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inguinal hernia, crural hernia, hernia, laparoscopy, laparoscopic inguinal hernia
Inguinal hernia in laparoscopy, why?

Laparoscopic surgery of inguinal hernia 

When, after diagnosis, I propose to a patient to operate on his inguinal hernia laparoscopically, it is natural for me to be bombarded with questions.

In fact, inguinal hernias can be operated on under local anesthesia using relatively simple, widely standardized, and highly effective techniques.

Laparoscopic inguinal hernia, inguinal hernia surgery, inguinal hernia, inguinal hernia pain, inguinal hernia surgery,

However, there are many considerations in favor of laparoscopic inguinal hernia repair., that chart the way in choosing the technique.

The first comes from a long way back; from 1647 even, the year when French physicist and mathematician Blaise Pascal discovered his famous law.

In his experiment, Pascal introduced a 10-meter-long pipe into a barrel filled with water, then filled the pipe with water as well: the result was that the pressure inside the barrel increased so much that it broke.

Applied to hernia surgery, Pascal's law tells us that when the mesh we use to repair a hernia is placed on the inner surface of the herniated defect area, it is the same pressure present inside the abdomen that anchors it to the abdominal wall; whereas if we place it on the outer surface, the pressure tends to make it detach.

So operating aninguinal hernia laparoscopically means to perform a surgery in which the repair is more stable than that done "from the outside." And this is a very, very good reason to propose the surgery of repairing the inguinal hernia in laparoscopy..

Another important reason is that by operating on aninguinal hernialaparoscopically, we are able to diagnose the possible presence of other wall defects, which are often present in these patients and not looked for or not seen by the examiner-such as, for example, an umbilical hernia or a contralateral inguinal hernia, i.e., on the other side, a crural hernia-and repair them during the same surgery.

TAPP hernioplasty - plug

Third, equally central reason: laparoscopic inguinal hernia surgery causes much less postoperative pain than surgery performed conventionally.

What's more, many (most) surgeons who operate openly have the habit of using "plugs ," which are sort of "plugs" of plastic material that are inserted into the inner inguinal ring for the purpose of reducing its size. This is a very bad habit, because these plugs have an unpleasant tendency to migrate, often ending up inside the abdominal cavity and causing adhesions with the intestinal loops, which, in the most serious cases, can end up injured by these plastic boulders, up to intestinal perforation.

In the photograph above, here is what we found in one of our last surgeries: a plug that had entered the abdominal cavity, causing severe adhesions with peritoneal fat and intestinal loops. And it was not the firsttime.

Remember: if you are going to have surgery for aninguinal hernia, ask the Surgeon if he plans to use a plug; if he says yes, think about it!

So, summing up:

LAPAROSCOPIC INGUINAL HERNIA:

Better repair of the herniated defect, with larger mesh and optimal tightness
Ability to diagnose and repair other hernias that escaped diagnosis during surgery
Less postoperative pain

These are the reasons - and they are not a few! - to propose laparoscopic inguinal hernia repair surgery. Add to this the fact that, for years now, the scientific community of surgeons dealing with the abdominal wall has established that laparoscopic inguinal hernia surgery represents the "gold standard" for the treatment of this frequent, bothersome and sometimes very serious condition.

However, probably following ingrained habits that make open inguinal hernioplasty surgery a surgery that can be performed by any surgeon, even those who are not particularly specialized in abdominal wall surgery, and also because laparoscopic inguinal hernia surgery is by no means simple, but involves a long and arduous learning curve, today the vast majority of surgeons do not engage in laparoscopic inguinal hernia surgery. Obviously, to the great detriment of the patient.

Laparoscopic inguinal hernia surgery in my center

laparoscopic inguinal hernia

For years I have been working to make my center, the St. Catherine of Siena Clinic in Turin, Italy., a Center of Excellence for the treatment of abdominal wall pathologies, particularly insisting on minimally invasive laparoscopic surgery. I introduced, first in Europe, the endoscopic diastasis surgery of the rectus abdominis muscles (of which I now hold the largest case history in the world) and, first in the world, the surgery of large laparoceles by endoscopy, with an original technique derived from the Carbonell-Bonafé technique, also with preoperative preparation with botulinum toxin and progressive pneumoperitoneum for the reconstruction of the space in the abdominal cavity (techniques well known and widely used abroad, but practically unknown in Italy; in this, too, excuse my lack of modesty, I arrived first...). Continuing on the path of offering the patient the best possible therapeutic choices, and in line with international recommendations, I have decided to offer inguinal hernia repair by laparoscopy to all my patients.. Operationally, for the patient this involves general anesthesia instead of local, and one night of hospitalization.

How does the surgery take place? You can take a look at the video below to understand the basic surgical steps forlaparoscopic inguinal hernia repair.

How to get enrolled for this surgery? Simply schedule an appointment or a video consultation.

VIDEOCONSULTO TORINO - CLINICA SANTA CATERINA DA SIENA STUDIO DE MEDICA - CHIVASSO

Otherwise, you can contact me with the form below:

[contact-form to=’info@cuccomarinomd.com’ subject=’Richiesta da un utente’][contact-field label=’Nome’ type=’name’ required=’1’/][contact-field label=’E-mail’ type=’email’ required=’1’/][contact-field label=’Telefono’ type=’text’ required=’1’/][contact-field label=’Caro Dottore, vorrei…’ type=’textarea’ required=’1’/][/contact-form]

What our patients think of us is much more important than what we say.

Dr. Salvatore Cuccomarino
Cuccomarino, MD
Medical Surgeon Specialist in General Surgery
19 Villa della Regina Street
Turin,Turin
10131
EN
Phone 0118199300

 

botulinum toxin, botox, anal fissure
Botulinum toxin and anal fissure

Botulinum toxin and anal fissure.

botulinum toxin, anal fissure, BOTOX Our new video clip is dedicated to the treatment of anal fissure with botulinum toxin.
BoTox has been used for a few decades in the Non-surgical, outpatient treatment of anal fissure. The efficacy is really high, and the side effects are negligible, so much so that it is possible to say that with BoTox it is possible, in effective terms, to achieve a chemical sphincterotomy comparable to surgical sphincterotomy, which is currently the gold standard in the treatment of anal fissure,but can have post-surgical complications, such as incontinence, that are not observed with BoTox.

Botulinum toxin: not in the public

It is worth mentioning, however, that the use of BoTox for the treatment of anal fissure is off label, and therefore not adopted in public health facilities.

Our video on botulinum toxin treatment of anal rade

[youtube https://www.youtube.com/watch?v=lXrv6tg1PEg?version=3&rel=1&fs=1&autohide=2&showsearch=0&showinfo=1&iv_load_policy=1&wmode=transparent&w=672&h=408]

Source: coloproctologiatorino

Botulinum toxin in the treatment of anal fissure

Botulinum toxin and anal fissure
Our new video clip is dedicated to the treatment of anal fissure with botulinum toxin.
BoTox has been used for a few decades in the non-surgical, outpatient treatment of anal fissure. The efficacy is really high, and the side effects are negligible, so much so that it can be said that with BoTox it is possible, in effective terms, to achieve a chemical sphincterotomy comparable to surgical sphincterotomy, which is currently the gold standard in the treatment of anal fissure,but it can have post-surgical complications, such as incontinence, that are not observed with BoTox.
Botulinum toxin: not in the general public
It is worth mentioning, however, that the use of BoTox for the treatment of anal fissure is off label, and therefore not adopted in public health facilities.
Our video on botulinum toxin treatment of anal fissure

[youtube https://www.youtube.com/watch?v=lXrv6tg1PEg?version=3&rel=1&fs=1&autohide=2&showsearch=0&showinfo=1&iv_load_policy=1&wmode=transparent&w=672&h=408]

Source: coloproctologiatorino

Too young? Colon cancer in the under-50s

COLON CANCER: AN UNDER-50 DISEASE?

Although among individuals over the age of 50, the incidence and mortality of colorectal cancer have declined in recent years, thanks largely to screening programs, for reasons as yet unknown the incidence of the disease in the population under the age of 50 has increased dramatically. In the United States alone, as per epidemiological records, the incidence of colorectal cancer per 100,000 young adults has increased by 1.6 percent in women and 1.5 percent in men per year between 1992 and 2005; also in the U.S., the number of newly diagnosed cases per year in the under-50s reaches 13,000.

colon cancer, under 50

COLON CANCER UNDER 50: HIGH MORTALITY

The dramatic finding is the high mortality observed in these patients, mainly due to a delay in diagnosis, for which both patients and physicians are responsible: the former because they often do not understand or underestimate the symptoms, and the latter because they tend not to correlate the symptoms with the pathology, in view of the age of the patients: the consequence is that a diagnostic error is recorded in 15-50% of cases, depending on the reports.

Doctors have always associated the occurrence of colon cancer at a young age with certain hereditary syndromes, such as Lynch syndrome. However, today we know that in about 75% of cases in these patients the cancer is not correlated with either a hereditary syndrome or any familiarity.

On the other hand, it is interesting to note that, in the U.S., the increased incidence over the past 30 years of colon cancer in the under-50s is accompanied, in the same group of patients, by a parallel increase in the incidence ofobesity and diabetes. In the same population, an increase in the consumption of sugar-sweetened beverages and a decrease in the intake of milk - rich in calcium, which seems to be a protective factor against colon cancer- was observed during the same period. Other factors, both behavioral and dietary, have also been recorded to be associated with early onset of the disease, and among them are increased consumption of industrial meat preparations, alcohol abuse and poor exercise. However, there is still insufficient data available. Currently, research is underway on possible relationships between the disease and changes in gut flora and exposure to environmental toxins and drugs such as statins and antibiotics.

COLON CANCER UNDER 50: WHAT TO DO?

What to do, then? Colon cancer is a curable disease when diagnosed early, but the dramatic reduction in the average age of its onset should give both epidemiologists and us clinicians pause for thought. I personally believe that the maximum effort should be produced both in identifying risk factors in young adults and ineducating this population group, making them aware of possible early signs of the disease - changes in alvus, bleeding, changes in the appearance of stool... - and, above all, in expanding screening programs, including by implementing new molecular biology techniques, some of which we have discussed in previous articles.

Source: "Why Is Colorectal Cancer Targeting the Young?", by Cynthia J. Gordon

Too young? Colon cancer in the under-50s

Although among individuals over the age of 50 the incidence and mortality of colorectal cancer have been declining in recent years, thanks largely to screening programs, for reasons as yet unknown the incidence of this disease in the population under the age of 50 has increased dramatically. In the United States alone, as per epidemiological records, the incidence of colorectal cancer per 100,000 young adults has increased by 1.6 percent in women and 1.5 percent in men per year between 1992 and 2005; also in the U.S., the number of new cases diagnosed each year in the under-50s reaches 13,000.
The dramatic fact is the high mortality observed in these patients, mainly due to a delay in diagnosis, for which both patients and physicians are responsible: the former because they often do not understand or underestimate the symptoms, and the latter because they tend not to correlate the symptoms with the disease, in view of the age of the patients: the consequence is that a diagnostic error is recorded in 15-50% of cases, depending on the reports.
Doctors have always associated the occurrence of colon cancer at a young age with certain hereditary syndromes, such as Lynch syndrome. However, today we know that in about 75% of cases in these patients the tumor is not correlated with either a hereditary syndrome or any familiarity.
On the other hand, it is interesting to note that, in the U.S., the increased incidence over the past 30 years of colon cancer in those under 50 is accompanied, in the same group of patients, by a parallel increase in the incidence of obesity and diabetes. In the same population, an increase in the consumption of sugar-sweetened beverages and a decrease in the intake of milk - rich in calcium, which seems to be a protective factor against colon cancer - was observed during the same period. Other factors, both behavioral and dietary, have also been reported to be associated with early onset of the disease, and among them are increased consumption of industrial meat preparations, alcohol abuse, and poor exercise. However, there is still insufficient data available. Currently, research is underway on possible relationships between the disease and changes in intestinal flora and exposure to environmental toxins and drugs such as statins and antibiotics.
What to do, then? Colon cancer is a curable disease when diagnosed early, but the dramatic reduction in the average age of its onset should give both epidemiologists and us clinicians pause for thought. I personally believe that maximum effort should be produced both in identifying risk factors in young adults, and in educating this population group, making them aware of possible early signs of the disease -- changes in alvus, bleeding, changes in the appearance of stool... -- and especially in expanding screening programs, including implementing new molecular biology techniques, some of which we have discussed in previous articles.
"Why Is Colorectal Cancer Targeting the Young?" by Cynthia J. Gordon.

Source: coloproctologiatorino

anal fissure
That small, painful wound...

Today we are talking about fissures.
And not because anal fissure is a little-covered topic or unknown to most, no really: you will find thousands of pages to read in Dr. Google's big bag-and among them some of ours on the dedicated page of our website, including our patient brochure.
So we are not going to tell you that anal fissure is a tear in the anoderm, nor that it is closely related (among other things) to constipation and pregnancy, or that it is extremely painful at defecation and for hours afterwards, and among the main causes of the "blood stains" that can be seen on toilet paper.
We are not going to tell you anything about the "pathophysiology" of anal fissure (the injury that causes spasm of the anal sphincter, which results in decreased blood flow to the injured area, which slows or stops healing altogether, keeping the vicious cycle active in a kind of mythological Uroboros...) - no; nor are we going to talk about the psychological aspects of this pathology, which even patients know very well (the pain is so much and such that one is afraid to go to the bathroom, which aggravates constipation and makes subsequent defecation extremely more painful).
Rather, we want to protest the barbaric methods of treatment adopted by many proctologists in Italy.
Serial anal dilations are a medieval procedure, painful, barbaric, often ineffective, and poorly accepted by many patients. Why should one agree to let something "in" when the pain at the "outflow" of something else from the same place is excruciating? Really, we can never understand it.
The solution to anal fissure is to cause, pharmacologically or surgically, a relaxation of the internal sphincter of the anus: in the former case we speak of "chemical sphincterotomy," in the latter of "sphincterotomy" tout court.
If the sphincter relaxes, it resumes blood flow to the anal fissure area, which heals: simple, right? And why induce sphincter relaxation by (painful) dilation if there are topical medications that can accomplish this? And again: why insist on local therapy of an anal fissure that does not heal, if with surgery--simple and perfectly tolerated when performed by skilled hands--the pain disappears in a matter of hours?
Many proctologists, in Italy, say the surgery is risky and can cause incontinence. True! you can have incontinence related to gas, which of disappears quickly and without leaving relics; the rates of fecal incontinence are negligible: and all this in front of the patient who, the day after surgery says, "What miracle is this? I have no more pain!"
The surgery also cures the psychological aspects of the pathology: these are people who dream about the fissure - with terror - at night; and we, with a surgical procedure that takes less than half an hour, can free them from these nightmares.
Think about it before you buy dilators; ask for a second opinion, you will not be disappointed!

proctological problems in pregnancy
Pregnancy, hemorrhoids & co.

Proctologists are among the most frequent visitors to obstetrics departments. Proctologic problems in pregnancy, and in particular constipation, hemorrhoids, anal fissures, and pelvic floor dysfunction, are indeed very frequent, and often persist even after sweet expectation. In fact, the peak is reached immediately after childbirth (especially if it was a vaginal delivery), with rates as high as over 30% for hemorrhoids; but the whole pregnancy, and especially the last trimester, can be affected.
The reason is simple: just think of the gradual increase in abdominal pressure that occurs during gestation. The baby develops and grows, and with it the uterus, which begins to compress the abdominal organs; constipation appears, which can be aggravated by taking iron supplements, often prescribed by gynecologists. Venous pressure increases, which hinders the outflow of blood from the hemorrhoid pads: which, along with constipation, can cause hemorrhoidal congestion and formation of a mucous prolapse. It is also not uncommon for thrombi, i.e., blood clots, to form within the hemorrhoids: these are usually very painful and often require urgent surgical treatment, which consists of incision of the thrombosed hemorrhoid and removal of the clots.
With constipation, then, anal fissure goes hand in hand. Anal fissure is a laceration of the anodermis, caused in most cases by the elimination of hard, dehydrated feces; it is a very painful lesion, especially at the time of defecation, and the pain may persist for hours after that. The mechanism that self-sustains fissures is diabolical: the anodermis is torn, which causes pain that causes spasm of the internal anal sphincter; this results in decreased blood flow to the area of the wound, which because of this does not tend to heal, and in this way the cycle begins again.

Proctological problems in pregnancy: what treatment?

Treatments of proctologic problems in pregnancy are limited by two considerations: the first is that many medications cannot be taken by mothers-to-be; for example, anal fissure therapy involves so-called chemical sphincterotomy, that is, the local application of ointments containing active ingredients that cause the release of the internal anal sphincter: these active ingredients are contraindicated in pregnancy. The second consideration is that we try to procrastinate surgical interventions as much as possible, because it is not uncommon that after childbirth the pathological condition is reduced, especially in the case of hemorrhoids: so an acute picture that would seem to indicate urgent intervention, often, a month after childbirth, is resolved with "simple" sessions of elastic ligatures.
How to avoid, of course as far as possible, proctological problems in pregnancy? The most important thing is to maintain regular bowel movements: going to the bowels regularly, if possible every day, and with soft stools shelters (within certain limits) the appearance of fissures and hemorrhoidal crises. Fiber supplements can be taken - there are plenty on the market - and it is extremely important to drink a lot (at least a couple of liters of water a day) and enrich the diet with fruits and vegetables. The advice of the coloproctologist is always essential.
The appearance of acute and worsening anal pain should prompt the new mother to urgently consult her trusted coloproctologist, who will know what to do, what to prescribe, and, at the limit, whether to indicate urgent surgery.

dearterization
Hemorrhoid dearterization "...by the eyes of the Surgeon"

I am returning to THD, or transanal hemorrhoid dearterization technique (indicated, I remind you, in grade II and III hemorrhoidal prolapse), by posting a video clip of the surgery as seen "by the eyes of the Surgeon"; all thanks to a high-definition micro-camera built into my glasses.
You will see the surgery as I see it, as I perform it: nothing better to fully appreciate this ultratechnological technique. I plan to relive other videos of other surgical methods with the same system, because there is nothing better, for a patient, than to understand clearly and by simple means what is being proposed. Happy viewing!

Hemorrhoid dearterization "...by the eyes of the Surgeon"

 

malattia diverticolare, diverticolite
Il Giano Bifronte della Medicina, ovvero: della malattia diverticolare

Poche malattie tra quelle a maggior diffusione in Occidente sono più capricciose ed infide della malattia diverticolare. E forse dovrei dire che, nonostante sia molto diffusa, la malattia diverticolare viene spesso sottostimata dalla Medicina Generale, che ancora oggi la tratta secondo paradigmi dimostratisi, nel tempo, sbagliati. Questo contribuisce ad alimentare il carattere “ombroso” della condizione, la qual cosa confonde ulteriormente le idee dei Medici, specie dei Medici di base e di alcuni Medici di Pronto Soccorso, che non sanno mai se definirla come patologia “internistica” o “chirurgica”. Che facciamo? La passiamo allo Specialista in Medicina Interna? Al Gastroenterologo? Al Chirurgo dell’Apparato Digerente? Tanti dubbi non rallentano certo, anzi spesso promuovono, la progressione della malattia, che da condizione sicuramente di interesse internistico non raramente si trasforma in urgenza chirurgica.
La malattia diverticolare è una patologia del nostro tempo, legata molto verosimilmente alla diminuita introduzione di fibre con la dieta ed al progressivo invecchiamento (e quindi deterioramento organico) della popolazione.
I dati di cui disponiamo, che vengono da esami radiologici ed autopsie, ci confermano la sua ampia diffusione, essendo essa presente (anche se non di rado del tutto asintomaticamente) nel 30-40% della popolazione con più di 60 anni.
Infatti, la malattia diverticolare può non dare segno di sé, o quasi, per tutta la vita. A volte, specie nei periodi di stitichezza, e soprattutto se siamo stitici tout court, possiamo notare un dolorino più o meno accentuato nella parte inferiore sinistra dell’addome; meno frequente è l’eliminazione di sangue con le feci, che fa scattare il campanello d’allarme e ci induce ad andare dal medico.
In circa un terzo dei casi, però, i diverticoli si infiammano: essi, infatti, sono come tante piccole appendici localizzate nel colon discendente e nel colon sigmoideo; ed, esattamente come succede all’appendice “ufficiale” quando si sviluppa un’appendicite, possono infiammarsi, e l’infiammazione complicarsi: i diverticoli infiammati possono provocare la formazione di ascessi e perforarsi, causando una peritonite a volte molto grave, associata a febbre alta ed a malessere generale pronunciato. Ecco la diverticolite. La quale è l’altra faccia di Giano, quella più malefica, della malattia diverticolare. Non di rado, la diverticolite impone l’intervento chirurgico: che, se non eseguito in urgenza, viene comunque proposto già al secondo episodio diverticolitico, o addirittura al primo se il paziente è giovane, visto che la probabilità di recidive sempre più aggressive è molto elevata.

Chirurgia della malattia diverticolare

La chirurgia della diverticolite è cambiata col tempo, grazie anche al sempre maggior ricorso alle tecniche minimamente invasive laparoscopiche. Negli anni ’80 del secolo scorso, noi chirurghi tendavamo ad essere molto aggressivi: operavamo il paziente in urgenza, portavamo via il segmento di colon malato e confezionavamo il cosiddetto “ano preternaturale”: ovvero la colostomia, il famoso e famigerato “sacchetto”, che il paziente si teneva 5-6 mesi per essere poi rioperato per la ricostruzione del transito. Era l’intervento di Hartmann, che tante vite ha salvato, da un lauto, e tante morti causato dall’altro, e che ancora oggi, in occasioni ben determinate, viene realizzato. Questo intervento non è per niente facile, ed è gravato da non poche complicazioni; nel complesso, la chirurgia di Hartmann per diverticolite acuta ha una morbilità (ovvero dà origine a complicanze postchirurgiche) che può arrivare fino al 50% dei casi in funzione della gravità del quadro diverticolitico iniziale; ed una mortalità che in alcune casistiche supera anche il 20% dei casi.
Oggi, come ho detto, le tecniche di diagnosi (soprattutto l’affinamento delle metodiche TAC e lo sviluppo della colonscopia virtuale) e l’affermarsi della laparoscopia ci consentono di “mirare” meglio sia il momento in cui intervenire che la tecnica da adottare. La crisi diverticolare (ovvero, il paziente che arriva in Pronto Soccorso accusando un importante dolore al quadrante inferiore sinistro dell’addome, con febbre, nausea e malessere generale) in genere è dovuta alla microperforazione di un diverticolo, che puo “autocontenersi per tamponamento” (sembra difficile, ma non lo è poi tanto: avete presente quando da ragazzini si riparavano le camere d’aria forate della bicicletta incollandoci sopra una toppa di gomma? Beh, è più o meno la stessa cosa…) dando luogo ad una peritonite molto localizzata: in questo caso, studio TAC per confermare la situazione addominale, riposo intestinale per qualche giorno e terapia antibiotica mirata sono la condotta medica giusta. Se l’ “autotamponamento” è insufficiente o inefficace, ovvero se la TAC ci dice che in peritoneo è già presente qualcosa che non dovrebbe esserci (per esempio, del liquido libero o del pus) allora si va all’intervento chirurgico urgente, che oggi può e deve essere realizzato per via mininvasiva laparoscopica: si introduce l’ottica laparoscopica e si esplora l’addome che, quando si confermi per visione diretta che il problema è limitato e localizzato, viene lavato accuratamente e drenato. In questo caso, qui finisce il primo tempo della chirurgia: il paziente viene sottoposto a terapia antibiotica, riposo intestinale, ed al momento giusto rimandato a casa, con l’indicazione a sottoporsi ad intervento chirurgico elettivo dopo 3-4 mesi.
A volte, tuttavia (sempre meno spesso, fortunatamente…), un semplice lavaggio-drenaggio non è sufficiente, ed il paziente deve essere sottoposto ad intervento di resezione del tratto di intestino malato e colostomia – il famoso intervento di Hartmann, insomma: solo che oggi la chirurgia, nella maggior parte dei casi, può e deve essere eseguita per via laparoscopica: la qual cosa riduce i rischi e le complicanze postchirurgici, e consente, dopo qualche mese, una ricanalizzazione anch’essa laparoscopica.
Nel caso in cui invece il lavaggio-drenaggio sia sufficiente, l’intervento definitivo, che come ho detto viene eseguito dopo 3-4 mesi, è la resezione del viscere malato con ricostruzione del transito nello stesso tempo, la quale anch’essa, nella maggior parte dei pazienti, può, e deve, essere eseguita per via laparoscopica.
Attenzione: dal punto di vista tecnico chirurgico questo intervento è molto complesso, dev’essere eseguito rispettando i criteri dell’arte (altrimenti è inefficace) e deve essere realizzato da un’équipe esperta in chirurgia laparoscopica avanzata e chirurgia laparoscopica del colon. Non è cosa per tutti, insomma. Only the braves!
Se avete problemi diverticolari, e soprattutto se siete giovani, consultateci: spesso bastano alcuni semplici provvedimenti “igienici” per tenere sotto controllo la situazione. E, se siete candidabili all’intervento, avrete la sicurezza di affidarvi a Chirurghi per i quali la laparoscopia non ha più segreti…

ernie, Panama
Ernie panameñe: chronicle of a success story

And so, I was in Panama. I caught up with old friends, met new ones, but above all I had the joy of operating with them, explaining my techniques, demonstrating and teaching them, and helping a few patients solve their wall problems.
In four days I performed about 20 surgeries, half of them minimally invasive laparoscopic; I was fortunate to have access to ultramodern and super-accessorized operating rooms, and to use very high quality prostheses, such as the Herniamesh Relimesh or the brand new Hybridmesh, a mesh that within two years resorbs 75%, ultimately leaving very little foreign material in the patient. A fantastic mesh for wall repairs, for example, in athletes or adolescents. Nothing to do with the now very scarce resources of the Italian National Health System, destined, moreover, to become even thinner in the coming years.
I have operated on patients with inguinal hernias, crural hernias, epigastric hernias, laparoceles following, above all, gynecological operations or cesarean sections. Operations in some cases very complex, but always completed with excellent results. In short, it was really exhilarating, a complete success. And here is the photo chronicle of those days!

hernias, inguinal hernia, laparocele, Panamá
The operating room staff. I'm the one in the second row, with the colorful beret: local beauties first!

 

IMG-20150930-WA0001
Rather complex case: large abdominal hernia on Pfannestiel incision, the cut normally used by gynecologists for hysterectomies and cesarean deliveries. Here I am drawing the shape of the prosthesis on the patient's abdomen, a prosthesis that will be placed laparoscopically

 

IMG-20150930-WA0003
With my great friend Miguel Aguirre. I am cutting out the mesh, a Relimesh, to be placed minimally invasively laparoscopically

 

IMG-20150930-WA0006
Still with Miguel, as we design the Relimesh net shape for another patient.

 

IMG-20150930-WA0007
Group photo of the surgical team

 

IMG-20150930-WA0008
The magic of lights in laparoscopic surgery!