how to prevent hernia recurrence
TRANSCRIPT
![Page 1: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/1.jpg)
How to prevent Recurrences in Laparoscopy for Hernia
Dr John ThanakumarMBBS (Vellore), MS (Vel), MNAMS (Vel), FRCS, FRCS, Dip MIS, FALS
Chairman, ANURGAG HOSPITALCoimbatore.
President IAGES 2012-14.
Dr Pravin Hector John MS
![Page 2: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/2.jpg)
Light Weight Mesh Heavy Weight Mesh
![Page 3: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/3.jpg)
Elasticity
Flexibility
Shrinking
Inflammation
Pain
LW Mesh
![Page 4: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/4.jpg)
Recurrence Adhesions
Infection
BUTLWM
![Page 5: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/5.jpg)
![Page 6: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/6.jpg)
Choice of patientCollagen disease
Smoking
Obesity
Malnutrition
Diabetes Type II
Chronic lung disease
Coagulopathy
Steroids
Radiotherapy Chemotherapy
Jaundice
Male genderAnemia
![Page 7: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/7.jpg)
Choice of hernia
• Surgeon’s inexperience in laparoscopy
• Surgeon’s inexperience in technique
• Giant hernias
• Recurrences after laparoscopy
![Page 8: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/8.jpg)
Dissection• Do not miss out hernial sacs
• Do not miss out lipomas of cord
• Dissect medially across midline
• Dissect medial, posterior and lateral margins well
• Good hemostasis
• Difficulty- convert
![Page 9: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/9.jpg)
Dissect Across Midline and Down to Bladder
![Page 10: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/10.jpg)
Dissect Sac and Ligate
![Page 11: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/11.jpg)
Center fix mesh,fix, unroll
![Page 12: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/12.jpg)
Dissection of Borders
MedialAcross midline
LateralUpto ASIS
Nerves
PosteriorUpto Psoas
Peritonealize the Cord
![Page 13: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/13.jpg)
Choice of Mesh
• Large hernia- use standard prolene mesh
• Large hernia do not use LWM
• Not too small mesh for large hernias
• Do not slit meshes
• No infolding of the mesh at corners
• While desufflating, hold the mesh (TEP)
![Page 14: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/14.jpg)
Mesh• Size 15X 12 cm
• No slitting of mesh
• Blunten the corners
• Center of mesh to be against center of defect
• Mesh to cover 5 cm all around defect
• Mesh to cover the Myopectineal orifice of Fruchaud
• Apply wrinkle free
![Page 15: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/15.jpg)
Fixation of Mesh
• Use 1 stapler at Cooper for fixation; 2nd for prevention of rotation of mesh in hernias
• Large hernia, use fixation near Cooper, medial and laterally above the ilio pubic tract
• Sutures / fixation as good
![Page 16: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/16.jpg)
Tips to prevent recurrence
• Best knowledge & display of anatomy
• Always meshes for adult hernias
• Awareness of one’s limitations
• Advanced laparoscopic skills
• Strict and standardized principles of dissection
![Page 17: How to prevent hernia recurrence](https://reader030.vdocument.in/reader030/viewer/2022013111/55a720e11a28ab4c0a8b456f/html5/thumbnails/17.jpg)
• Anurag Hospital,
• 8, Krishna Nagar,Sowripalayam
• Coimbatore - 641028.
• Tel: 0422- 6587871
• www.anuraghospital.com
• Email: [email protected]
With the best compliments of
Centre for Advanced Laparoscopy and Bariatric Surgery