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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1101_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Foreword
- •Disclosure
- •Reason 8: Need for a Multidisciplinary Approach
- •References
- •Acknowledgments
- •Contents
- •Contributors
- •Reason 1: Surgeons’ Need
- •Reason 2: Patients’ Need
- •Reason 3: Need to Share Knowledge and the Existing Expertise
- •Reason 4: Frequency of Abdominal Wall Defects
- •Reason 5: Complexity of Most Abdominal Wall Defects
- •Reason 6: Three Principles of Surgical Care
- •Reason 7: New Technologies
- •1: Intraoperative Decision-Making Process: The Art and the Science
- •Introduction
- •The Anatomy of Surgeons’ Intraoperative Decisions
- •Intraoperative Endpoints of Resuscitation
- •Damage Control on Demand
- •Staged Operations
- •Temporary Closure
- •Summary
- •References
- •2: History of Abdominal Wall Repair: In Search of New Techniques and Materials
- •Introduction
- •Early Reports in the Annals of Surgery
- •Prosthetic Materials
- •Finding the Perfect Mesh
- •Nonabsorbable Mesh
- •Absorbable Mesh
- •Laparoscopic Repair
- •Conclusion
- •References
- •3: Anatomy and Physiology of the Abdominal Wall: Surgical Implications
- •Introduction
- •Anatomical Boundaries
- •Abdominal Wall Distensibility
- •Surgical Implications
- •Conclusion
- •References
- •Causes of Complex Abdominal Wall Defects
- •Abdominal Wall Infections and Recurrent Incisional Hernias
- •Damage Control, the Open Abdomen and Approach
- •Resection of Abdominal Wall Tumors
- •The Biology of Complex Abdominal Wall Defects
- •Complex Recurrent Incisional Hernias and the Pathophysiology of Wound Healing of the Abdominal Wall
- •Biological and Mechanical Factors Involved
- •Local and General Factors Affecting Wound Healing
- •Local Factors
- •Closure Under Tension and Blood Supply
- •Hematoma
- •Infection
- •Irradiation
- •Mechanical Stress
- •Surgical Technique
- •Tissue Type
- •General Factors
- •Anemia
- •Diabetes
- •Nutrition
- •Steroids
- •Jaundice
- •Malignant Disease
- •Obesity
- •Temperature
- •Trauma, Hypovolemia, and Hypoxia
- •Uremia
- •Complex Abdominal Wall Defects from Damage Control Surgery and the Open Abdomen
- •Summary
- •References
- •5: Preoperative Patient Optimization
- •Introduction
- •Preoperative Optimization
- •Preoperative Evaluation
- •Timing of the Surgical Repair
- •Preoperative Evaluation Clinic
- •Assessing the Perioperative Risk
- •Neurological System Evaluation
- •Cardiovascular System Evaluation
- •Respiratory System Evaluation
- •Renal System Evaluation
- •Gastrointestinal System Evaluation
- •Endocrine System Evaluation
- •Hematologic and Coagulation Evaluation
- •Infections
- •Nutritional Evaluation and Optimization
- •Control of Premorbid Conditions
- •Social and Addiction Issues
- •Prevention Strategies
- •Summary
- •References
- •Introduction
- •Diagnosis
- •Ultrasonography
- •Postoperative Radiologic Assessment
- •Recurrence
- •Computerized Scan
- •Barium Studies with Small-Bowel Follow-Through
- •Magnetic Resonance Imaging
- •Operative Planning Guided by Imaging Techniques
- •Intraoperative Guidance
- •Summary
- •References
- •Anatomy
- •Acute Setting
- •Leaving the Abdomen Open
- •“Closing” the Abdomen
- •Towel Clip Closure
- •Suture Closure
- •Retention Sutures
- •Temporary Silos
- •Combination Closure
- •Vacuum-Assisted Wound Closure
- •Open Packing
- •Skin Graft
- •Chronic Conditions
- •Indications for Surgical Repair
- •Comorbidities
- •Materials
- •Synthetic Mesh
- •Biologic Mesh
- •Grading System
- •Principles of Repair
- •Mesh Placement
- •Other Surgical Approaches
- •Autogenous Reconstruction
- •Tissue Expanders
- •Laparoscopy
- •Minimally Invasive Techniques
- •Summary
- •References
- •8: Surgical Strategies in the Management of Open Abdomen
- •Introduction
- •Considerations Before Closure
- •Conduct of the “Take-Back” Operation
- •Temporary Abdominal Closure Techniques
- •ABThera ™
- •Vacuum-Assisted Closure
- •Poor-Man’s VAC
- •Bogota Bag
- •Wittman Patch
- •Surgical Zipper
- •Skin-Only Closure
- •Considerations in the Patient with a Temporary Abdominal Closure
- •Management of Complications of Open Abdomen
- •Abscess
- •Hernia
- •Fistula
- •Conclusion
- •References
- •9: Practical Approach to Patient with a Hostile Abdomen
- •Introduction
- •Key Questions
- •Preoperative Conditions
- •Scenario 1
- •Scenario 2
- •Scenario 3
- •Creating a Surgical Plan
- •Involving the Patient
- •Timing of the Operation
- •Preparing for the Operation
- •Entering the “Frozen Lake”
- •Mobilizing the Entire GI Tract
- •How Much of the Intestines to Resect and How to Create the Anastomoses
- •Close or Cover the Abdomen
- •Summary
- •References
- •10: Complex Abdominal Wall Reconstruction: The Plastic Surgeon’s Perspective
- •Introduction
- •Current Indications for Utilization of Bioprosthetic Mesh
- •Patient Selection
- •Abdominal Wall Reconstruction Principles
- •Component Separation Technique
- •Staged Abdominal Wall Reconstruction
- •Postoperative Care
- •Conclusions
- •References
- •11: Staged Reconstructions of Abdominal Wall Defects
- •Introduction
- •Three Stages of Reconstruction
- •Stage 1: Temporary Abdominal Closure
- •Stage 2: The Maturation Period
- •Tensor Fascia Latae Flap for Abdominal Wall Reconstruction
- •Selection of the Appropriate Reconstruction Method
- •Summary
- •References
- •12: Selection of Prosthetic Materials in the Repair of Complex Abdominal Wall Defects
- •Introduction
- •Considerations When Selecting Prosthetic Materials for the Management of CAWD
- •Prosthetic Mesh
- •Synthetic Non-absorbable Polymers
- •Polypropylene
- •Polyester
- •Expanded Polytetrafluoroethylene (ePTFE)
- •Absorbable Synthetic Polymers
- •Composites
- •Biologic Prosthetics
- •Fibrin Sealant in Hernia Repairs
- •Complications
- •Conclusion
- •References
- •13: Reconstruction of Abdominal Wall in Trauma Patients After Damage Control
- •Introduction
- •Damage Control
- •Extending Damage Control in the ICU
- •Damage Control Resuscitation
- •Damage Control Ventilation
- •Damage Control Nutrition
- •Damage Control Infection Management
- •Temporary Abdominal Wall Closure Options
- •Early Abdominal Wall Closure
- •Complications of Abdominal Wall Reconstruction
- •Conclusion
- •References
- •Introduction
- •Conclusion
- •References
- •15: Abdominoplasty and Panniculectomy in the Presence of Abdominal Wall Hernias
- •Introduction
- •Clinical Anatomy
- •Skin and Subcutaneous Fat
- •Anterior Rectus Sheath and Linea Alba
- •Vascularity and Innervation
- •Preoperative Considerations
- •Assessment of Risk Factors
- •Prior Hernia Surgical History
- •Operative Steps
- •Design Patterns for Panniculectomy
- •Technique of Perforator Sparing
- •Technique of Skin and Fat Excision
- •Closure Techniques
- •Clinical Example
- •Postoperative Care
- •Management of Complications
- •Conclusions
- •References
- •Introduction
- •A Nine-Step Treatment Strategy
- •Step 2: S = Sepsis Control
- •Step 3: O = Optimization of Nutrition
- •Step 4: W = Wound Care
- •Step 6: T = Time of Operation or Takedown of ECF
- •Step 7: S = Surgical Creativity
- •Surgical Approach
- •One Alternative Approach
- •Issues with Adhesiolysis
- •Fistula Resection
- •Anastomoses
- •Choice of Mesh
- •Mesh Placement
- •Onlay Placement
- •Underlay Placement
- •Interposition or Bridge Placement
- •Step 8: P = Postoperative Care
- •Step 9: L = Long-Term Follow-Up
- •Summary
- •References
- •17: Abdominal Wall Closure in Recipients of Intestinal and Multivisceral Transplants
- •Introduction
- •Abdominal Wall
- •Graft Retrieval
- •Implantation
- •Timing
- •Monitoring of the Graft
- •Immunosuppression/Rejection
- •Results
- •Ethical Considerations
- •Fascia of Rectus Muscle
- •Graft Retrieval
- •Storage and Implantation
- •Timing
- •Monitoring of the Graft and Immunosuppression
- •Results
- •Conclusions
- •References
- •18: Minimally Invasive Component Separation in the Repair of Large Abdominal Wall Defects
- •Introduction
- •Component Separation Technique
- •Minimally Invasive Component Separation Technique
- •Introduction
- •Minimally Invasive Component Separation Technique Without the Use of Video-Assisted Equipment
- •Video-Assisted Component Separation Technique
- •Comparing Results from Different Component Separation Techniques
- •Preoperative Care
- •Surgical Technique: General Considerations
- •Step-by-Step Surgical Technique
- •Step 1
- •Step 2
- •Step 3
- •Step 4
- •Step 5
- •Step 6
- •Postoperative Care
- •Special Situations
- •The Open Abdomen
- •The Use of Tissue Expanders
- •Stomas
- •Previous Component Separation
- •Summary
- •References
- •19: Laparoscopic Techniques in the Repair of Large Defects
- •Introduction
- •Patient Preparation, Equipment, and Positioning
- •Surgical Technique
- •Postoperative Care
- •Complications and Outcome
- •References
- •20: Perioperative Surgical Consideration of Patient Undergoing Abdominal Wall Reconstruction
- •Introduction
- •Preoperative Preparation
- •Indications for and Timing of Surgery
- •Operative Approach
- •Intraoperative Considerations
- •Other Tissue Transfer
- •Postoperative Care
- •Postoperative Complications
- •Summary
- •References
- •21: Abdominal Compartment Syndrome and Hypertension in Patients Undergoing Abdominal Wall Reconstruction
- •Introduction
- •Preoperative Considerations for Prevention of IAH/ACS
- •Patient Selection
- •Size of Hernia: “Loss of Domain”
- •Size of Defect
- •Intraoperative Considerations
- •Postoperative Considerations
- •Postoperative Care/Monitoring
- •Therapy for Postoperative IAH/ACS
- •Medical/Minimally Invasive Therapy
- •Surgical Decompression
- •Summary
- •References
- •22: Short-Bowel Syndrome: A Clinical Update
- •Introduction
- •Pathophysiology of Short-Bowel Syndrome
- •Nutritional and Metabolic Management of Short-Bowel Syndrome
- •Immediate Postoperative Period
- •Bowel Adaptation Period
- •Long-Term Management Period
- •Surgical Considerations
- •Intestinal Transplantation in Patients with Short-Bowel Syndrome
- •Summary and Conclusions
- •References
- •23: Nutritional Management of Gastroenterocutaneous Fistulas
- •Introduction
- •Management of Enterocutaneous Fistulas
- •Total Parenteral Nutrition
- •Role of Somatostatin
- •Enteral Nutrition
- •Immune-Modulating Nutritional Supplementation
- •Conclusion
- •References
- •Index


Surgery of Complex Abdominal Wall Defects


R i f a t L a t i fi
Editor
Surgery of Complex
Abdominal Wall Defects

Editor
Rifat Lati fi , MD, FACS
Department of Surgery
The University of Arizona
Tucson, Arizona
USA
Trauma Section, Department of Surgery
Weill Cornell Medical College
Hamad General Hospital
Doha , Qatar
ISBN 978-1-4614-6353-5 ISBN 978-1-4614-6354-2 (eBook)
DOI 10.1007/978-1-4614-6354-2
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2013939780
© Springer Science+Business Media New York 2013
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is
concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction
on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this
legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally
for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work.
Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the
Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions
for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution
under the respective Copyright Law.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
While the advice and information in this book are believed to be true and accurate at the date of publication, neither
the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may
be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)

To Dr. Stanley J. Dudrick, the father of modern surgical nutritional support,
my mentor, teacher, and friend, who taught me reoperative complex surgery
and how to care for most complex and dif fi cult surgical patients, and whose
extraordinary personal attributes and professional, educational, and scienti fi c
contributions will endure into future generations of surgeons all over the
world.


Foreword
A surgeon can do more for the community by operating on hernia cases and seeing that his recurrence rate is
low than he can by operating on cases of malignant disease.
Sir Cecil Wakely, 1948, president of the Royal College of Surgeon
Oh, if only it were that simple! Certainly, Sir Wakely was referring to inguinal and perhaps
umbilical hernias in this well-known quotation from the middle of the last century. I wonder if at
the time he could have imagined the true complexity of the problem: our limited understanding
of the dynamic physiology of abdominal wall tension and the need for more re fi ned surgical
techniques to manage abdominal wall defects. Perhaps most shocking of all to Sir Wakely might
have been the ability for patients to withstand and survive catastrophic illness resulting in complex abdominal wall defects. Even as recently as 25 years ago, it was hard to believe that a patient
who had lost integrity of the abdominal wall as a result of injury, abdominal sepsis, or gastrointestinal failure could even survive, let alone return to functional status. However, with the evolution of resuscitation, operation, and surgical critical care for patients with devastating abdominal
injury and illness, a high survival rate is now a reality. With this, our ability to manage the attendant complications, including complex abdominal wall defects with and without intestinal fi stula,
has improved dramatically. This has happened because the clinical circumstances have demanded
it, and our zeal to improve care is no less ardent than that of Sir Wakely over a half century ago.
The editor, Dr. Rifat Lati fi , and contributors to this work have produced what I believe is the
quintessential and seminal resource on this vexing and challenging topic. Surgery of Complex
Abdominal Wall Defects is the fi rst textbook of its kind to provide a comprehensive review of
modern management of abdominal wall problems. It eloquently reviews the anatomy and
physiology of the abdominal wall and the pathophysiology of abdominal wall defects. It provides a valuable history of abdominal wall repair and then systematically provides the latest
approach to operative repair, including preoperative preparation, acute management of the
open abdomen, the approach to the hostile abdomen in the intermediate term, critical strategies
in long-term reconstruction, and the full spectrum of special circumstances that arise along the
way. Nowhere will you fi nd a more comprehensive and practical guide for the management of
these patients. If nothing else, this text provides the fundamental context in which these problems will be discussed and in which future advances are made.
I commend the authors on this accomplishment, and I encourage the readers to pay close
attention to the content. Herein lies the state-of-the-art surgical management for patients with
complex abdominal wall defects. Sir Wakely would be proud to know how far the art and science of the approach to these patients have come.
Greenville, NC, USA Michael F. Rotondo, MD, FACS
vii


Disclosure
Dr. Rifat Lati fi is a speaker for LifeCell Corporation and has received a grant through
International Virtual e-Hospital Foundation, a not-for-pro fi t organization that made possible
administrative support and secretarial help for this book.
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