Keyhole Laparoscopic Hernia Repairs: What s the Benefit for Your Patients?
|
|
- Anna Harmon
- 6 years ago
- Views:
Transcription
1 InTouch ARTICLE Keyhole Laparoscopic Hernia Repairs: What s the Benefit for Your Patients? Author: Mr Steve Warren Date: Mary View Road, Highgate, London, N6 4DJ Tel enquiries@highgatehospital.co.uk
2 Keyhole Laparoscopic Hernia Repairs: What s the Benefit for Your Patients? By Mr Steve Warren Consultant General, Laparoscopic & Colorectal Surgeon Patients might visit their General Practitioner with a groin hernia, incisional, umbilical or ventral hernia, and ask about laparoscopic versus open repair techniques and their potential benefits or risks. Increasingly patients will have seen information about laparoscopic surgery in the media, or have relatives, friends or colleagues who have had a laparoscopic approach. So which is best? Groin Hernias Can groin hernias be ignored and watched? Studies have repeatedly shown that groin hernias will continue to develop and become symptomatic, and of course waiting until the defect becomes larger is associated with increased recurrence rates once repaired and a very small risk of bowel incarceration/ strangulation. Obviously treatments are tailored to individual patients meaning that advice given to a 23 year old fit builder will be different to a 95 year old co-morbid patient. Inguinal or femoral groin hernias can be approached by both an open or laparoscopic technique but both require a polypropylene mesh to avoid recurrences. Recurrence rates for experienced surgeons should be equal at less than 1%. With the open method, an incision is made in the groin and muscles and fascia divided before excision of the hernial sac and mesh repair. This disruption causes the post-operative pain for up to four weeks and limits normal activity. Furthermore, nerves injured during this dissection can lead to chronic unremitting groin pain which is therefore much higher with open compared to the laparoscopic approach. With laparoscopic repairs only 3 tiny 5mm port sites are used and the mesh repair of the hernial defect is performed without significant groin dissection. In my own recent audit of in excess of 500 patients the average pain relief requirements were a mere 24 hours of simple paracetamol, with a good proportion requiring absolutely no analgesia, and average return to a completely normal lifestyle by 11 days, with some returning to work within the first few days. Because of the larger incision and muscular dissection in the groin where we all have more skin flora, the open approach is more susceptible to bleeding and wound infection (6.7% in a UK recent audit) and a proportion of these will develop catastrophic mesh infections, which is virtually unknown with the laparoscopic method. High risk groups such as diabetics, immunosuppressed etc might therefore be better with a laparoscopic repair. With recurrent and bilateral hernias, there is absolutely no question that a laparoscopic repair is best, formally accepted by NICE guidelines in When bilateral hernias are encountered, no new incisions are made and hence there is no additional pain over a unilateral repair. In our very early publication in 2001, we found that actually 34% of clinically unilateral hernias are actually bilateral, and if the asymptomatic undisclosed side is left then p.25 InTouch MAY 2015
3 approximately 50% will go on to develop a symptomatic hernia within one year (and nearly 100% if you wait long enough since exactly the same intra-abdominal forces have been applied to both groins over the years). The advice therefore is to repair bilateral hernias laparoscopically at the same single operation, though this might be too painful with the open method. When a patient has a recurrence of a previous open repair, there has already been an extensive groin dissection and particularly if mesh has been used previously, the resultant scar tissue makes an open recurrent operation far more difficult with higher bleeding and wound infection rates, a greater likelihood of injury to testicular blood vessels and nerves with resultant chronic groin pain and higher rates of re-recurrence afterwards. With a laparoscopic recurrent hernia repair of a previous open approach, the intra-abdominal tissue planes are completely unscarred which means complication rates are no worse for primary or recurrent laparoscopic operations. So when are open hernia repairs advocated? For a laparoscopic repair, the patient must have a general anaesthetic and some patient s comorbidities will preclude them from a GA. My practice is thus to offer these patients an open sedation and local anaesthetic repair. In the early days of laparoscopic hernia repair, opponents of the technique quoted higher major intra-abdominal injury rates eg bowel and vascular injuries. This was quite possibly as we were on our surgical learning curves in the infancy of general surgical laparoscopic operations. It is now apparent that these risks are extremely low eg 1 in 3000 for major vascular injury falling to 1 in 5000 once the laparoscopic surgeon has exceeded 100 repairs, and erroneously assumes no vascular injury with the open repair! With inadvertent laparoscopic bowel injury at 1 in 1500, rates do increase with previous open intra-abdominal surgery such as laparotomies, colectomies etc. Obviously these risks vary according to the size and type of previous open operation, position of the scar, reason for the open surgery and numbers of open operations. An open minicholecystectomy scar or appendicectomy will have a different risk level than multiple lower abdominal incisions for peritonitis and subsequent adhesions, and the latter should only be approached by the most experienced laparoscopic surgeons or an open repair is advised once risks have been fully discussed with the patient. What about very challenging groin hernias? Extremely large inguinoscrotal hernias can be very difficult to repair laparoscopically particularly if the bowel is incarcerated with adhesions within the scrotal hernial sac. Often I consent patients for a hybrid approach whereby I commence laparoscopically but if I cannot reduce the scrotal contents, then I perform a small scrotal incision to free adhesions, before returning to complete the repair laparoscopically, with patients benefitting from the less painful laparoscopic repair, lower risk of wound infection and huge scrotal haematomas are often seen after the open inguinoscotal hernia repair, and earlier return to normal activities without chronic groin pain risks. Previous open prostatectomies and recurrence of a previous laparoscopic mesh hernia repair are very challenging laparoscopically due to potentially dense adhesions within the anticipated field of laparoscopic surgery. Nevertheless, these can be repaired laparoscopically using different techniques eg applying a second mesh fixed with glue etc, but again as previously stated with intra-abdominal adhesions, challenging hernias should only be approached by the most experienced laparoscopic surgeons. Incisional Hernias By definition, incisional hernias are going to be more challenging laparoscopically since the patient will have had a previous operation, potentially with a varying degree of adhesions. However, often these patients have a much higher BMI with bigger omentum anteriorly protecting the underlying bowel from adhesions to the hernia. Also some patients seem to develop more adhesions than others even when the surgeon might predict dense adhesions, though the surgery might actually turn out to be surgeon friendly! Therefore I always start laparoscopically with an extremely low rate of conversion to open, due to the benefits outweighing an open repair. The benefits of laparoscopic incisional hernia repair again relate to post-operative pain and recovery essentially avoiding re-laparotomy to place a mesh via an open repair (with the disadvantage of more adhesions with possible later bowel obstructive episodes), though these benefits are more marginal laparoscopically since the mesh needs to be stapled to the abdominal wall musculature which is probably just as painful. For this reason I have recently started piloting the use of glue for mesh fixation, and very early results seem to show some improvement in postoperative pain. InTouch MAY 2015 p.26
4 The greatest benefits relate to recurrence and mesh infection. Open suture repairs have recurrence rates as high as 40-50% and open mesh repairs have a 12-15% recurrence. With the increased potential in an obese group of patients for disastrous mesh infections, wound haematomas and hence wound and mesh infections, the mesh usually needs to be removed and at a later date the resultant re-recurrence repaired. On my published figures with laparoscopic mesh repair of incisional hernias requiring a mean mesh size of 12x12cm, our 2 year recurrence rate was a very acceptable 2.7%. Where the tiny laparoscopic incisions are necessarily away from the incisional hernia and the mesh never touches the patient s skin flora, we have never seen a mesh infection. Sometimes with the laparoscopic approach we find additional undeclared hernias within a long laparotomy wound which would otherwise enlarge and become symptomatic, but which may never have been discovered with an open repair until they recur. Technically, with laparoscopic incisional hernia repair, the mesh is fixed with the abdominal wall distended by the necessary neumoperitoneum, and when this is deflated at the end of the operation, the mesh repair becomes tension-free as opposed to the open repair where the tight mesh becomes tighter as the patient awakes from the GA and muscle relaxation. This might in part explain higher recurrence rates. Umbilical, Paraumbilical & Ventral Hernias The argument for the laparoscopic repair of these hernias is similar to incisional hernias, both with recurrence and infection. However, with small asymptomatic umbilical hernias it is very difficult to advocate a painful stapled laparoscopic mesh repair and not simply to wait and see whether the hernia enlarges. Actually the majority will and of course the larger the defect, the higher the resultant recurrence rate. It is tempting therefore to suggest an open suture repair of a small hernial defect, but again in our historical audit even these small umbilical hernias are associated with a 23% two year recurrence rate. For these reasons I am currently trialling a new glue fixation of meshes laparoscopically placed, with some early success for symptomatic and enlarging umbilical and ventral hernias. Summary Laparoscopic Versus Open Hernia Repair for Your Patients Personally as a laparoscopic enthusiast I would recommend laparoscopic mesh hernia repairs though would tailor my advice to individual patients. In those too unfit for GA, with dense complicated adhesions in complex hernias, or simply informed patient choice, then I would perform local anaesthetic and sedation open repairs. However this is the minority of patients; open outweighs laparoscopic with an earlier return to work with less post-operative discomfort, no chronic pain, lower wound complications, no mesh infections and generally lower recurrence rates. For larger obese patients potentially with diabetes, laparoscopic approaches show greater benefit by avoiding a larger incision, wound haematoma and infection and less mesh infection, and earlier mobilization reducing other post-operative complications. For more challenging hernia repairs I would advocate referral to an experienced laparoscopic surgeon with a proven and audited track record. Inguinal hernia LAPAROSCOPIC OPEN Post-op pain Rapid return to normal lifestyle Wound/ mesh complications ++ Chronic groin pain ++ Recurrence rates + + Incisional, Umbilical & Ventral hernia Post-op pain Rapid return to normal lifestyle Wound/ mesh complications ++ Recurrence rates + ++ p.27 InTouch MAY 2015
5 Referring a patient If you would like to refer a patient for an appointment with this consultant, please contact us on T: E: enquiries@highgatehospital.co.uk Suggest a topic for future issues If you have a suggestion for a topic or condition you would like to see covered in a future edition, please send your suggestions to enquiries@highgatehospital.co.uk View Road, Highgate, London, N6 4DJ Tel enquiries@highgatehospital.co.uk
Hernias Umbilical Hernia When to See a Surgeon? What Are Symptoms of an Umbilical Hernia? How is Repair Performed?
Hernias Umbilical Hernia An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias are common and typically harmless. They
More informationMr John Groom The Complete Guide to Hernia
Mr John Groom The Complete Guide to Hernia What Do They Have in Common? AA Both Subjects Controversial! Debate 1. Laparoscopic verses Open Hernia Repair Beautiful Big splash Debate 2. Use of Mesh in Hernia
More information2015 General Surgery Survival Guide
2015 General Surgery Survival Guide Chapter 10: Hernia Repair Know What to Look for When Coding Hernia Repair Reporting hernia repair can be tricky. But if you know what to look for then half the work
More informationInguinal and Femoral Hernias. August 10, 2016 Basic Science Lecture Department of Surgery University of Tennessee Health Science Center
Inguinal and Femoral Hernias August 10, 2016 Basic Science Lecture Department of Surgery University of Tennessee Health Science Center Background Approximately 20 million groin hernias are repaired each
More informationThe Emergency Hernia or The call you don t want at 2:00 a.m.*
or The call you don t want at 2:00 a.m.* *Or even at 8:00 a.m. Michael G. Sarr, MD Professor of Surgery Mayo Clinic South Canada WEST CANADA EAST CANADA Clinical talk Hernias Inguinal Umbilical Incisional
More informationThe pillars defining our quality care. We Care!
The pillars defining our quality care We Care! 1 An umbilical hernia occurs when a tissue bulges out through an opening in time muscles on the abdomen near the navel or belly button (umbilicus). About
More informationGROIN HERNIA PATIENT INFORMATION PRODUCED BY THE BRITISH HERNIA SOCIETY
GROIN HERNIA PATIENT INFORMATION PRODUCED BY THE BRITISH HERNIA SOCIETY Who is this information for? This information is for people who have a groin hernia. It explains what it is, how it is diagnosed,
More informationShared Decision Making
Deciding what to do about inguinal hernia This short decision aid is to help you decide what treatment to choose if you have an inguinal hernia. This document is a summary of the online patient decision
More informationHernia. emoryhealthcare.org
Hernia Have you noticed a bulge or pain in your abdominal wall or groin? If so you may have a hernia. You may be in the process of confirming this diagnosis with your Primary Care Physician or already
More informationINCISIONAL HERNIAS. Contents What is an Incisional Hernia?... 3
Contents What is an Incisional Hernia?................... 3 When can I return to normal activities?....... 6 YOUR GUIDE TO INCISIONAL HERNIAS An IPRS Guide to provide you with exercises and advice to ease
More informationP R E S E N T S Dr. Mufa T. Ghadiali is skilled in all aspects of General Surgery. His General Surgery Services include: General Surgery Advanced Laparoscopic Surgery Surgical Oncology Gastrointestinal
More informationHernia surgery in adults
Page 1 of 9 Hernia surgery in adults Introduction This leaflet will give you information about having hernia surgery. It also answers some of the commonly asked questions and outlines some of the risks
More informationHernia Surgery in Adults
Page 1 of 7 Hernia Surgery in Adults Introduction This leaflet provides information on hernias in the adult patient and the treatment options available. This leaflet is intended as a guide and is not a
More informationLAPAROSCOPIC HERNIA REPAIR
LAPAROSCOPIC HERNIA REPAIR Treating Your Hernia with Laparoscopy When You Have a Hernia Anyone can have a hernia. This is a weakness or tear in the wall of the abdomen. It often results from years of wear
More informationCommissioning Policy. Hernia Repair in Adults. Criteria Based Access. Date Adopted: 22 nd December 2017 Version:
Commissioning Policy Hernia Repair in Adults Criteria Based Access Date Adopted: 22 nd December 2017 Version: 1819.2.00 Title of document: Authors job title(s): Document Control Hernia Repair in Adults
More informationSurgical treatment of hernia policy
Acknowledgements The authors are grateful for the invaluable support of the North East London Commissioning Support Unit in ensuring liaison with individual service and business managers at the James Paget
More informationAbout your hernia repair
Other formats What is a hernia? About your hernia repair If you need this information in another format such as audio tape or computer disk, Braille, large print, high contrast, British Sign Language or
More informationINGUINAL HERNIA REPAIR PROCEDURE GUIDE
ROOM CONFIGURATION The following figure shows an overhead view of the recommended OR configuration for a da Vinci Inguinal Hernia Repair (Figure 1). NOTE: Configuration of the operating room suite is dependent
More informationTransabdominal pre peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair
Transabdominal pre peritoneal (TAPP) vs totally extraperitoneal (TEP) laparoscopic techniques for inguinal hernia repair An inguinal hernia (hernia of the groin) is a weakness in the wall of the abdominal
More informationEarly View Article: Online published version of an accepted article before publication in the final form.
: Online published version of an accepted article before publication in the final form. Journal Name: Journal of Case Reports and Images in Surgery doi: To be assigned Early view version published: November
More informationLaparoscopic Hernia Repair, Indications, Superiority and Outcome
Laparoscopic Hernia Repair, Indications, Superiority and Outcome Mr. Amir Morgan MBBCh; MSc; MD; FICS; JAG; FRCS Consultant Laparoscopic Colorectal & General Surgeon Lead of medical education and surgical
More informationAbout your Hernia Operation
Patient Information About your Hernia Operation Introduction We expect you to make a rapid recovery after your operation and to experience no serious problems. However, it is important that you should
More informationCommissioning Policy Individual Funding Request
Commissioning Policy Individual Funding Request Hernia Repair in Adults Criteria Based Access Policy Date Adopted: 22 December 2017 Version: 1718.3.01 Individual Funding Request Team - A partnership between
More informationUNDERSTANDING HERNIA
UNDERSTANDING HERNIA Understanding hernias A hernia (or rupture ) is a weakness or defect in the wall of the abdomen.this weakness may be present from birth or it can be caused by the wear and tear from
More informationSTOMA SITING & PARASTOMAL HERNIA MANAGEMENT
STOMA SITING & PARASTOMAL HERNIA MANAGEMENT Professor Hany S. Tawfik Head of the Department of Surgery & Chairman of Colorectal Surgery Unit Benha University Disclosure No financial affiliation to disclose
More informationInguinal Hernia. Incarcerated hernia
Inguinal Hernia An inguinal hernia occurs when soft tissue usually part of the membrane lining the abdominal cavity (omentum) or part of the intestine protrudes through a weak point in the abdominal muscles.
More informationInguinal hernias may be present from birth but may not become evident until later in life. They are usually more common in men.
This booklet is designed to give you information about inguinal hernia repair done under general anaesthesia. We hope it will answer some of the questions that you or those who care for you may have at
More informationGeneral Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons
General Surgery Curriculum Royal Australasian College of Surgeons, General Surgeons Australia & New Zealand Association of General Surgeons MODULE TITLE: ABDOMINAL WALL, RETROPERITONEUM, UROGENITAL 5-May-2013
More informationLaparoscopic umbilical herniorrhaphy: a novel technique of hernia neck closure and outcomes in the first 19 cases
Original Article Page 1 of 7 Laparoscopic umbilical herniorrhaphy: a novel technique of hernia neck closure and outcomes in the first 19 cases Cheyenne Vetter 1, Yagan Pillay 2 1 Department of Family Medicine,
More informationPrevention and Surgical management of Parastomal hernias; When to treat?
Prevention and Surgical management of Parastomal hernias; When to treat? Sabry A. Mahmoud (MD) Prof of General & Colorectal Surgery Mansoura University It is an incisional hernia that develops at the site
More information34 yo M presented in ER of KCH at 7/06/10 Painful lump lt groin + vomiting Pain started 2 hrs before presentation. PMH known left inguinal hernia PSH
Case Presentation 34 yo M presented in ER of KCH at 7/06/10 Painful lump lt groin + vomiting Pain started 2 hrs before presentation. PMH known left inguinal hernia PSH negative NKDA Case Presentation VS:
More informationLaparoscopic Inguinal Hernia Repair
1 Laparoscopic Inguinal Hernia Repair Hernia is a medical condition where a part of the intestine bulges out of the weak abdominal muscles. Inguinal hernia is a type of hernia which occurs in the groin
More informationFarah S, Kiyingi A, Leinkram C. The Melbourne Hernia Clinic Masada Hospital 26 Balaclava Road St Kilda East Victoria, Australia 3168.
Medium to Long term results following open intra-abdominal repair of large incisional hernias with a new composite polypropylene and silicone mesh, without components separation. Farah S, Kiyingi A, Leinkram
More informationCOMPLICATIONS OF HERNIA REPAIR
COMPLICATIONS OF HERNIA REPAIR Stanley Rogers, MD Associate Clinical Professor of Surgery University of Califronia, San Francisco Paré was respected as a hernia specialist, and was known to have elevated
More informationTechnique Guide. Bard MK Hernia Repair. Featuring Modified Onflex Mesh SOFT TISSUE REPAIR. Anterior Approach to a Preperitoneal Inguinal Hernia Repair
Bard MK Hernia Repair Featuring Modified Onflex Mesh Technique Guide Anterior Approach to a Preperitoneal Inguinal Hernia Repair SOFT TISSUE REPAIR Right Procedure. Right Product. Right Outcome. The opinions
More informationInadvertent Enterotomy in Minimally Invasive Abdominal Surgery
SCIENTIFIC PAPER Inadvertent Enterotomy in Minimally Invasive Abdominal Surgery Steven J. Binenbaum, MD, Michael A. Goldfarb, MD ABSTRACT Background: Inadvertent enterotomy (IE) in laparoscopic abdominal
More informationFacing a Hernia Repair?
Facing a Hernia Repair? Learn about minimally invasive da Vinci Surgery www.olarts.com The Condition: Hernia A hernia happens when part of an internal organ or tissue bulges through a hole or weak area
More informationLaparoscopic Ventral. Mesh Rectopexy (LVMR)
Laparoscopic Ventral Mesh Rectopexy (LVMR) Questions & Answers GLASGOW COLORECTAL CENTRE Ross Hall Hospital 221 Crookston Road Glasgow G52 3NQ e-mail: info@colorectalcentre.co.uk Ph: Main hospital switchboard
More informationHERNIA SURGERY. Surgery to Repair Your Abdominal Wall
HERNIA SURGERY Surgery to Repair Your Abdominal Wall Understanding Hernias A hernia (or bulge ) is a weakness or defect in the wall of the abdomen. This weakness may be present at birth. Or, it can be
More informationInguinal Hernia Repair Advice for parents/carers
Inguinal Hernia Repair Advice for parents/carers Children s Services Women & Children s Group This leaflet has been designed to give you important information about your child s inguinal hernia and to
More informationFurther information You can get more information and share your experience at
GS11 Open Inguinal Hernia Repair (female) Further information You can get more information and share your experience at www.aboutmyhealth.org You can get information locally from: Hospital switchboard,
More informationThis short decision aid is to help you decide what treatment to choose if you have an inguinal hernia.
Shared Decision making inguinal hernia Next clinical review date March 2018 Deciding what to do about inguinal hernia This short decision aid is to help you decide what treatment to choose if you have
More informationHernia Repair: Measures of Success and Perioperative Considerations
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:
More informationA comparative study of open versus laparoscopic incisional hernia repair
International Surgery Journal Bathalapalli JMR et al. Int Surg J. 2017 Mar;4(3):916-920 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Original Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20170428
More informationInguinal Hernia Repair Advice for Parents / Carers
Inguinal Hernia Repair Advice for Parents / Carers Name: Who to contact and how: Notes: Diana, Princess of Wales Scartho Road Grimsby DN33 2BA Scunthorpe General Hospital Cliff Gardens Scunthorpe DN15
More informationGS12 Laparoscopic Inguinal Hernia Repair (TAPP)
GS12 Laparoscopic Inguinal Hernia Repair (TAPP) What is an inguinal hernia? An inguinal hernia is a common type of hernia, causing a lump and sometimes pain in the groin. Your surgeon has recommended a
More informationInternational Journal of Current Research and Academic Review ISSN: Volume 3 Number 1 (January-2015) pp
International Journal of Current Research and Academic Review ISSN: 2347-3215 Volume 3 Number 1 (January-2015) pp. 348-354 www.ijcrar.com Study of Operative Procedures and their Indications in Management
More informationCAT FOR TREATMENT. Clinical Scenario:
CAT FOR TREATMENT Clinical Scenario: A 30-year old male footballer presented at surgical OPD with clinical of painful, reducible groin hernia. I advice him for surgical management and gave him the possible
More informationA 5 YEAR EXPERIENCE OF ANTERIOR ABDOMINAL WALL HERNIAS IN NIGER DELTA UNIVERSITY TEACHING HOSPITAL, OKOLOBIRI, BAYELSA STATE OF NIGERIA
ORIGINAL RESEARCH ARTICLE A 5 YEAR EXPERIENCE OF ANTERIOR ABDOMINAL WALL HERNIAS IN NIGER DELTA UNIVERSITY TEACHING HOSPITAL, OKOLOBIRI, BAYELSA STATE OF NIGERIA *B.G. FENTE. P.J. ALAGOA, J. P. AKPOTU
More informationCase Report. XCM Biologic Tissue Matrix. Components separation using sandwich technique for reconstruction of abdominal wall defect.
Case Report XCM Biologic Tissue Matrix. Components separation using sandwich technique for reconstruction of abdominal wall defect. XCM Biologic Tissue Matrix. Components separation using sandwich technique
More informationProf. Francesco Guarnieri
Dear Sir / Madam, with today's visit, after evaluation of your clinical status, you may be admitted to the program of surgical treatment in Day Surgery. The organization of our department, in fact, requires
More informationCODING AND PRACTICE MANAGEMENT CORNER
Hernia repair and complex abdominal wall reconstruction by Christopher Senkowski, MD, FACS; Mark Savarise, MD, FACS; John S. Roth, MD, FACS; and Jan Nagle, MS, RPh 52 The American College of Surgeons (ACS)
More informationCommunity Hernia Repair Service
Community Hernia Repair Service January 5, 2018 1.0 Background information 1.1 Project team Project sponsor (SRO) Sarah Walker Project lead (PM) Samson Agboola Contract lead Robert McGowan Provider lead
More informationThe use of peritoneal flaps in the repair of large incisional hernia
The use of peritoneal flaps in the repair of large incisional hernia Marc Huyghe MD GZA St Augustinus Hospital (Antwerp) Mesh 2017 - Paris Peritoneal flap in the repair of incisional hernia - definition
More informationMohs surgery. Information for patients Dermatology
Mohs surgery Information for patients Dermatology Why have I been given this leaflet? You have been given this leaflet because you are going to have a procedure known as Mohs surgery. This leaflet explains
More informationIntroduction Facts you should know:
Introduction Facts you should know: - Mid inguinal point = ASIS to pubis symphysis (femoral artery) - Midpoint of inguinal ligament = ASIS to pubic tubercle (deep inguinal ring: 1 to 2cm above femoral
More informationTension-free Vaginal Tape (TVT)
Page 1 of 7 Tension-free Vaginal Tape (TVT) Introduction This leaflet will provide you with basic information about the Tension--free Vaginal Tape (TVT) procedure. What is a TVT? TVT is an operation to
More informationFollow this and additional works at: Part of the Other Medical Specialties Commons, and the Surgery Commons
Lehigh Valley Health Network LVHN Scholarly Works Department of Surgery Hernias Lauren Dudas MD Lehigh Valley Health Network, Lauren.Dudas@lvhn.org Follow this and additional works at: http://scholarlyworks.lvhn.org/surgery
More informationDGAFMS MEDICAL MEMORANDUM ON INGUINAL HERNIA AND THEIR DISPOSAL. 2. Three Primary causes can be distinguished in the etiology of Hernia.
DGAFMS MEDICAL MEMORANDUM ON INGUINAL HERNIA AND THEIR DISPOSAL Definition :- 1. Hernia is defined as the protrusion of a viscus on part of a viscus through an abnormal opening. Etiology : 2. Three Primary
More informationSINGLE INCISION ENDOSCOPIC SURGERY (SIES)
EAES CONSENSUS CONFERENCE SINGLE INCISION ENDOSCOPIC SURGERY (SIES) STATEMENTS AND RECOMMENDATIONS EAES appreciates your input! Please give your opinion on the below statements and recommendations of the
More informationJMSCR Vol 04 Issue 09 Page September 2016
JMSCR Vol 4 Issue 9 Page 4-47 September 6 www.jmscr.igmpublication.org Impact Factor 5.44 Index Copernicus Value: 8.7 ISSN (e)-47-76x ISSN (p) 455-45 DOI: http://dx.doi.org/.855/jmscr/v4i9.7 Comparative
More informationInguinal Hernia and Comparison between Mesh Repair and Conventional Repair of Hernia with Respect to Hernia Recurrence: A Clinical Study
Original Article Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2016/588 Inguinal Hernia and Comparison between Mesh Repair and Conventional Repair of Hernia with Respect to Hernia : A
More informationHernia Repair in Adults (18 years and over)
Commissioning Policy Hernia Repair in Adults (18 years and over) June 2017 This policy applies to patients for whom the following Clinical Commissioning Groups are responsible: NHS South Worcestershire
More informationRole of Prolene Mesh in the repair of Recurrent Congenital Inguinal Hernia: a Pilot Study
Annals of Pediatric Surgery, Vol 5, No 1, January, 2009, PP 11-15 Original Article Role of Prolene Mesh in the repair of Recurrent Congenital Inguinal Hernia: a Pilot Study Ehab El-Shafei Pediatric Surgery
More informationPATIENT INFORMATION: UMBILICAL HERNIA REPAIR T2400
1 of 5 MR S T R BAILEY BSc Msc FRCS (Gen Surg) Consultant General, Colorectal & Laparoscopic Surgeon Consulting at: Spire Tunbridge Wells Hospital, Maidstone & Tunbridge Wells NHS Trust, Kent Institute
More informationPilot study of selective fixation of mesh in laparoscopic extra-peritoneal inguinal hernia repair (TEP)
Original article: International J. of Healthcare and Biomedical Research, Volume: 05, Issue: 04, July 2017, 77-84 Pilot study of selective fixation of mesh in laparoscopic extra-peritoneal inguinal hernia
More informationTechnical points of the laparoscopic transabdominal preperitoneal (TAPP) approach in inguinal hernia repair
Surgical Technique Page 1 of 5 Technical points of the laparoscopic transabdominal preperitoneal (TAPP) approach in inguinal hernia repair Qiwei Shen, Qiyuan Yao Department of General Surgery, Huashan
More informationINGUINAL HERNIAS. Contents What is an Inguinal Hernia?... 3
Contents What is an Inguinal Hernia?..................... 3 When can I return to normal activities?....... 6 YOUR GUIDE TO INGUINAL HERNIAS An IPRS Guide to provide you with exercises and advice to ease
More informationII.- PLUG. NAME of the products. Premilene Mesh Plug MANUFACTURER. B Braun DESCRIPTION. Polypropylene mesh for plug technique
II.- PLUG Premilene Mesh Plug B Braun Polypropylene mesh for plug technique Premilene Mesh Plug is a monofilament polypropylene mesh plug designed for the repair of recurrent hernias and can also be used
More information7/2/2015. Incidence. *Mudge M et al, Br. J. Surg, 1985, 72:70-71
Ventral Hernia Repair: Revisonal Surgery Natan Zundel MD FACS Professor of Surgery Vice-Chairman Department of Surgery FIU Herbert Wertheim College of Medicine. Miami Florida DISCLOSURE Ethicon Endosurgery
More informationInstructions After Hernia Operation Pain Year
Instructions After Hernia Operation Pain Year Hernia Repair Instructions Following Surgery. Everyone's pain tolerance is different. You may apply ice to the incision for the first 2 days after your surgery.
More informationTitle at a Single Institution. Issue Date Right.
NAOSITE: Nagasaki University's Ac Title Author(s) Laparoscopic Repair of a Ventral He at a Single Institution. Ono, Shinichiro; Kawashita, Yujo; K Citation Acta medica Nagasakiensia, 57(2), p Issue Date
More informationJMSCR Vol 06 Issue 03 Page March 2018
www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i3.65 Comparative Study of Onlay and
More informationInguinal hernia surgery
Inguinal hernia surgery You will soon be admitted to HMC Bronovo for inguinal hernia surgery. This folder provides information about the cause, possible symptoms and the treatment of your inguinal hernia.
More informationA Case Report of a Repair of a Ruptured Incisional Hernia Using Polypropylene Mesh and Component Separation Technique A Rambhajan, T Bernard ABSTRACT
A Case Report of a Repair of a Ruptured Incisional Hernia Using Polypropylene Mesh and Component Separation Technique A Rambhajan, T Bernard ABSTRACT Incisional hernias are a common complication of laparotomies
More informationProceedings of the 9th International Congress of World Equine Veterinary Association
www.ivis.org Proceedings of the 9th International Congress of World Equine Veterinary Association Jan. 22-26, 2006 - Marrakech, Morocco Reprinted in IVIS with the permission of the Conference Organizers
More informationInguinal Hernia. Hernia Awareness Month. What is a Hernia? Common Hernia Types
Hernia Awareness Month What is a Hernia? A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example, the intestines may break through a weakened
More informationFurther information You can get more information and share your experience at
GS12 Laparoscopic Inguinal Hernia Repair (TAPP) Further information You can get more information and share your experience at www.aboutmyhealth.org Local information You can get information locally from:
More informationLaparoscopic Inguinal Hernia Repair (TEP) Brought to you in association with EIDO Healthcare and endorsed by the Royal College of Surgeons England.
Laparoscopic Inguinal Hernia Repair (TEP) Brought to you in association with EIDO Healthcare and endorsed by the Royal College of Surgeons England. Discovery has made every effort to ensure that we obtained
More informationWhat is Laparoscopy All About?
Disclaimer This movie is an educational resource only and should not be used to manage surgical health. All decisions about the management of Laparoscopy must be made in conjunction with your Physician
More informationUsing NSQIP as a Platform for Registries Challenges and Potential Solutions
Using NSQIP as a Platform for Registries Challenges and Potential Solutions Mary Hawn MD, MPH FACS Professor and Chief of Gastrointestinal Surgery University of Alabama at Birmingham NSQIP Annual Meeting
More informationInguinal Hernia Repair by Surgical Trainees at a Malaysian Teaching Hospital
Original Article Inguinal Hernia Repair by Surgical Trainees at a Malaysian Teaching Hospital Kin Yoong Chan, Muhammad Rohaizak, Nadesan Sukumar, Shaharin Shaharuddin and Ali Yaakub Jasmi, Department of
More informationOpen Tension-Free Mesh Repair for Adult Inguinal Hernia: Eight Years of Experience in a Community Hospital
Original Articles Asian Journal of Surgery Excerpta Medica Asia Ltd Open Tension-Free Mesh Repair for Adult Inguinal Hernia: Eight Years of Experience in a Community Hospital Shunji Yamamoto, Toshiki Maeda,
More informationSemmelweis University, Faculty of Medicine, 1 st Department of Surgery. Surgery of hernias. László NEHÉZ M.D.
Surgery of hernias László NEHÉZ M.D. Definition: Semmelweis University, Faculty of Medicine, 1 st Department of Surgery A hernia is where an internal part of the body, such as an organ, pushes through
More informationRobot Assisted Rectopexy
1. Abdominal cavity approach 1A Trocars Introduce Introduce five trocars to gain access to the abdominal cavity (in da Vinci Si type; In Xi type the trocar placement may differ slightly). First the camera
More informationPost-Operative Laparoscopic Appendectomy Guide. Dr. Buck Parker, MD FACS Board Certified Surgeon
Post-Operative Laparoscopic Appendectomy Guide Dr. Buck Parker, MD FACS Board Certified Surgeon www.drbuckparker.com Thanks! Thanks so much for downloading my laparoscopic appendectomy guide! This guide
More informationLaparoscopic Inguinal Hernia Repair (TAPP) Brought to you in association with EIDO Healthcare and endorsed by the Royal College of Surgeons England.
Laparoscopic Inguinal Hernia Repair (TAPP) Brought to you in association with EIDO Healthcare and endorsed by the Royal College of Surgeons England. Discovery has made every effort to ensure that we obtained
More informationPORTSMOUTH HOSPITALS NHS TRUST. Patient Information Leaflet: Having an Incisional Hernia Operation
PORTSMOUTH HOSPITALS NHS TRUST Patient Information Leaflet: Having an Incisional Hernia Operation This information leaflet has been created by the Portsmouth specialist laparoscopic surgeons: Miss A. M.
More informationAbdominal Wound Dehiscence. Presenter: T Mohammed Moderator: Dr H Pienaar
Abdominal Wound Dehiscence Presenter: T Mohammed Moderator: Dr H Pienaar Introduction Wound Dehiscence is the premature "bursting" open of a wound along surgical suture. It is a surgical complication that
More information2018 REIMBURSEMENT GUIDE
TABLE OF CONTENTS: Component Separation Technique and Hiatal Hernia Repair...08 Hernia Repair...03 Laparoscopic Repair Hernia...06 Stoma Procedures...11 Level II Codes...13 -PCS Codes...14 Modifiers...13
More informationPolicy No: FCHN.MP Page 1 of 6 Date Originated: Last Review Date Current Revision Date 7/10/07 06/2014 7/2/14
Page 1 of 6 Date Originated: Last Review Date Current Revision Date 7/10/07 06/2014 7/2/14 SUBJECT: Abdominoplasty, Panniculectomy and Ventral/Incisional Hernia RELATED POLICIES/RELATED DESKTOP PROCEDURES:
More informationDischarge advice laser treatment of varicose veins. Day Surgery Unit Patient Information Leaflet
Discharge advice laser treatment of varicose veins Day Surgery Unit Patient Information Leaflet Introduction Laser treatment is one of the latest forms of treatment that can be offered to certain patients
More informationAbstract. Chronic pain review following Lichtenstein hernia repair: A Personal Series. Maurice Brygel (1) Luke Bonato (2) Sam Farah (3)
Chronic pain review following Lichtenstein hernia repair: A Personal Series Maurice Brygel (1) Luke Bonato (2) Sam Farah (3) (1) Mr Maurice Brygel MBBS FRACS General Surgeon, Director Melbourne Hernia
More informationLife Science Journal 2017;14(1) Single port versus multiport laparoscopic trans abdominal preperitoneal hernia repair.
Single port versus multiport laparoscopic trans abdominal preperitoneal hernia repair. Hany Mohamed El-Barbary, FRCS, FACS, Department of General Surgery, Faculty of Medicine, Ain shams university (ASU)
More informationNeedlescopic Surgery Versus Single-port Laparoscopy for Inguinal Hernia
SCIENTIFIC PAPER Needlescopic Surgery Versus Single-port Laparoscopy for Inguinal Hernia Yi-Wei Chan, MD, MSc, Christian Hollinsky, MD ABSTRACT Background and Objectives: In recent years, 2 modifications
More informationChildren s Hospital Of Wisconsin
Children s Hospital Of Wisconsin Co-Management Guidelines To support collaborative care, we have developed guidelines for our community providers to utilize when referring to, and managing patients with,
More informationEmergency presentation of hernias of the torso: What your surgeon wants to know.
Emergency presentation of hernias of the torso: What your surgeon wants to know. Ken F Linnau, MD, MS Emergency Radiology UW Medicine Harborview Medical Center klinnau@uw.edu Nordic Forum 2017 Helsinki,
More informationGlue for mesh fixation in laparoscopic ventral hernia repair. An experimental comparison with conventional fixation.
Glue for mesh fixation in laparoscopic ventral hernia repair. An experimental comparison with conventional fixation. A.Vanlander, F. Berrevoet MD PhD Department of General and Hepatobiliary Surgery and
More informationTHE INS AND OUTS OF HERNIAS WHERE TO START? WHAT IS A HERNIA? CLINICAL INDICATIONS THE INGUINAL CANAL THE CLINICAL QUESTION 18/09/2018
THE INS AND OUTS OF HERNIAS Cassandra Harrison BA/BSc, MMRU, AMS WHERE TO START? The Clinical Question Essential anatomy Inguinal hernia Scanning technique Variations WHAT IS A HERNIA? CLINICAL INDICATIONS
More informationHERNIAS .(A) .(B) 5. .(A) 7..( (Lumbar hernia),
HERNIAS ysms91@wonju.yonsei.ac.kr 1..(B) 2..(B) 3..(A) 4. (Hesselbach's striangle).(b) 5.,.(A) 6. (Sliding hernia).(a) 7..( (Lumbar hernia), (Obturator hernia), (Sciatica hernia)).(b) Hernia = rupture
More information