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Volker Schumpelick
Robert J. Fitzgibbons (Eds.)
Hernia Repair Sequelae
Volker SchumpelickRobert J. Fitzgibbons (Eds.)
Hernia Repair Sequelae
In Collaboration with Joachim Conze
With 236 Figures and 97 Tables
1 23
Prof. Dr. Volker Schumpelick
Chirurgische KlinikUniversitätsklinikum AachenPauwelsstraße 3052074 AachenGermanye-mail: [email protected]
Prof. Dr. Robert J. Fitzgibbons
Department of SurgeryCreighton University601 North 30th StreetSuite 3740Omaha, NE 68131USAe-mail: [email protected]
ISBN 978-3-642-04552-3 Springer-Verlag Berlin Heidelberg New York
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V
Preface
At the last Suvretta meeting in 2006 on recurrent hernia prevention and treatment, we dem-onstrated that with the wide range of available techniques, materials, and meshes at our dis-posal today, an experienced hernia surgeon will be able to prevent or at least treat a recurrent hernia.
But whereas recurrences can be treated successfully in most cases, some other hernia repair sequelae can result in severe, sometimes untreatable problems, e.g. pain, infection, ad-hesion, or infertility. That was the reason to focus the 5th Suvretta meeting in 2008 on hernia repair sequelae. We are convinced that such sequelae can be a more serious problem for the patient than the mostly treatable recurrent hernia. Therefore, it was appropriate to focus the 5th Suvretta meeting on these longterm problems.
During a four-day meeting, we discussed all technical aspects of the various operations and materials to generate a consensus concerning the best techniques and meshes. We ex-plored methods to improve surgical techniques to look into the multifactorial causes of post hernia repair sequelae. In the seclusion of the Swiss plateau valley we had a perfect setting to discuss these important hernia repair problems in detail with the top hernia specialists in the world.
With this book, the results of this exceptional 5th Suvretta meeting have been made acces-sible for every surgeon who is interested in hernia surgery and its sequelae.
V. Schumpelick
VII
List of First Authors
Alfieri, S.
Department of Digestive SurgeryCatholic University of Sacred HeartLargo Agostino Gemelli 800168 [email protected]
Amid, P. K.
Department of SurgeryDavid Geffen School of Medicine at UCLALichtenstein Hernia Institute at UCLA1260 15th Street, Suite 1200Santa Monica, CA [email protected]
Arlt, G. D.
Department of SurgeryPark-Klinik WeissenseeSchönstrasse 8013086 [email protected]
Aufenacker, T. J.
Department of Surgery (C22)Canisius Wilhelmina Ziekenhuis (CWZ)Postbus 90156500 GS NijmegenThe [email protected]
Aydede, H.
Associate Professor of SurgeryCelal Bayar University Medical FacultyDepartment of [email protected]
Bachman, S. L.
University of MissouriDepartment of SurgeryMissouri Hernia InstituteUniversity of Missouri–Columbia414 McHaney HallColumbia, MO 65211USA
Bellows, C.
Associate Professor of SurgeryChief, General SurgeryDirector of Surgical ResearchGeneral and Laparoscopic SurgeryTulane UniversityNew Orleans, LAUSA
Berger, D.
Department of SurgeryStadtklinik Balgerstrasse 5076532 [email protected]
Binnebösel, M.
Department of SurgeryRWTH Aachen University HospitalPauwelsstrasse 3052074 [email protected]
Bringman, S.
Clintec, Karolinska InstitutetStockholm, SwedenDepartments of Surgery, Södertälje HospitalSödertä[email protected]
Champault, G. G.
Paris University XIII – Medical School »Léonard de Vinci« Department of Digestive SurgeryUniversity Hospital Jean Verdier Avenue du 14 Juillet93140 [email protected]
Chowbey, P. K.
Minimal Access, Metabolic and Bariatric Surgery CentreSir Ganga Ram HospitalRoom No. 200 (IInd floor)New Delhi 110060India [email protected]
Conze, J.
Department of SurgeryUniversity Hospital RWTHPauwelsstrasse 3052074 [email protected]
Demirer, S. D.
Ankara University School of MedicineDepartment of [email protected]
Deysine, M.
Professor of SurgeryWinthrop University HospitalMineola, [email protected]
Diaz, J. J., Jr.
Division of Trauma and Surgical Critical CareDepartment of SurgeryVanderbilt University Medical CenterNashville, [email protected]
Dilek, O. N.
Professor of General SurgerySchool of MedicineKocatepe UniversityPK:7003100 [email protected]
Falagas, M. E.
Department of Medicine, Henry Dunant Hospital, Athens, GreeceDepartment of Medicine, Tufts University School of Medicine, Boston, MA, USAAlfa Institute of Biomedical Sciences (AIBS)9 Neapoleos Street, 151 23 MarousiAthens, [email protected]
Fawole, A. S.
Department of Academic SurgerySt. James’s University HospitalBeckett StreetLeeds LS9 [email protected]
Flament, J. B.
Department of SurgeryFaculty of MedicineUniversity of Reims Champagne-ArdenneGeneral Surgery ServiceHôpital Robert DebréRue Serge Kochman51100 [email protected]
Franz, M. G.
Associate Professor of SurgeryChief, Minimally Invasive SurgeryUniversity of MichiganDepartment of Surgery2214F Taubman Center1500 East Medical Center DriveAnn Arbor, MI [email protected]
Goldenberg, A.
Associate ProfessorDepartment of SurgeryFederal University of Sao [email protected]
Gryska, P. vR.
Tufts University School of MedicineBoston, MADepartment of SurgeryNewton-Wellesley HospitalSuite 365, 2000 Washington StreetNewton, MA [email protected]
Hansson, B.
Department of Surgery Canisius Wilhelmina Hospital NijmegenThe Netherlands
Hegarty, D.
Department of Anaesthesia, Inten-sive Care & Pain MedicineCork University [email protected]
Honigsberg, E.
Mount Sinai Medical Center1010 5th AvenueNew York, NY 10028USA
Hopf, H. W.
Department of Anesthesiology, University of UtahMedical Director, Urban Central Region Wound Care ServicesLDS Hospital8th Avenue and C StreetSalt Lake City, UT [email protected]
Jansen, M.
Department of SurgeryUniversity HospitalRWTH AachenPauwelsstrasse 3052074 [email protected]
Jansen, P. L.
Department of SurgeryUniversity HospitalRWTH AachenPauwelsstrasse 3052074 [email protected]
VIII List of First Authors
IXList of First Authors
Junge, K.
Department of SurgeryTechnical University of Aachen Pauwelsstrasse 30, 52057 [email protected]
Kaemmer, D.
Department of SurgeryRWTH AachenPauwelsstr. 3052074 [email protected]
Kavvadias, T.
Department of Obstetrics and GynaecologyLucerne Cantonal HospitalLucerneSwitzerland
Kehlet, H.
Section for Surgical Patho-physiology 4074Rigshospitalet Copenhagen UniversityBlegdamsvej 92100 [email protected]
Klinge, U.
Institute for Applied Medical EngineeringHelmholtz Institute for Applied Medical Technology RWTH Aachen University Pauwelsstraße 20-3052074 [email protected]
Kolbe, T.
Biomodels Austria, University of Veterinary MedicineVeterinärplatz 11210 [email protected]
Kukleta, J. F.
Klinik Im ParkSeestrasse 2208027 [email protected]
Kurzer, M.
British Hernia Centre87 Watford WayLondon NW4 [email protected]
Lammers, B. J.
Department for Colorectal and Hernia SurgeryLukaskrankenhaus [email protected]
Matthews, B. D.
Chief, Section of Minimally Invasive SurgeryDepartment of SurgeryWashington University School of Medicine660 S. Euclid Ave., Campus Box 8109St. Louis, MO [email protected]
Miserez, M.
Department of Abdominal SurgeryUniversity HospitalsHerestraat 493000 [email protected]
Montgomery, A.
Department of SurgeryMalmö University Hospital20502 Malmö[email protected]
Morales-Conde, S.
University Hospital Virgen del Rocío. Betis-65, 1º41010 [email protected]
Muschaweck, U.
Hernienzentrum Dr. Muschaweck – MünchenArabellastrasse 581925 [email protected]
Neumayer, L.
Professor of SurgeryDepartment of SurgeryUniversity of UtahSalt Lake City VA Healthcare System1950 Circle of Hope Room 6540Salt Lake City, UT [email protected]
Nordin, P.
Head of the Swedish Hernia RegisterDepartment of SurgeryÖstersund Hospital831 83 Ö[email protected]
Otto, J.
Department of SurgeryUniversity HospitalRWTH AachenPauwelsstrasse 3052074 [email protected]
X List of First Authors
Page, B. P.
University Department of SurgeryWestern InfirmaryGlasgow G11 [email protected]
Pascual, G.
Department of Medical SpecialitiesAlcalá UniversityNetworking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BNN)MadridSpain
Peiper, C.
Surgical ClinicEvangelisches KrankenhausWerler Strasse 11058455 [email protected]
Penkert, G.
Friederikenstift HannoverDepartment of NeurosurgeryHumboldtstrasse 530169 [email protected]
Read, R. C.
Emeritus Professor of Surgery304 Potomac StreetRockville, MD [email protected]
Schippers, E.
Surgical ClinicDepartment of General and Visceral SurgeryJuliusspitalJuliuspromenade 1997070 Wü[email protected]
Schug-Paß, C.
Department of SurgeryCenter for Minimally Invasive SurgeryVivantes Hospital SpandauNeue Bergstrasse 613585 [email protected]
Schumpelick, V.
Department of SurgeryUniversity Hospital RWTHPauwelsstrasse 3052074 [email protected]
Simons, M. P.
Department of SurgeryOnze Lieve Vrouwe GasthuisPostbus 955001090 HM AmsterdamThe [email protected]
Smeds, S.
The Sergel ClinicDepartment of Clinical and Experi-mental MedicineFaculty of Health SciencesUniversity HospitalLinköping University58185 Linkö[email protected]
Stanton-Hicks, M.
Vice Chairman, Anesthesiology InstituteConsulting Staff, CCF Shaker Children’s Pain RehabilitationCleveland ClinicPain Management Department9500 Euclid Avenue – C-25Cleveland, OH [email protected]
Stroh, C.
Department of General, Abdominal and Paediatric SurgeryMunicipal Hospital (Teaching Hospital of the Friedrich-Schiller University at Jena, Germany)Strasse des Friedens 12207548 [email protected]
Stumpf, M.
Department of SurgeryRWTH AachenPauwelsstrasse 3052074 [email protected]
van der Kolk, B. M.
Department of Surgery, Division of Abdominal SurgeryRadboud University Nijmegen Medical CenterNijmegenThe Netherlands
Witkowski, P.
Department of Surgery Division of Abdominal Organ TransplantationColumbia University177 Fort Washington Ave,7HS, Room 200CNew York, NY [email protected]
XI
Contents
I Risk for the Spermatic Cord
1 Are There Adverse Effects of Herniorrhaphy Techniques on Testicular Perfusion? . . . . . . . . . . 3
2 The Effects of Mesh Bioprosthesis on the Spermatic Cord Structures in a Rat Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3 Damage to the Spermatic Cord by the Lichtenstein Procedure in a Pig Model–Preliminary Results . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4 Influence of Prosthetic Implants on Male Fertility in Rabbits and Rats . . . . . . . . . . . . . . . . . 29
5 The Effects of a Mesh Bioprosthesis on the Spermatic Cord Structures . . . . . . . . . . . . . . 39
6 Influence of Prosthetic Implants on Male Fertility in Rats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
7 What Can We Do To Decrease the Risk of Vas Deferens Injury due to Inguinal Hernioplasty? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
8 The Long-Term Effect on Testicular Function of a Mesh Bioprosthesis Used for Inguinal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . 57
9 Reoperation Following Lichtenstein Repair: What Do Vas and Nerves Look Like? . . . . . . . . . 65
10 Damage to the Spermatic Cord from Groin Herniorrhaphy: A Review . . . . . . . . . . . . . . 71
II Risk for Infection
11 Mesh Infection Following Hernia Repair: A Frequent Problem? . . . . . . . . . . . . . . . . . . . . . . . 79
12 Patient Factors as a Major Determinant of Wound Outcome and Infection After Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
13 Mesh-Related Infections After Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
14 Human Acellular Dermal Matrix for Ventral Hernia Repair in the Compromised Surgical Field . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
15 Fate of the Inguinal Hernia Following Removal of Infected Prosthetic Mesh . . . . . . .113
16 Mesh Infection–Therapeutic Options . . . . . . .11917 Does Antibiotic Prophylaxis Prevent the
Occurrence of Wound Infection After Groin Hernia Surgery? . . . . . . . . . . . . . . . . . . . . . . . . . . . .125
18 Infection Control in a Hernia Clinic: 24-Year Results of Aseptic and Antiseptic Measure Implementation in 4,620 »Clean Cases« Based on Up-To-Date Micro-biological Research . . . . . . . . . . . . . . . . . . . . . . . .135
19 Components Separation Technique: Pros and Cons . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143
III Risk for Pain
20 Self-Assessment of Discomfort and Pain after Inguinal Hernia Repair: A Reflection of Both Individual Pain Propensity and Surgical Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . .155
21 Chronic Pain After Inguinal Hernia Repair . . .16322 What Do We Know About the Patho-
physiology and Pathology of Neuropathic Pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169
23 Surgical Trauma of Nerves–Causes of Neuropathic Pain, Classification, and Options in Surgical Therapy . . . . . . . . . . . . . . . .177
24 Risks for Pain–Neuropathic Pain: How Should We Handle the Nerves? . . . . . . . .185
25 What To Consider as Clinicians About Chronic Postoperative Pain and Inguinal Herniorrhaphy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191
26 Risk Factors for Chronic Pain After Groin Hernia Surgery . . . . . . . . . . . . . . . . . . . . . .199
27 Ischemic Inflammatory Response Syndrome as an Alternative Explanation for Postherniorrhaphy Pain . . . . . . . . . . . . . . . . .207
28 Postoperative CRPS in Inguinal Hernia Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
29 Chronic Pain After Open Mesh Repair of Incisional Hernia . . . . . . . . . . . . . . . . . . . . . . . .221
XII Contents
30 Clinical Results After Open Mesh Repair . . . .22731 Acute and Chronic Pain After Laparoscopic
Incisional Hernia Repair . . . . . . . . . . . . . . . . . . . .23332 Effect of Nerve Identification on the Rate
of Postoperative Chronic Pain Following Inguinal Hernia Surgery . . . . . . . . . . . . . . . . . . . .239
33 Discomfort 5 Years After Laparoscopic and Shouldice Inguinal Hernia Repair: A Report from the SMIL Study Group . . . . . . .245
34 Recurrence or Complication: The Lesser of Two Evils? A Review of Patient-Reported Outcomes from the VA Hernia Trial . . . . . . . . .251
35 Chronic Pain After Inguinal Hernia Repair: The Choice of Prosthesis Outweighs That of Technique . . . . . . . . . . . . . .257
36 The Effect of Polypropylene Mesh on the Ilioinguinal Nerve in Open Mesh Repair of Groin Hernia . . . . . . . . . . . . . . . . . . . . .265
37 Lightweight Macroporous Mesh vs. Standard Polypropylene Mesh in Lichtenstein Hernioplasty . . . . . . . . . . . . . . . . . .275
38 Does the Choice of Prosthetic Mesh Type Make a Difference in Postherniorrhaphy Groin Pain? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279
39 New Understanding of the Causes and Surgical Treatment of Postherniorrhaphy Inguinodynia and Orchialgia . . . . . . . . . . . . . . .287
40 Surgery for Chronic Inguinal Pain: Neurectomy, Mesh Explantation, or Both? . . . 293
41 Results of Tailored Therapy for Patients with Chronic Inguinal Pain . . . . . . . . . . . . . . . . .299
IV Risk for Adhesion
42 Adhesion as a Chronic Inflammatory Problem? Risk for Adhesions, Migration, and Erosions? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305
43 Biological Tissue Graft: Present Status . . . . . .31744 IPOM Results of 344 Consecutive Patients
with a PVDF-Derived Prosthesis . . . . . . . . . . . . . 32345 Pooled Data Analysis of Laparoscopic vs.
Open Ventral Hernia Repair: 14 Years of Patient Data Accrual . . . . . . . . . . . . . . . . . . . . . . .331
46 Tissue Ingrowth, Adhesion, and Mesh Contraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .345
47 Effect of Different Mesh Materials on Adhesion Formation . . . . . . . . . . . . . . . . . . . . . . .353
48 Tissue Ingrowth and Laparoscopic Ventral Hernia Mesh Materials: An Updated Review of the Literature . . . . . . . . . . . . . . . . . . . .365
49 Porosity and Adhesion in an IPOM Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .375
50 Benefit of Lightweight and/or Titanium Meshes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .381
51 ePTFE Prostheses and Modifications . . . . . . . .39352 The Role of Stem Cells in Abdominal
Wall Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .401
V Risk for Migration and Erosion
53 Safety and Durability of Prosthetic Repair of the Hiatal Hernia: Lessons Learned from a 15-Year Experience . . . . . . . . . . . . . . . . . . . . . . .413
54 Mesh Migration into the Esophageal Wall After Mesh Hiatoplasty . . . . . . . . . . . . . . . .421
55 Complications After Gastric Banding–Results in Germany . . . . . . . . . . . . . . . . . . . . . . . .429
56 Alloplastic Implants for the Treatment of Stress Urinary Incontinence and Pelvic Organ Prolapse . . . . . . . . . . . . . . . . . . . . . . . . . . . .439
57 Prophylactic IPOM Mesh To Prevent Parastomal Hernias . . . . . . . . . . . . . . . . . . . . . . . .445
58 Laparoscopic Parastomal Hernia Repair: Pitfalls and Complications . . . . . . . . . . . . . . . . . .451
59 Concept of Visible Mesh and Possibili-ties for Analysis of Mesh Migration and Shrinkage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .457
VI Strategy to Improve Results
60 Who Has the Major Role in Hernia Surgery: The Surgeon or the Material? . . . . . . . . . . . . . . .463
61 Two Controversial Concepts: Standard Procedure in a Standard Patient Versus Tailored Surgery with Procedures Adjusted to Individual Patients . . . . . . . . . . . . . . . . . . . . . .467
XIIIContents
VII Pro and Contra
62 In Support of a Standard Technique for Inguinal Hernia Repair . . . . . . . . . . . . . . . . . . . . .475
63 In Support of Individual Selection of Technique as Related to the Patient–Improvement by Better Selection of Patients Who Can Be Offered a Less Risky Technique: Groin Hernia . . . . . . . . . . . . . . . . . . .479
64 In Support of Standard Procedure in Abdominal Hernia Repair . . . . . . . . . . . . . . . . . .485
65 In Support of Individualized Procedures in Abdominal Wall Hernia Repair . . . . . . . . . . .493
66 In Support of Standard Procedure in Hiatal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . .503
67 Strategy To Improve the Results? In Support of Individualized Procedures in Hiatal Hernia Repair . . . . . . . . . . . . . . . . . . . . .513
68 Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . .521 Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .525