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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.