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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:

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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

 

waiting times in the NHS
Waiting times in the NHS: why wait?

waiting times in the NHSI waiting times in the NHS, in recent years, unfortunately, have expanded enormously. The continuous spending cuts, Interest focused on only a few pathologies - undoubtedly important, but not the only ones, and perhaps nealso the most frequent - the failure, for economic reasons, to renew operating room equipment and principals, and the limited opportunities for physicians to keep up to date, often crushed by very heavy shifts due to the blocking of turnover - again for economic reasons - of health personnel in public hospitals, mean that many patients have to wait many months if not years to undergo surgery - for example, for diseases that are undoubtedly benign but often seriously interfere with the daily life of the sufferer.
I am talking especially about the proctological pathologies, as hemorrhoids, anal fissures, anal fistulas, and of the abdominal wall pathologies - inguinal hernias, umbilicals, epigastric, diastasis of the rectus abdominis muscles. Conditions that often afflict young, busy patients, interfering with their well-being, their daily commitments, and their serenity.
Today many people, in order to obviate the intolerable increase in the waiting times in the NHS of our country, resort to the integrative health care, taking out insurance that allows them to deal with their health problems without worry and in the right timeframe. For those who may not yet have access to these forms of insurance, which are actually The future for health protection in our country, our group has agreed, with primary clinics in Turin, of the surgical benefit packages, which allow the intervention to be approached for hemorrhoids, anal fissure, perianal fistula, inguinal hernia and umbilical at a low cost and by installment, if desired.
NHS waiting times, hemorpex system, HPS, hemorrhoids, dearterization, hemorrhoid dearterization, THDAll using the most modern and minimally invasive techniques: for example, for the treatment of hemorrhoids up to grade III, the HPS (HemorPex System) technique, which makes it possible to greatly contain postoperative pain and to Discharge the patient on the same day as the surgery, with a quick return to his life and normal activities
To get more information or request a quote, email us at. info@cuccomarinomd.com o contact us through our social od the contact form below.

 

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Cuccomarino, MD
Dr. Salvatore Cuccomarino's surgical team, for the future of Surgery. Turin.
Turin, TO
EN
Phone 0110438161

Groin hernia and Trabucco technique in Argentina
Groin hernia and Trabucco's technique: in Argentina!

Inguinal hernia, Trabucco technique, inguinal hernia pain, inguinal hernia pain,La Trabucco technique for inguinal hernia repair has also arrived in Argentina. Last week I was busy demonstrating the simplicity and effectiveness of this technique by operating in several hospitals in Rosario and Buenos Aires. The activity of disseminating the technique of Trabucco has been enthusiastically received by Argentine colleagues, especially by physicians in specialty training who have realized that this method for repairing the inguinal hernia is easy, effective, and reproducible. All the surgeries I have performed have been broadcast live to groups of Surgeons who are specialists in abdominal wall surgery around the world; and one surgery went live streaming on YouTube: you can, if you wish, find it at the end of the article.

What really matters is, once again, the dissemination of knowledge and the mutual exchange of Trabucco technique, inguinal hernia, inguinal hernia causes, cure for inguinal hernia, inguinal hernia pain,ideas and observations. It is clear that the technique of Trabucco is not the only viable option for surgery of the inguinal hernia: Today it is increasingly evident and recognized that, for example, in many situations (as in the bilateral inguinal hernia and in the recurrent inguinal hernia) the technical "gold standard" is laparoscopic surgery - an option that I ALWAYS offer to my patients, and it is a pity that very few Surgeons in Italy do this; but the technique of Trabucco remains an important arrow in the Surgeon's quiver, allowing him to offer the patient a procedure that does not require general anesthesia, is quick, painless, and minimally invasive (the incision we normally use does not exceed 4 to 5 cm).

Inguinal hernia surgery is among the most frequently performed in the world, yet it continues to be burdened with a number of complications-postoperative pain, hematomas, seromas, early and late recurrences-sincerely unjustifiable and unpleasant for both patient and operator. Trabucco's technique makes it possible to offer the patient a standardized procedure geared toward maximum reduction of pain and other postoperative complications and with recurrences of less than 2 percent; it represents a valid alternative to laparoscopic surgery in unilateral inguinal hernia and allows the Surgeon to use high-tech nets that guarantee maximum patient comfort, such as the HerniameshHybridmesh®, a partially absorbable quadriaxial net whose weight is reduced by 75% in about two years, minimizing discomfort due to the "foreign body" sensation. Unfortunately, this net is not available in most Italian Hospitals; however, thanks to an exclusive agreement with the manufacturer, I am able to offer it to my patients.

And here is the video of the inguinal hernia repair surgery with Trabucco technique performed in Buenos Aires and broadcast live on YouTube! In this surgery, I actually use a Hybridmesh, and in the video I illustrate its main features. Enjoy watching!

Dr. Salvatore Cuccomarino
Cuccomarino, MD
Medical Surgeon Specialist in General Surgery
General, Laparoscopic and Digestive Surgery. Coloproctology. Hernia and Abdominal Wall Surgery.
Corso Galileo Ferraris 3
Chivasso,Turin
100034
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

medicitalia, la nostra pagina su medicitalia, salvatore cuccomarino, Cuccomarino MD
Our page on MEDICITALIA

ASPETTANDO IL PROSSIMO ARTICOLO, VISITA LA NOSTRA PAGINA SU MEDICITALIA

Il nostro prossimo articolo, che stiamo terminando in queste ore, tratterà degli esercizi di Kegel per l’incontinenza urinaria e fecale.

medicitalia, salvatore cuccomarino, cuccomarino, la nostra pagina su medicitaliaNell’attesa, visitate la nostra pagina su MEDICITALIA, sito primario di informazione medica e prenotazione online di visite specialistiche. Ci sono le nostre risposte a molti consulti, ed un paio di articoli su emorroidi e legatura elastica che hanno riscosso un certo successo.

A prestissimo!

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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!

 

what is a hernia
I have a hernia-but what is a hernia!!!?

Often, when we talk to our patients, we forget that medical language is a kind of "initiatory" language, little understood by those outside the environment. Therefore, the patient knows he has something but does not always know what.

This is especially true for conditions that are considered "minor" (which they are not): if the person in front of me has a tumor, I spend a lot of time explaining his situation well; but if he has an inguinal hernia, or hemorrhoids, I take it for granted that he already knows what it is, and I don't waste too much time in explanations.
But is it really a matter of wasting time? How many people really know what a hernia is-and, consequently, are able to understand whether and how dangerous it is?

Let's try to get some clarity.

What is a hernia

"A hernia is defined as the exit of a viscera from the cavity that normally contains it, through an orifice, an anatomical channel, or otherwise a continuous solution."

This is the classic definition of hernia, of any hernia, from inguinal hernia to herniated disc; but it is not so readily understood unless one has at least some basic knowledge of anatomy.

So let's try to reason by similarity. If you are of my generation, the generation of kids who when they punctured a bicycle tire did not change it but patched the inner tube, it will come easy to you.

Think precisely of a tire; and imagine that the tire tears, and out of the tear comes the inner tube, as in the photograph below: that's what a hernia is: the tear represents "the orifice, anatomical channel or otherwise continuous solution" of the definition from before; what we surgeons call "the herniated defect."

what is a hernia, abdominal hernia, inguinal hernia

The air chamber that comes out of the tear is the "hernial sac": in the case of the inguinal hernia, it is the peritoneum that used to line the "torn" inguinal wall on the inside and now peeps through the tear itself.

If then the sac contains a "viscera" that has pushed through the "tear"-and which in the case of an abdominal hernia (abdominal hernias are, depending on where in the abdominal wall they occur, inguinal hernia, crural hernia, umbilical hernia, epigastric hernia, Spigelius hernia...) is usually fat (the omentum) or a piece of intestine-these are the "herniary contents." Easy, right?

Now that (I hope) it is clear what a hernia is, let's come to the other question: why can a hernia be dangerous and must be operated on? Well, in abdominal hernias--of which the most common are inguino-crural and umbilical--and particularly, paradoxically, in those in which the defect is small, it is possible, as already mentioned, for the herniated content to be an intestinal loop. Sometimes, it happens that the leaked loop cannot be "reduced," that is, relocated to its natural position inside the abdomen. This is referred to in this case as an incarcerated hernia. The incarcerated loop, because of the compression it undergoes, becomes soaked with fluid and "swells," and this can cause compression of the arteries and veins that supply it. This is strangulated hernia, an extremely life-threatening condition because it is at very high risk of necrosis (i.e., death) of the intestinal loop and its perforation (as in the case of the photo opposite).

That is why all hernias should be referred to a surgeon experienced in abdominal wall surgery, the only specialist who can determine whether to operate, when, and with what technique.

inguinal hernia
Stitches no, stitches yes-Mr. Rossi and the inguinal hernia

I do not have accurate and up-to-date statistical data, but off the top of my head I would say that the most widely used technique in Italy foringuinal hernia surgery is the Trabucco technique.

Ermanno Trabucco, a Neapolitan surgeon who moved to New York early in his career, was one of the pillars of abdominal wall surgery in the 20th century; and his technique, developed in the 1980s, represents one of the milestones in the history of inguinal hernia repair.

The principle on which it is based is simple and - like all simple things - ingenious: if you have to use a net to repair the hernia, and if you put this net in an enclosed, virtual space, then it is impossible for it to move: therefore, it is useless to put stitches to fix it - which solves at least some of the problems related to the infamous "post hernioplasty inguinodynia," a terrible term for the postoperative inguinal pain that, not so rarely, remains in patients. In fact, this pain is due, at least in part, to the phenomenon of "nerve entrapment": sometimes, some of the often almost invisible sensory nerve sprigs located in the inguinal region are "trapped" by the stitches that are affixed to fix the mesh; this causes the onset of pain, varying in intensity and duration but not infrequently chronic and excruciating.

Trabucco called this space the "inguinal box," described it accurately in his papers and proved the validity of his idea with the results of his daily clinical work.

And, indeed, Trabucco's technique is simple, standardized, easily reproducible and easy to teach. It is, in fact, the classic "ideal" surgical technique, which admits of no argument, no interpretation, no error. It is almost a profession of faith (scientific faith, of course).

A great many Italian surgeons claim to use Trabucco's technique in their surgeries. But-will this really be the case?

In fact, if you talk to them, someone says, "Mah... I put a stitch on the tubercle... you know, just in case..." - "Mah... I leave the cord under the band, it looks more natural to me...." I don't want to go into technical details, boring for most, however... nice, beautiful, typical of much Italian surgery: we do things because "it seems to us," "just in case," not because there is the slightest scientific basis.

AND, MOST IMPORTANTLY, IT'S NOT TREBUCHET'S TECHNIQUE. Call it "Mr. Rossi's technique," folks, and let the Great Surgeons rest in peace.