Treatment of Incisional (Ventral) Hernias: Laparoscopic
Repair*
Adrian E. Park, MD
Incisional hernia is a common complication of abdominal surgery. In prospective studies,
primary incisional hernias occur in 11 to 20 percent of patients undergoing laparotomy.
Most hernias occur during the first five years, with less than 50 percent occurring
in the first year and up to 80 percent occurring by the third year. Recurrence after
primary repair of incisional hernia tends to appear soon: over 80% within the first
year.
Several risk factors have been implicated in the development of primary incisional
hernias such as wound infection, hematoma, obesity, diabetes mellitus, corticosteroid
use and type of incision (transverse vs midline). However in a study authored by
Hesselink, the only statistically significant factor that correlated to the development
of recurrences of incisional hernia repair following repair was size of defect greater
than 4 cm. Although obesity, diabetes mellitus, lower midline incision, and wound
infection correlated with an increased incidence of recurrences, it was not statistically
significant.
Age, gender, steroids, and repair techniques did not correlate with increased incidence
of recurrences. This study added to the growing literature advocating the need to
move from tissue (tension) repair to the use of a mesh (tension free) in the repair
of incisional hernias. |
Abstracts
"Dome
Down" Laparoscopic Cholecystectomy
Glenn L. Sandler, MD
Endoscopic
Drainage of Pancreatic Pseudocyst
Gary C. Vitale, MD
Thoracoscopic
Splanchnicectomy for Pancreatic Pain
Henry L. Laws, MD
CT
Guided Percutaneous Drainage of Infected Acute Necrotizing Pancreatitis
Patrick C. Freeny, MD
Management
of Metastatic Carcinoma
T. S. Ravikumar, MD
Management
of Liver Trauma
Juan C. Asensio, MD
Management
of Benign Liver Tumors
Leslie H. Blumgart, MD, FRCS
Role
and Techniques of "Dome-Down" Laparoscopic Cholecystectomy
Glenn L. Sandler, MD
Thoracoscopic
Splanchnicectomy for Pancreatic Pain
Henry L. Laws, MD
Current
ConceptsæAdequate Pain Management
Young K. Choi, MD
Prevention
and Management of Infection Complicating Acute Pancreatitis
Henry L. Laws, MD
Indication
for and Timing of ERCP in Biliary Pancreatitis
John Baillie, MB, ChB, FRCP
Timing
of Laparoscopic Cholecystectomy After Biliary Pancreatitis
Gary C. Vitale
Magnetic
Resonance Angiography
Martin R. Prince, MD, PhD
Pancreatic
Imaging
Patrick C. Freeny, MD
Endoscopic
Ultrasonography
Charles Noyer, MD
Limited
Gastric Resection
Jo Buyske, MD
Current
ConceptsæManagement of Pancreatic Carcinoma
Henry A. Pitt, MD
Watchful
Waiting in the Management of Inguinal Hernia
Robert J. Fitzgibbons, MD
Treatment
of Incisional (Ventral) Hernias: Open Repair
Maximo Deysine, MD, FACP
Treatment
of Incisional (Ventral) Hernias: Laparoscopic Repair
Adrian E. Park, MD
Indications
for Converting to Open Operation
John G. Hunter, MD
Medicolegal
Implications of Common Bile Duct Injury During Laparoscopic Cholecystectomy
Kenneth A. Kern, MD, FACS
Role
and Technique of Pylorus Preserving Pacreatectomy
Henry A. Pitt, MD |
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