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.