Newer Concepts and Procedures in Hernia Surgery - An Atlas

Description

The atlas focuses on the surgical steps of the latest hernia surgeries elucidated by labeled pictures. It aims to explain the technical aspects of hernia procedures. It includes images that are both graphic and intraoperative clinical photographs for better understanding. The book is written by international experts who have invented and pioneered the newer hernia procedures.   Hernia surgery has evolved at a tremendous pace in the last decade. In the last decade, there has been a proliferation of more than 20 procedures in hernia repair, and they offer advantages compared to the older procedures in various clinical situations. Presently, the resources, including images of the newer procedures, are limited to the published journals. This book aims to fill this gap by providing technique based knowledge in an illustrated manner for learning newer hernia procedures. It is written in a succinct style.  The book serves as a ready reference for practicing surgeons, minimal access surgeons and, resident surgeons, fellows. Foreword Foreword Preface Contents About the Editors Part I: Newer Concepts in Inguinal Hernia Surgery 1: Understanding the Critical View of the Myopectineal Orifice (MPO) for Safe Minimally Invasive Surgical Inguinal Hernia Repair 1.1 Following Are the Steps to Achieve a Critical View of the MPO 1.2 Conclusion References Part II: Newer Procedures in Inguinal Hernia Surgery 2: Inguinal Hernia Repair by Enhanced View Totally Extraperitoneal (eTEP) Approach 2.1 Where Does the eTEP Concept Come From? 2.2 Indications and Case Selection 2.3 Contraindications 2.4 Instruments and Energy Source 2.5 Team Organization, Anesthesia, and Position 2.6 Technique and Key Steps 2.7 Tips and Tricks 2.8 Complications and Management 2.9 Conclusion References 3: Robotic Transabdominal Preperitoneal Repair (rTAPP) for Groin Hernia 3.1 Indication and Case Selection 3.2 Contraindications 3.3 Instruments and Energy Source 3.4 Team Setup, Anesthesia, and Position 3.5 Key Steps 3.6 Surgical Techniques/Variations 3.7 Tips and Tricks 3.8 Complications and Management 3.9 Conclusion References Part III: Newer Procedures in Ventral Hernia Surgery 4: Anterior Component Separation Technique and Its Modifications for Ventral Hernia Repair 4.1 Introduction 4.2 Objective 4.3 Preoperative Counseling 4.4 Perioperative Pain Control 4.5 Anatomic Considerations 4.5.1 Musculofascia 4.5.2 Defect 4.5.3 Viscera 4.5.4 Skin 4.6 Selecting Mesh Material and Plane of Mesh Placement 4.6.1 Plane of Mesh Placement 4.6.2 Mesh Material 4.7 Operative Technique 4.7.1 Laparotomy and Adhesiolysis 4.7.2 Development of the Retrorectus Plane 4.7.3 Alternative Development of the Preperitoneal Plane 4.7.4 Anterior Subcutaneous Dissection 4.7.5 Initial Incision of the EO Aponeurosis 4.7.6 Blunt Separation of the EO and IO Aponeuroses and Muscles 4.7.7 Creation of Lateral Craniocaudal Tunnel 4.7.8 EO Aponeurosis Release and Further Separation of the EO and IO Muscles 4.7.9 Contralateral Release 4.7.10 Defect Sizing and Selection of Mesh 4.7.11 Mesh Inset 4.7.12 Primary Fascial Closure (Standard MICS) 4.7.13 Inlay-Bridging Repair (MICSIB) 4.7.14 Skin Resection and Placement of Subcutaneous Drains 4.7.15 Quilted Subcutaneous Closure and Skin Closure 4.8 Postoperative Care References 5: Open Posterior Component Separation: Transversus Abdominis Release (PCS-TAR) for Ventral Hernia 5.1 Introduction 5.2 Indications 5.3 Contraindications 5.4 Instruments and Energy Source 5.5 Team Setup, Anesthesia, and Position 5.6 Key Steps 5.7 Surgical Techniques/Variations 5.7.1 Rives-Stoppa Retrorectus Dissection 5.7.2 Transversus Abdominis Release 5.7.2.1 Lateral Preperitoneal Dissection 5.7.2.2 Inferior Preperitoneal Dissection 5.7.2.3 Superior Preperitoneal Dissection 5.7.2.4 Mesh Reinforcement and Closure 5.8 Tips and Tricks 5.9 Postoperative Management 5.10 Complications References 6: Down to Up Posterior Component Separation Technique 6.1 Indications and Case Selection 6.2 Contraindications 6.3 Instrument and Energy Source 6.4 Team Setup, Anesthesia, and Position 6.5 Key Steps 6.6 Surgical Techniques/Variations 6.7 Tips and Tricks 6.7.1 Starting the Surgery 6.7.2 Medial Release of Posterior Rectus Sheath 6.7.3 Lateral Release of Posterior Rectus Sheath 6.7.4 Find the Diaphragm and Psoas Muscle 6.8 Complications and Management 6.8.1 Seromas 6.8.2 Hematomas 6.8.3 Surgical Site Infection 6.8.4 Anastomotic Dehiscence or Enterocutaneous Fistula References 7: Peritoneal Flap/Hernia Sac Technique for Midline Ventral Hernia 7.1 Introduction 7.2 History of the Hernia Sac Technique 7.3 Indications and Case Selection 7.4 Contraindications 7.5 Instruments and Energy Source 7.6 Team Setup, Anaesthesia, and Position 7.7 Key Steps 7.8 Surgical Techniques and Variations 7.8.1 Step 1: Incision/Laparotomy/Adhesiolysis 7.8.2 Step 2: Retro-Rectus Dissection 7.8.3 Step 3: Closure of the Posterior Rectus Sheath, Hernia Sac Complex 7.8.4 Step 4: Mesh Placement 7.8.5 Step 5: Anterior Layer Closure 7.8.6 Step 6: Skin and Subcutaneous Fat Closure 7.9 Tips and Tricks 7.9.1 Skin Excision 7.10 Postoperative Care, Complications, and Management 7.11 Wound Complications 7.12 Conclusion References 8: Peritoneal Flap/Hernia Sac Technique for Transverse Ventral Hernia 8.1 Introduction 8.2 Indications and Case Selection 8.3 Contraindications 8.4 Instruments and Energy Source 8.5 Team Setup, Anesthesia, and Position 8.6 Key Steps 8.7 Surgical Techniques and Variations 8.7.1 Step 1: Incision/Laparotomy/Adhesiolysis 8.7.2 Step 2: Retro-Rectus, Inter-Oblique, and Crossover Dissection 8.7.3 Step 3: Closure of the Posterior Layer, Mesh Insertion, and Anterior Layer 8.8 Tips and Tricks, Postoperative Care, Complications, and Management 8.9 Conclusion References 9: Subcutaneous Onlay Endoscopic Approach (SCOLA) 9.1 Introduction 9.2 Indications 9.3 Surgical Technique 9.3.1 Patient and Surgical Team Positioning 9.3.2 Trocar Placement 9.3.3 Subcutaneous Dissection 9.3.4 Midline Closure 9.3.5 Mesh Placement 9.3.6 Mesh Fixation 9.4 Postoperative Management 9.5 Complications 9.6 Different Names for the Same Procedure 9.7 Conclusions References 10: Endoscopic and Endoscopically Assisted Mini or Less Open Sublay (EMILOS and MILOS) Mesh Repair of Abdominal Wall Hernias 10.1 Introduction 10.2 The E/MILOS Concept (MILOS and EMILOS Operation) 10.3 MILOS and EMILOS Repairs 10.4 E/MILOS Definitions 10.5 Indications for MILOS and EMILOS Repair 10.6 The Surgical Steps of the E/MILOS Repair of Midline Hernias 10.6.1 Phase 1 10.6.2 Phase 2 10.6.3 Phase 3 10.7 E/MILOS Repair of Lateral Abdominal Wall Hernias 10.8 E/MILOS Operation of Ventral Hernias with Concomitant Diastasis Recti 10.9 Treatment Algorithm 10.9.1 Mesh Augmentation of Diastasis Recti (DR) 10.9.2 Mesh Augmentation with Plication of DR 10.10 E/MILOS TAR Options 10.11 Results 10.12 Discussion 10.13 Advantages of the E/MILOS Hybrid Concept 10.14 Conclusion References 11: Transabdominal Preperitoneal (TAPP) Repair of Ventral Hernia 11.1 Indication of TAPP for Ventral Hernias 11.2 Contraindications 11.3 Instruments and Energy Sources 11.4 OT Setup 11.5 Operative Procedure 11.6 Transabdominal Partially Extraperitoneal (TAPE) Technique 11.7 Tips and Tricks References 12: Laparoscopic Transabdominal Retromuscular (TARM) Repair for Ventral Hernia 12.1 Introduction 12.2 Contraindications 12.3 Indications and Case Selection 12.4 Essential Equipment, Instruments, and Energy Sources 12.5 Team Setup, Anesthesia, and Patient Position (Figs. 12.1 and 12.3) 12.6 Key Steps 12.7 Surgical Techniques and Variations 12.7.1 Technique 1: 3 Port TARM/One P-PRS Flap (Figs. 12.1 and 12.2) 12.7.2 Technique 2: 6 Port TARM (Figs. 12.1, 12.2, 12.3, 12.4, 12.5, 12.6, 12.7, and 12.8)—Two P-PRS Flap Technique 12.7.3 Technique 3: TARM-TAR 12.8 Tips and Tricks 12.9 Complications and Their Management 12.10 Specific Advantages of the TARM Technique References 13: Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) 13.1 Introduction 13.2 Indications, Case Selection, and Contraindications 13.3 Instruments and Energy Source 13.4 Team Setup, Anesthesia, and Position 13.5 Key Steps of the Surgical Technique 13.5.1 Access and Pneumoperitoneum 13.5.2 Trocars 13.5.3 Adhesiolysis 13.5.4 Measure of the Hernia Defect 13.5.5 Creating the Flap at the Posterior Fascia of the Rectus Muscle 13.5.6 Suture of the Flap of the Posterior Fascia 13.5.7 Size of the Mesh 13.5.8 Fixation of the Mesh 13.6 Tips and Tricks 13.6.1 Regarding Trocar Placement 13.6.2 Regarding Measure of the Defect 13.6.3 Regarding the Flap of Fascia 13.6.4 Regarding Suturing the Flaps 13.6.5 Regarding Mesh Size and Introduction into the Cavity 13.6.6 Regarding Fixation 13.6.7 Final Tips to Finish the Surgical Procedure 13.7 Final Remarks References 14: Robotic Transabdominal Retromuscular Umbilical Prosthetic Hernia Repair (rTARUP) 14.1 Introduction 14.2 Indications and Case Selection 14.3 Contraindications 14.4 Instruments and Energy Source 14.5 Team Setup, Anesthesia, and Position 14.6 Key Steps 14.6.1 Abdominal Access and Trocar Placement 14.6.2 Docking 14.6.3 Adhesiolysis and Developing a Retromuscular Plane 14.6.4 Primary Closure of the Defect 14.6.5 Placement of Mesh with Minimal Fixation 14.6.6 Closure of the Posterior Lamina of the Left Rectus Sheath 14.7 Complications and Management References 15: Enhanced View Totally Extraperitoneal (eTEP) Repair for Midline Hernia 15.1 Introduction 15.2 Indications and Contraindications 15.2.1 Instruments 15.2.2 Position of the Patient 15.2.3 Team Setup 15.2.4 Key Steps 15.2.4.1 For Hernias Located in the Lower Part of the Abdomen 15.2.4.2 For Hernias Located in the Upper Part of the Abdomen 15.3 Transversus Abdominis Release (TAR) 15.4 Division of the Transversus Abdominis 15.5 Development of the Pre-transversalis/ Retro-Muscular Space 15.6 Closure of the Posterior Layer 15.7 Restoration of the Linea Alba 15.8 Mesh Placement 15.9 Complications and Management References 16: Enhanced View Totally Extraperitoneal (eTEP) Repair for Iliac Fossa and Lumbar Hernias 16.1 Introduction 16.2 Preoperative Preparation 16.3 eTEP with TAR for Iliac Fossa Hernias 16.3.1 Patient Position and Team Setup 16.3.2 Operative Procedure 16.4 Unique Features of eTEP for Iliac Fossa Hernias 16.5 Flank Hernias 16.6 eTEP for Lumbar Hernias 16.6.1 Patient Position and Team Setup 16.6.2 Operative Procedure 16.7 Discussion 16.8 Conclusion References 17: Enhanced View Totally Extraperitoneal (eTEP) Repair for Subxiphoid and Subcostal Hernias 17.1 Introduction 17.2 European Hernia Society Hernia Classification System 17.3 Indications and Case Selection 17.3.1 Contraindications 17.3.2 Instruments and Energy Source 17.3.3 Team Setup, Anesthesia, and Position 17.3.4 Key Steps 17.3.5 Surgical Techniques/Variations 17.4 Tips and Tricks 17.5 Complications and Management References 18: Robotic Transversus Abdominis Release (RoboTAR) for Ventral Hernia Repairs 18.1 Introduction 18.2 Indications and Case Selection 18.3 Contraindications 18.3.1 Operative Techniques 18.3.1.1 Gaining Entry into the Abdomen: Patient Positioning, Trocar Placement, and Docking 18.3.1.2 Division of Posterior Rectus Sheath and Subsequent Mobilization to the Linea Semilunaris 18.3.1.3 Three Ways to TAR Bottoms-Up Technique Novitsky Way Top-Down Technique 18.3.1.4 Initial Deployment and Fixation of Mesh 18.3.1.5 Double Docking Method and Contralateral Dissection 18.3.1.6 Closure of the Posterior and Anterior Rectus Sheath 18.3.1.7 Final Mesh Deployment 18.4 Discussion 18.5 Tips and Tricks 18.6 Conclusion References 19: TAR Plus (TAR plus Peritoneal Flap Hernioplasty) for Large Midline Ventral Hernias 19.1 Indications and Case Selection 19.1.1 Background 19.1.2 Indications 19.2 Contraindications 19.3 Instruments and Energy Source 19.4 Team Setup, Anesthesia, and Position 19.5 Key Steps 19.6 Surgical Techniques/Variations 19.7 Tips and Tricks 19.8 Complications and Management 19.9 Conclusion References 20: Extraperitoneal Repair for Parastomal Hernia 20.1 Introduction 20.2 Indications and Case Selection 20.3 Contraindications 20.4 Instruments and Energy Source 20.4.1 Open Approach 20.4.2 Laparoscopic Approach 20.4.3 Robotic Approach 20.5 Team Setup, Anesthesia, and Position 20.6 Key Steps 20.7 Surgical Techniques/Variations 20.7.1 Open Extraperitoneal Parastomal Hernia Repair 20.7.1.1 Variation 1: Keyhole Mesh Configuration During Open TAR Parastomal Hernia Repair 20.7.1.2 Variation 2: Stapled Transabdominal Ostomy Reinforcement with Retromuscular Mesh (STORRM) 20.7.1.3 Variation 3: Pauli Parastomal Hernia Repair (PPHR) 20.7.2 Minimally Invasive Extraperitoneal Parastomal Hernia Repair 20.7.2.1 Variation 1: Single Dock PPHR Operation for Isolated Parastomal Hernia 20.7.2.2 Variation 2: Single Dock PPHR Operation for Parastomal Hernia and Small Midline Hernias 20.7.2.3 Variation 3: eTEP PPHR Operation for Parastomal Hernia and Midline Hernias 20.8 Tips and Tricks 20.9 Complications and Management 20.9.1 Infection 20.9.2 Stoma Complications 20.9.3 Recurrent Hernias 20.10 Conclusions References Part IV: Adjuncts in Hernia Surgery 21: Chemical Component Separation Technique: Use of Botulinum Toxin in Hernia Repair 21.1 Introductions 21.2 Indications 21.3 Contraindications 21.4 Steps 21.5 Tips and Tricks 21.5.1 Selection of Patient 21.5.2 Choosing the Injection Site 21.5.3 Volume of BTA Injected 21.5.4 Timing of Preoperative BTA 21.6 Complications 21.7 Literature Review 21.8 Conclusion References 22: Chemical Component Separation Technique in Hernia Repair 22.1 Introduction 22.2 Indications for the Use of Botulinum Toxin in Abdominal Wall Reconstruction 22.3 Adverse Effects and Contraindications 22.4 Technique 22.5 Tips and Tricks 22.5.1 Prehabilitation 22.6 Outcomes 22.6.1 Summary of Institutional Data 22.7 Future Directions References 23: Progressive Pneumoperitoneum (PPP) in Hernia Repair 23.1 Introduction 23.2 Indications and Case Selection 23.3 Contraindications 23.4 Placement of PPP, Instruments, and Energy Sources 23.5 Team Organization, Anesthetic Options, and Positions 23.6 Materials 23.7 Key Steps (Fig. 23.10) 23.8 Details of the Insufflation 23.9 Technical Variations 23.10 Some Tips and Tricks 23.11 Complications 23.12 Preventive Measures 23.13 Conclusion References 24: Intraoperative Abdominal Wall Extension (AWEX)/Intraoperative Fascia Traction (IFT): Significance and Technique as Applied to Complex Abdominal Wall Hernia 24.1 Development and Principle of the Technique 24.2 Patient Selection, Surgery Preparation, Teams, and Infrastructure 24.3 Contraindications 24.4 Application in Open Abdominal Wall Reconstruction 24.5 Setup and Positioning 24.6 Basic Technique of Intraoperative AWEX 24.7 IFT with the Fasciotens® Hernia System 24.8 Key Steps, Tips, Tricks, and Variations 24.9 Combinations with Laparoscopy, Mini- or Less-Open Sublay, and Robotic Repairs 24.10 Conclusions and Prospects References 25: Abdominoplasty in Ventral Hernia 25.1 Surgical Anatomy in Ventral Hernia 25.2 Patient Selection (Table 25.1) 25.2.1 Preoperative Optimization 25.3 Surgical Technique (Table 25.2) 25.4 Postoperative Care 25.5 Complications (Table 25.3) 25.5.1 Local Complications 25.5.2 Systemic Complications 25.6 Summary References