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Surgical Technology International

35th Edition

Contains 55 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.

456 pages

Nov 2019 - ISSN:1090-3941

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Hernia Repair

Novel Technique for Full-Thickness Abdominal Wall Closure in Laparoscopic Ventral Hernia Repair
Guy R. Voeller, MD, FACS, Professor of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, Albert K. Chin, MD , Chief Innovation Officer, TAS Medical, Inc., San Carlos, California, Karl A. LeBlanc, MD, MBA, FACS, FASMBS, Our Lady of the Lake Regional Medical Center, Surgeons Group of Baton Rouge, Baton Rouge, Louisiana

1200

 

Abstract


Laparoscopic ventral hernia repair incorporating a prosthetic mesh underlay, first described in 1993, has demonstrated a lower long-term recurrence rate versus open non-mesh repair. However, over the past 25 years, the laparoscopic approach to ventral/incisional hernias is utilized in only approximately 30% of cases. One of the reasons that prevents it from being utilized more often is the inability to readily, reliably, and easily close the fascial defect. A novel technique has been developed for full-thickness abdominal wall closure in laparoscopic ventral hernioplasty, utilizing puncture sites to place multiple self-locking ligature straps. Introduction of the straps into the abdominal cavity in orthogonal orientation to the skin surface, followed by subcutaneous retrieval of the contralateral tip of the strap, achieves incorporation of full-thickness abdominal wall on either side of the defect. The self-locking property of each strap allows tension to be applied in sequential fashion. Incremental tension application facilitates re-apposition of the borders in large defects. The increased width of the strap compared with conventional suture serves to resolve the force exerted upon tissue during the acute phase of defect closure. The instrumentation was tested in six ventral hernias created in resected porcine belly walls. Subsequent tests were conducted in three swine with large congenital umbilical hernias. One of the test animals was re-examined laparoscopically 30 days post repair, with full healing and no recurrence exhibited upon re-examination. We anticipate that the simplicity and functionality of this technique will translate to clinical utility in the significant cohort of human ventral hernia patients..

 

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Clinical Application of the Measurement of Abdominal Wall Tension in Hernia Repair
Jordan A. Bilezikian, MD, Justin D. Faulkner, MD, Sarah S. Fox, MD, Assistant Professor of Surgery, W. Borden Hooks IV, MD, FACS, Associate Professor of Surgery, William W. Hope, MD, FACS, Associate Professor of Surgery, New Hanover Regional Medical Center, Wilmington, NC

1203

 

Abstract


Abdominal wall tension is an integral concept in hernia repair. Most of the described techniques attempt to reduce abdominal wall tension by using mesh prosthetics or myofascial release. Although the concept of a “tension-free” hernia repair is well-understood and appreciated by surgeons, quantitative information about abdominal wall tension is limited.
This review evaluates the published literature related to abdominal wall tension and summarizes how the measurement of intraoperative tension can guide clinical decision-making.
Most of the methods and techniques for measuring abdominal wall tension are similar and involve the use of tensiometers. However, there is no accepted standardized technique. Baseline tension measurements confirm the concept of a baseline physiological tension, and it has been observed that tension does not correlate with hernia width. When the tension is considered to be too great during hernia repair, intraoperative techniques such as myofascial release can be used to reduce tension to physiological values.
Emerging data from clinical studies on tension have added to our understanding of the mechanics and physiology of the abdominal wall. Standardized devices and measurement techniques need to be developed and validated to foster the utility of tension measurements in hernia repair.

 

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