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Laparoscopic recurrent inguinal hernia
Recurrent inguinal hernia? better laparoscopy

Recurrent inguinal hernia: what is it?

L'inguinal hernia belongs to the large family of hernias of the abdominal wall and represents one of the most frequent diseases of surgical interest worldwide: it is estimated that hernias in general affect 5 to 7 percent of the population, and of these about 75 percent are inguinal hernias. In other words, about 2,736,000 people in Italy are affected by inguinal hernias. The majority of these patients end up undergoing surgery, which, in the first instance, is a relatively uncomplicated procedure that is performed under local anesthesia and requires only a few hours of hospitalization. However, in not a small percentage of cases, the repair, for a variety of reasons (ranging from errors in technique to the patient's failure to follow the rules imposed by the surgeon in the postoperative), fails; the hernia reforms: we speak, in this case, of recurrent inguinal hernia.

Recurrence: a frequent problem in inguinal hernias

Modern surgical techniques and the use of prostheses have substantially reduced the rate of recurrence after inguinal hernia surgery; however, a recent study, conducted on more than 46. 000 patients in Denmark, showed that the incidence of inguinal hernia recurrence continues to affect about 4 percent of patients; less than the double-digit percentages observed before the advent of mesh: but, taking into account the numbers reported earlier, theoretically in Italy alone,inguinal herniarecurrence affects more than 100,000 patients-a not a small city!

The problem then facing the Surgeon is: what is the correct treatment of recurrent inguinal hernia?

What is the correct treatment of recurrent inguinal hernia?

Most Surgeons treat therelapsed ing uinal hernia exactly as they had treated the primary inguinal hernia: that is, they operate on it anteriorly, redoing a surgical incision on the previous one, and trying to put a "patch" on it as best they can-very often "inventing" on the spot some variation of the most commonly used surgical techniques (which, in the act, also seems like a good solution). This, unfortunately, is conceptually wrong, as well as going against the indications of the main guidelines available today.

Operating a recurrent hernia with the traditional incision when the primary hernia has already been operated on anteriorly means re-injuring tissue over which the surgeon had already passed during the previous operation, in an area where the anatomy has been profoundly altered by the surgery undergone by the patient anyway, and where there are very intense fibrotic phenomena due to the presence of the mesh: the risk of vascular and nerve injury and postoperative pain increases, and by a great deal; the wall of the inguinal region is further weakened, and the risk of recurrence increases. The patient risks being entangled in an endless and painful odyssey.

Hernia recurrence: better laparoscopy

Le guidelines, in this case drawn up by the European Hernia Society, speak clearly: Recurrent inguinal hernia, guidelines, European Hernia Society

"If previously anterior: consider open preperitoneal mesh or endoscopic approach (if espertise is present)" - i.e., if the patient has previously been operated on anteriorly, open repair with mesh in the preperitoneal position (e.g., Stoppa's or Wantz's techniques) or the endoscopic technique are indicated, provided expertise is present, i.e., there is a Surgeon experienced in this procedure.

In fact, in Italy - for a thousand reasons, which it is not the case to analyze here - there are few Surgeons able to try their hand at inguinal hernia repair laparoscopically, especially if it is arecurrent inguinal hernia (and perhaps even fewer who are able to perform an operation with Stoppa or Wantz technique). These are difficult cases, with altered anatomy in any case (even if, "going from the inside," i.e., from the inner surface of the inguinal region, one is working in seemingly "virgin" territory), which can only be addressed by experienced surgeons. But the advantages are clear: one has the possibility of repairing the herniated defect with a significantly larger mesh than is used in traditional hernia surgery, placed in a "healthy" area than where the surgeon had previously worked; and not infrequently, one may find that one is actually not dealing with arecurring inguinal hernia, but with a new hernia, perhaps unnoticed during the previous surgery, or perhaps formed later; and that, lo and behold, there is also a hernia on the other side, in the other inguinal region, which neither the patient nor the surgeon had noticed, and which can be repaired during the same surgery, before it begins to bother. Not to mention that postoperative pain is significantly less than with traditional surgery, and the patient can return to his or her activities much more quickly.

The video of the surgical technique

And here, finally, is a video of a recent surgery I did for recurrent inguinal hernia, performed laparoscopically (T.A.P.P. technique, Trans Abdominal Pre Peritoneal). This was a utrasectomy patient in his fourth recurrent hernia (!!! That is, three other surgeons had already operated on him by going through the anterior route, evidently without great results). Not an easy surgery, as expected, but successfully concluded to the patient's satisfaction. The mesh, as prescribed by the guidelines, is placed in the preperitoneal space, but without the large incisions required for Stoppa or Wantz techniques (in fact, the patient will be left with three small scars, two 10 mm and one 5 mm...).

The patient was discharged the day after surgery, and had no discomfort or complications in the postoperative period. These results are obtained in the vast majority of cases of patients operated on laparoscopically. But - I repeat - laparoscopic inguinal hernioplasty , especially in cases of recurrent inguinal hernia, is not for everyone, and must be performed by an experienced surgeon.

Enjoy your viewing!

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Dr. Salvatore Cuccomarino
Cuccomarino, MD
Medical Surgeon Specialist in General Surgery
Corso Galileo Ferraris 3
Chivasso,Turin
100034
EN
Phone 0110438161
hernia, abdominal hernia, abdominal hernia surgery, hernia surgery, Chivasso Hospital
Inguinal and abdominal hernia surgery in Chivasso: new surgical techniques

surgery for inguinal hernia , surgery for laparocele, Chivasso, Chivasso Hospital, inguinal hernia, abdominal hernia, laparoceleAlready for some months we have introduced, In our hospital in Chivasso, some important technical news in the inguinal and abdominal hernia and laparocele surgery.

Especially with regard to laparoscopic, minimally invasive surgery of abdominal hernia and laparocele, we have introduced, first in Italy, a new technique that allows us not to place nets in contact with the intestinal loops. In fact, it is now increasingly common within scientific societies and specialized websites to report serious complications related to prostheses; in particular, it is now clear that there is no mesh that does not cause the formation of adhesions, and expose the patient to the risk of intestinal injury and occlusive crisis. For this reason, we have begun to place prostheses outside the peritoneum, with a technique known as TAPP (trans abdominal pre peritoneal) and previously used only for inguinal hernias. We have also modified, in suitable cases, the surgical access so that the scars are truly invisible. The following is a video of this new technique.

We also introduced a new and revolutionary surgical technique for the treatment of large abdominal hernias and large laparoceles (i.e., when the defect is greater than 12 cm). This is the anatomical separation of components sec. Carbonell-Bonafé, which was passed on to us precisely by Prof. Fernando Carbonell Tatay of the University of Valencia-currently one of the greatest wall surgeons in Europe.

The technique, as complex as it is effective, involves placing two large nets in the
retromuscular
(behind the rectus abdominis muscles and in the space between the external oblique and internal oblique muscles, to be precise); in cases of loss of right of domicile (i.e., when the abdominal space has shrunk so much that it can no longer accommodate herniated viscera), the use of botulinum toxin infiltrated preoperatively allows a good portion, if not all, of the lost volume to be recovered. Here is a video of the technique, made by our team for a recent scientific meeting of the Sociedad Hispanoamericana de Hernia.

In short, placing these new techniques alongside the already established procedures of hernioplasty according to Trabucco and laparoscopic inguinal hernioplasty, ' inguinal and abdominal hernia surgery in Chivasso becomes increasingly effective, refined, and safe.

For any information, please feel free to contact us through our website cuccomarinomd.com or by phone at 011-0438161

 

Dr. Salvatore Cuccomarino
Cuccomarino, MD
Coloproctology, advanced laparoscopic surgery, hernia and abdominal wall surgery
Corso Galileo Ferraris 3
Chivasso,Turin
10034
EN
Phone 0110438161

Laparocele, hernia, incisional hernia, abdominal hernia, eventration
And after the surgery, the laparocele

Laparocele, hernia, incisional hernia, abdominal hernia, eventrationAnd after the surgery, the laparocele. It is not so uncommon (indeed!) that after abdominal surgery a "bulge" appears near the surgical scar. It is the laparocele, o incisional hernia: the wall suture has failed ("suture dehiscence"), and now the viscera contained in the abdomen press toward the skin.

A laparocele is a true hernia. The difference is that it appears not at a naturally occurring orifice, but at a surgically created defect. There are many conditions that facilitate the occurrence of a laparocele, ranging from incorrect lifestyles (e.g., smoking), to physiological states (such as advanced age), dysmetabolic (e.g., malnutrition), and pathological (such as tumors).

Treatment of a laparocele is always surgical, and presupposes a careful preoperative study (the dynamic CT scan of the abdominal wall), which must lead to equally careful evaluations of the choice of surgical technique to be adopted.

Repair of a laparocele can in fact be performed either laparoscopically, minimally invasive, or open, but the two access modalities are not interchangeable. Minimally invasive surgery is effective in defects of more modest size, no more than 6-8 cm. In the case of larger defects, in fact, Placement and proper distension of the mesh can be difficult, exposing the patient to an increased risk of recurrence. In addition, a large laparocele also presents other issues that it is crucial to take into account: for example, the volume of the herniated viscera and the residual space of the abdominal cavity, which must be properly calculated: this is to avoid determining, with an incorrect repair, an intra-abdominal pressure increase, which can be a cause of respiratory failure in the patient. In addition, in large laparoceles there is oftenatrophy, associated with retraction, of the muscles of the abdominal wall: this may make it impossible to "reconstruct the midline," as it is called in the jargon, that is, to relocate the muscle-fascial layers of the wall in their correct position so as to repair the abdominal defect. In such cases, anatomical separation of components (SAC), i.e., isolation of the individual layers of the abdominal wall, is necessary: this allows both the muscle-fascial components to be brought closer to the midline and the placement of large meshes, which are essential for reconstructing both the structure and function of the abdominal wall in such cases.

These are very complex and time-consuming operations that can only be performed by highly experienced surgical teams. The most refined anatomical component separation technique is that of Carbonell-Bonafé, two Spanish surgeons who without difficulty can be counted among the great masters of 20th century wall surgery.

I was fortunate to learn the Carbonell-Bonafé technique directly from Professor Fernando Carbonell; currently, my team is among the very few (I think less than 5) in all of Italy performing it. Here is a short film of mine, summarizing in less than 20 minutes a catastrophic laparocele surgery repaired with Carbonell's technique that lasted about 5 hours.

inguinal hernia symptoms, inguinal hernia surgery, scrotal hernia, inguinal hernia symptoms, inguino-scrotal hernia, strangulated hernia, adult umbilical hernia, inguinal hernia surgery, inguinal hernia photo, inguinal hernia surgery, testicular hernia, abdominal laparocele, hernia symptoms, umbilical hernia surgery, inguinal hernia recurrence, crural hernia symptoms, spigastrium hernia, inguinal hernia photos,hernia symptoms, female inguinal hernia, inguinal hernia surgery, umbilical hernia surgery, epigastric hernia symptoms
Abdominal wall surgery in the cancer patient

inguinal hernia symptoms, inguinal hernia surgery, scrotal hernia, inguinal hernia symptoms, inguino-scrotal hernia, strangulated hernia, adult umbilical hernia, inguinal hernia surgery, inguinal hernia photo, inguinal hernia surgery, testicular hernia, abdominal laparocele, hernia symptoms, umbilical hernia surgery, inguinal hernia recurrence, crural hernia symptoms, spigastrium hernia, inguinal hernia photos,hernia symptoms, female inguinal hernia, inguinal hernia surgery, umbilical hernia surgery, epigastric hernia symptoms

Abdominal wall surgery

Abdominal wall surgery is a superspecialty surgery, in many respects more complex than most other abdominal surgeries (except, perhaps, pancreatic surgery and metabolic surgery), requiring years of study and application, and a very detailed knowledge of human anatomy, to be successfully performed. In our unfortunate country, by many of the many, too many big wigs in our own health care, abdominal wall surgery is considered a minor branch of the medical sciences; but one only has to cross the Alps to see how much it is valued, and even feared, in the international surgical environment. And this is well understood when one looks at the disasters, due to surgical unpreparedness, often combined by those who approach the operating table without due respect for the abdominal wall: which, it should be remembered, is one of the load-bearing walls of the "house" in which we live, our body. How would one live in a house with gutted walls? The quality of life would be abysmal; and abysmal is the quality of life of those who are recklessly operated on by those who do not know the laws-often very complex-that dictate that we follow the abdominal wall.

The history of abdominal wall surgery

abdominal wall surgery, inguinal hernia symptoms, inguinal hernia surgery, scrotal hernia, inguinal hernia symptoms, inguino-scrotal hernia, strangulated hernia, adult umbilical hernia, inguinal hernia surgery, inguinal hernia photos, inguinal hernia surgery, testicular hernia, abdominal laparocele, hernia symptoms, umbilical hernia surgery, inguinal hernia recurrence, crural hernia symptoms, spigastrium hernia, inguinal hernia photos,hernia symptoms, female inguinal hernia, inguinal hernia surgery, umbilical hernia surgery, epigastric hernia symptoms,La history of abdominal wall hernia surgery È the History of Surgery: all the greatest Surgeons, all those whose names are remembered, have applied and contributed to it. I have spoken about it at several national and international conferences and courses, because it is a fascinating tale; just as fascinating is the History of the invention of the prostheses we use today in abdominal wall surgery: to the eye, small sheets of plastic, but with extraordinary technological content inside that rests on more than a century of scientific research.

Course on abdominal wall surgery in the cancer patient

It is therefore a great honor for me, and a great pride, to participate, as the ONLY ITALIAN INVITED SPEAKER among dozens of sacred monsters of Spanish (among the best in the world) and Hispanoamerican Surgery, in the International Course of Abdominal Wall Surgery in the Oncological Patient organized by the Sociedad Hispanoamericana de Hernia and by theUniversity of Valencia next October.

The course is sponsored by the Generalitat Valenciana, the Asociación Española de Cirujanos and theInstituto Cervantes, to name but a few of the major Spanish institutions that have shown interest in our work; as well as by numerous international Scientific Societies.

We will hold our country's flag high, and honor our work!