2 viii program can improve the delivery of care and outcomes of patients with hernia, leading to added value for the institution and health care system. Updates in Mesh and Biomaterials 463 Brent D. Matthews and Lauren Paton Prior publications of the Surgical Clinics of North America have highlighted the technical challenges of abdominal wall reconstruction. This article provides an update on synthetic, biologic, and biosynthetic mesh research since the 2013 Surgical Clinics of North America hernia publication and highlights the future of mesh research. This update features research that has been conducted since the prior publication to guide surgeons to choose the best and most appropriate mesh for their patients. Role of Prophylactic Mesh Placement for Laparotomy and Stoma Creation 471 Irfan A. Rhemtulla, Charles A. Messa Iv, Fabiola A. Enriquez, William W. Hope, and John P. Fischer Incisional and parastomal hernias are a cause of significant morbidity and have a substantial effect on quality of life and economic costs for patients and hospital systems. Although many aspects of abdominal hernias are understood, prevention is a feature that is still being realized. This article reviews the current literature and determines the utility of prophylactic mesh placement in the prevention of incisional and parastomal hernias. Preoperative Planning and Patient Optimization 483 Clayton C. Petro and Ajita S. Prabhu This article reviews the literature that supports routine expectations for smoking cessation; weight loss; diabetic, nutritional, or metabolic optimization; and decolonization techniques before ventral hernia repair. These methods diminish postoperative complications. In an era of value-centric care, an upfront investment in patient optimization can improve the quality of the repair by reducing wound morbidity and hernia recurrence, naturally translating to a reduction in cost. The adoption of these practices and further study aimed at identifying other effective optimization techniques are encouraged. Enhanced Recovery After Surgery Protocols: Rationale and Components 499 Kyle L. Kleppe and Jacob A. Greenberg Enhanced recovery after surgery (ERAS) protocols are spreading throughout various fields in surgery. ERAS protocols involve the implementation of evidence-based elements of care that are applied throughout the entire perioperative period to facilitate optimal recovery for the patient. ERAS protocols have been associated with improvements in quality of care, patient-reported and operative outcomes, and patient safety as well as reductions in cost. Thus, ERAS protocols have led to an overall improvement in health care value for the patient and the health care system.

3 ix Incisional and Parastomal Hernias Incisional Hernia Repair: Open Retromuscular Approaches 511 Luciano Tastaldi and Hemasat Alkhatib Open retromuscular approaches are powerful tools in the surgical armamentarium for incisional hernia repair. In this article, the authors discuss concepts, surgical techniques and published literature about the most common abdominal wall reconstructive techniques performed with retromuscular mesh placement through an open approach. Incisional Hernia Repair: Minimally Invasive Approaches 537 Jeremy A. Warren and Michael Love Ventral hernia repair, a common surgical procedure, has long been a vexing problem, with no clear standard for repair and significant postoperative morbidity. Laparoscopic repair has the clear advantage of lower postoperative morbidity. However, application of laparoscopic ventral hernia repair is often limited by patient factors and hernia morphology. Long-term complications of intraperitoneal mesh and recurrence are concerning. Robotic-assisted surgery is the latest advance in minimally invasive hernia repair, combining the advantages of open repair with complete abdominal wall reconstruction and restoration of functional anatomy with the wound morbidity and decreased recovery time of laparoscopy. Umbilical Hernia Repair: Overview of Approaches and Review of Literature 561 Paul W. Appleby, Tasha A. Martin, and William W. Hope Umbilical hernias are ubiquitous, and surgery is indicated in symptomatic patients. Umbilical hernia defects can range from small (<1 cm) to very large/complex hernias, and treatment options should be tailored to the clinical situation. Open, laparoscopic, and robotic options exist for repair, with each having its advantages and disadvantages. In general, mesh should be used for repair, because it has been shown to decrease recurrence rates, even in small hernias. Although outcomes are generally favorable after umbilical hernia repairs, some patients have long-term complaints that are mostly related to recurrences. Surgical Management of Parastomal Hernias 577 Jennifer Colvin and Steven Rosenblatt Parastomal hernias are a common complication after ostomy formation that can require surgical repair when they become symptomatic. Operative planning and a thorough understanding of the anatomy of the abdominal wall are important. Simple fascial repair is associated with an unacceptably high recurrence rate and should be used as a temporary measure only. Stoma relocation has a high recurrence rate. Prophylactic mesh can and should be used. At this time, the use of mesh is considered the standard of care in the repair of parastomal hernias.

4 x Flank and Lumbar Hernia Repair 593 Lucas R. Beffa, Alyssa L. Margiotta, and Alfredo M. Carbonell Flank and lumbar hernias are challenging because of their rarity and anatomic location. Several challenges exist when approaching these specific abdominal wall defects, including location, innervation of the lateral abdominal wall musculature, and their proximity to bony landmarks. These hernias are confined by the costal margin, spine, and pelvic brim, which makes closure of the defect, including mesh placement, difficult. This article discusses the anatomy of lumbar and flank hernias, the various etiologies for these hernias, and the procedural steps for open and robotic preperitoneal approaches. The available clinical evidence regarding outcomes for various repair techniques is also reviewed. Inguinal Hernias Inguinal Hernia: Mastering the Anatomy 607 Heidi J. Miller The success of an inguinal hernia repair is defined by the permanence of the operation while creating the fewest complications at minimal cost and allowing patients an early return to activity. This success relies and depends on the surgeon s knowledge and understanding of groin anatomy and physiology. This article reviews relevant anatomy to inguinal hernia repair and technical steps to open tissue and mesh repairs as well as minimally invasive approaches. Inguinal Hernia: Four Open Approaches 623 Shirin Towfigh Open inguinal hernia approaches are varied. The best studied approaches are reviewed herein. The common factor among them is the imperative anatomy knowledge of the surgeon. This knowledge is key to improved outcomes. A tailored approach is best to determine which open technique, if any, is most appropriate for the patient. Although the anterior mesh approach is the most commonly applied, there is support in using the posterior approach or a tissue repair for subsets of patients, such as women. Minimally Invasive Approaches to Inguinal Hernias 637 Charlotte M. Horne and Ajita S. Prabhu Both the transabdominal preperitoneal approach and the total extraperitoneal approach to inguinal hernias provide an effective means of repairing inguinal hernias. The robotic platform can be used and may help to decrease immediate postoperative pain; however, as this is a fairly new technique, more research will help further determine long-term outcomes. In all methods of fixation, we ensure adequate fixation medially with tacks placed on the Cooper ligament. Awareness of the nerves and vessels helps to guide dissection as well as prevent inadvertent injury during mesh fixation.

5 xi Approach to the Patient with Chronic Groin Pain 651 Q. Lina Hu and David C. Chen Chronic postoperative inguinal pain has become a primary outcome parameter after elective inguinal hernia repair with significant consequences affecting patient productivity, employment, and quality of life. A systematic and thorough preoperative evaluation is important to identify the etiologies and types of pain. Owing to the complex nature of chronic pain, a multimodal and multidisciplinary treatment approach is recommended. Patients with chronic pain refractory to conservative measures may be considered for surgical intervention. Triple neurectomy remains the most definitive and accepted remedial operation performed and provides effective relief in the majority of patients.