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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1307_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface
- •Contents
- •Anatomy of the Anterior Abdominal Wall
- •Skin (Integument)
- •Subcutaneous Tissue (Adipose Tissue or Hypodermis)
- •Contributors
- •Introduction
- •Inguinal Hernia and Tissue Repairs
- •Ventral Hernia, Tissue, and Prosthesis Repairs
- •Modern Era of Hernia: Mesh Repairs and Laparoscopy
- •Future Directions
- •References
- •Musculoaponeurotic Plane
- •Extraperitoneal or Subperitoneal Space
- •Peritoneum
- •Topography of Anterior Abdominal Wall
- •Anatomy of the Inguinocrural Area
- •Inguinoabdominal Region
- •Inguinocrural or Femoral Region
- •Weakness Areas in Abdominal Wall
- •Areas of Anterior Wall Weakness
- •Semilunar Arch of Spiegel
- •Alba Line
- •Umbilicus
- •The Douglas Arch
- •Areas of Inguinal Weakness
- •Area of Femoral Weakness
- •Other Weakness Areas
- •Superior Lumbar (Grynfeltt-Lesshaft) Triangle (Fig. 2.8)
- •Inferior Lumbar (Petit) Triangle (Posterior Abdominal Wall) (Fig. 2.8)
- •Major Sciatic Hole (Sciatic Hernias), Pelvic Diaphragm (Perineal Hernias), and Obturator Membrane (Junction Pubis and Ischiatic Bone)
- •Dangerous Areas During the Surgical Treatment of Inguinal Hernias
- •Triangle of Doom (Fig. 2.9)
- •Triangle of Pain (Fig. 2.9)
- •Corona Mortis
- •Genital Branch of the Genitofemoral Nerve (Fig. 2.10)
- •Pathogenesis of Abdominal Wall Hernia
- •Biomechanical Factors
- •Collagen
- •Obesity
- •Genetic Factors
- •Chromosomal Disorders
- •Environmental Factors [ 9 – 12 ]
- •Smoking
- •Physical Exercise
- •Anatomic Position
- •Surgery
- •References
- •Midline Hernias
- •Epigastric or Supraumbilical
- •Umbilical
- •Infraumbilical
- •Yuxta or Paraumbilical
- •Incisional Hernias
- •Other Hernias
- •Lumbar Hernia
- •Obturator Hernia
- •Spigelian Hernia
- •Parastomal Hernias
- •Perineal Hernias
- •Sciatic Hernia
- •References
- •Introduction
- •Basic Instruments in Laparoscopic Hernia Repair
- •Energy Sources (Fig. 4.2)
- •Trocars and Laparoscopic Dissecting and Grasping Instruments
- •Trocars (Fig. 4.3)
- •Instruments
- •Optics
- •Role of Triangulation Techniques and Ergonomics in Laparoscopic Surgery
- •Incisional Ventral Hernia
- •Inguinal Hernia
- •Prosthetic Biomaterial to Repair the Incisional Hernia
- •Incisional Ventral Hernia
- •Double-Crown Technique in Ventral Hernia
- •Inguinal Hernia
- •Fixation of the Biomaterial
- •Ventral Hernia
- •Inguinal Hernia
- •Complications
- •Postoperative Seroma
- •Summary
- •References
- •Introduction
- •Indications
- •Contraindications
- •Absolute Contraindications
- •Relative Contraindications
- •Surgical Technique
- •Position of the Patient
- •Trocar Position
- •Recommended Instruments
- •Operative Technique
- •Potential Complications and Their Prevention
- •Intraoperative Complications
- •Postoperative Complications
- •Controversies
- •Mesh Selection
- •Summary of Literature
- •References
- •Introduction
- •Indications
- •Bilateral Inguinal Hernia
- •Unilateral Inguinal Hernia
- •Recurrent Inguinal Hernia
- •Inguinal Hernia in Women
- •High Suspicion of Inguinal Hernia
- •Contraindications
- •Prior Infraumbilical Surgery
- •Recurrent Inguinal Hernia with Mesh
- •Contraindications for General Anesthesia
- •Special Situations
- •Inguinoscrotal Hernia
- •Incarcerated Hernia
- •Strangulated Hernia
- •Patient Preparation and Positioning
- •Necessary Equipment
- •Surgical Technique
- •Incision
- •Fixation Selection
- •Creation of the Preperitoneal Space
- •Reduction of the Hernial Sac
- •Opening of the Bogros’ Space
- •Introduction of the Mesh
- •Prosthetic Fixation
- •Evacuation of the Pre-pneumoperitoneum and the Closure of Trocars
- •Complications
- •Intraoperative
- •Hemorrhage
- •Damage to the Inguinal Cord
- •Peritoneal Rupture
- •Postoperative
- •Seroma
- •Scrotal Hematoma
- •Ischemic Orchitis
- •Chronic Pain
- •Controversies in Laparoscopic Inguinal Hernia Repair
- •TEP Versus TAPP: Which Is Better for the Patient?
- •Hernia in Sportsmen: Diagnosis and Treatment
- •Coagulation Disorders and TEP
- •Which Technique of Space Creation Best Achieves the Required Extraperitoneal Space?
- •References
- •Introduction
- •Types of Materials
- •Relevance of the Molecular Weight, Pore Diameter, and Other Prosthetic Features
- •The Prosthetic Mesh in TEP
- •The Prosthetic Mesh in TAPP
- •The New Materials: Biological Mesh
- •Appendix 7.1 Biomaterials Abbreviations
- •References
- •Introduction
- •The Importance of Fixation Methods in Laparoscopic Inguinal Hernia Surgery
- •Atraumatic Fixation
- •Traumatic Fixation Methods
- •Acute Pain
- •Chronic Pain
- •References
- •Introduction
- •Indications
- •Surgical Technique
- •Patient Positioning
- •Pneumoperitoneum
- •Adhesiolysis and Replacing Hernia Content (Fig. 9.5)
- •Placement and Fixation of Mesh (Fig. 9.6)
- •Complications
- •Intraoperative
- •Postoperative
- •Controversies
- •New Trends
- •References
- •Biomaterial Concept
- •Laminar Prostheses (Fig. 10.1a–c)
- •Reticular Prostheses (Fig. 10.2a, b)
- •Composite Prostheses (Fig. 10.3a–c)
- •Nonabsorbable Prosthesis [ 1 – 6, 8, 9 ]
- •Polyester (Dacron)
- •Polypropylene
- •Composite Mesh
- •Absorbable Prosthesis (Fig. 10.5a–f) [ 6, 8 – 11 ]
- •Absorbable Synthetic Prostheses (Polymer of Glycolic Acid Esters or with Lactic Acid (Polyglactin 910), PGA-TMC)
- •Biological Absorbable Meshes
- •Recommendations for the Meshes We Use in Laparoscopic Surgery for Ventral Hernia
- •Positioning Systems
- •Self-Adhesion
- •Complications in Prostheses in Ventral Hernia Repair
- •Recurrence
- •Seroma [ 12 – 18 ]
- •Infection [ 18 – 21 ]
- •Adhesions [ 16 – 18 ]
- •Intolerance [ 20, 21 ]
- •References
- •Introduction
- •Traumatic Fixation
- •Nonabsorbable Tackers
- •Absorbable Tackers
- •Transmural Sutures
- •Atraumatic Fixation (Tissue Adhesives)
- •Synthetic: Cyanoacrylate
- •Semisynthetic Adhesives (BioGlue)
- •Fibrin Sealants
- •Fixing Method: Traumatic vs. Nontraumatic
- •Acute and Chronic Pain
- •Recurrence
- •Adhesions
- •Surgical Time
- •Costs and Hospital Stay
- •References
- •Introduction
- •Common Surgical Management
- •Subxiphoid Hernia
- •Surgical Technique
- •Subcostal Hernias
- •Surgical Technique
- •Suprapubic Hernias
- •Surgical Technique
- •Lumbar Hernias
- •Surgical Management
- •Surgical Technique
- •Parastomal Hernias
- •Surgical Management
- •Surgical Technique
- •Spiegel Hernia
- •Conclusion
- •References
- •Introduction
- •Inguinal Hernia in Urgent Situations
- •Incarcerated Hernia
- •Strangulated Hernia
- •Surgical Treatment of Urgent Inguinal Hernia
- •Access
- •Reduction of the Hernia Contents
- •Treatment of Content
- •Treatment of Hernia Defect
- •Ventral Hernia in Urgent Situations
- •Surgical Treatment of Urgent Ventral Hernia
- •References
- •Introduction
- •Extended Totally Laparoscopic Inguinal Hernioplasty Extraperitoneal (e-TEP)
- •Indications
- •Contraindications
- •Surgical Technique
- •Complications
- •Closure of the Defect in Ventral Hernia Laparoscopic Repair
- •Surgical Technique [ 2, 3 ]
- •Laparoscopic Transabdominal Preperitoneal Repair of Ventral Hernia
- •Laparoscopic Repair of the Diastasis Recti
- •Endoscopic Approach in Diastasis Recti and Associated Umbilical Hernia
- •Technique
- •Single Incision in Abdominal Wall Surgery
- •Technique
- •Main Advantages of Using a Single Port in Abdominal Wall Surgery
- •Robotic Surgery
- •References
- •Index

Advances in
Laparoscopy of the
Abdominal Wall Hernia
Juan Manuel Suárez Grau
Juan Antonio Bellido Luque
Editors

Advances in Laparoscopy
of the Abdominal Wall Hernia


Juan Manuel Suárez Grau
Juan Antonio Bellido Luque
Editors
Advances in Laparoscopy of
the Abdominal Wall Hernia

Editors
Juan Manuel Suárez Grau
Department of Surgery
General Hospital of Riotinto
Huelva
Juan Antonio Bellido Luque
General Hospital of Riotinto
Huelva
Spain
Spain
Abdominal and Laparoscopic Surgery Unit
Abdominal and Laparoscpy Surgery Unit
Sagrado Corazón Clinic
Seville
Sagrado Corazón Clinic
Seville
Spain
Spain
Research Center (IBfi s)
University Hospital Virgen del Rocío
Seville
Spain
ISBN 978-1-4471-4699-5 ISBN 978-1-4471-4700-8 (eBook)
DOI 10.1007/978-1-4471-4700-8
Springer London Heidelberg New York Dordrecht
Library of Congress Control Number: 2013956608
© Springer-Verlag London 2014
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfi 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 specifi 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 specifi 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)

This book is dedicated to all the people who
make the daily work of a surgeon possible.
In particular, I thank my colleagues in
Riotinto Hospital and Sagrado Corazón
Clinic in Seville: I can always count on your
support for all the ventures upon which we
have embarked and upon which we will
embark in the future.
I am especially grateful to my professors, who
awakened my interest, both in surgery and
medical research.
I would also like to thank all the surgeons
who have helped me train in laparoscopic
surgery.
Most of all, I thank my family: Carolina,
Claudia, and Sabina, who have had to
endure the long hours of work that have
made this book possible.
In my doctoral thesis, I cited this quote from
Goethe, and I would like to do so again:
“Whatever you can do or dream you can,
begin it. Boldness has genius, power and
magic in it.”
I would like also thank you to Liz Corra and
her incessant work and supervision
regarding every detail of this book.


Pref ace
In the history of general surgery, there is a turning point, after the fi rst cholecystectomy performed by P. Mouret in Lyon. This new approach Mouret employed helped
avoid aggressive incisions that had long recoveries, and it improved aesthetic results.
One of the most important factors is that, since then, this approach has become universally accepted by practitioners as well as the public.
Hernia surgery has been the perfect candidate for short-stay centers and has been
treated as a surgery that fi lls the small time gaps in an operating theater schedule
between longer surgeries, without any hope of advancing beyond polypropylene
meshes. Fortunately, this fi eld of surgery has grown in the wake of improvements in
materials, meshes, and sutures and in the wake of surgeons who specialize in the
abdominal wall.
PTFE was a breakthrough, addressing the problems of intra-abdominal adhesions of polypropylene mesh, allowing for the fi rst incursions into the world of laparoscopic incisional hernia.
The double crown technique has been accepted, and the fi xation of the mesh has
advanced slowly toward a path increasingly atraumatic and physiological (absorbable tackers, glues, etc.).
Companies have experienced the possibility of expanding their products into the
area of hernia surgery because of the large numbers of such surgeries. And today we
can fi nd multiple international, national, and regional associations specializing in
the abdominal wall. Journals are now published that are specifi c to this pathology.
The quantum leap to laparoscopy is more obvious every day, above all in incisional hernias in the midline abdominal wall.
Inguinal hernia surgery is the current challenge. This type of surgery is in greater
demand, and the number of surgeons who are interested in this technique is growing
daily. Advances in trocars, mesh, and clips are accompanied by the training in laparoscopic surgery of residents and young surgeons. Surgical training is increasingly
directed toward minimally invasive surgery and clearly contemplates the hernia
pathology within the techniques to be developed in the future. Robotics surgery and
single port laparoscopfi c surgery are clear examples of this signifi cant development.
vii

viii
Preface
In this book, we have attempted to cover the techniques already established as
well as the new advances in laparoscopic surgery of the abdominal wall. We intend
herewith to create a useful guide for those surgeons who face hernias on a daily
basis and who intend to further train themselves in this fi eld.
Seville, Spain Juan Manuel Suárez Grau, MD, PhD

Contents
1 A Brief Historical Review of Surgical Treatment of Hernia . . . . . . . 1
Jose J. Diaz Jr.
2 Anatomy of the Abdominal Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Cristina Méndez García, Salud García Ruiz,
and Carmen Cepeda Franco
3 Classifi cation of Ventral Hernias and Inguinal Hernias. . . . . . . . . . . 23
Joaquín Luis García Moreno and Ignacio Durán Ferreras
4 Basic Concepts in Laparoscopic Hernia Repair . . . . . . . . . . . . . . . . . 37
Juan Antonio Martín Cartes, Juan Marín Morales,
and Juan Manuel Suárez Grau
5 Laparoscopic Inguinal Hernia Repair: TAPP. . . . . . . . . . . . . . . . . . . 53
Juan Manuel Suárez Grau and Isaías Alarcón del Agua
6 Laparoscopic Inguinal Hernia Repair: TEP . . . . . . . . . . . . . . . . . . . . 65
Juan Antonio Bellido Luque and Maria Sánchez Ramírez
7 Prostheses in Laparoscopic Inguinal Hernia Repair . . . . . . . . . . . . . 89
Antonio Tejada Gómez and Araceli Bellido Luque
8 Prostheses Fixation During Laparoscopic
Inguinal Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Salvador Morales Conde and María Socas Macías
9 Laparoscopic Ventral Hernia Repair. . . . . . . . . . . . . . . . . . . . . . . . . . 117
Juan Guadalajara Jurado and Julio Gómez Menchero
10 Prostheses in Laparoscopic Ventral Hernia Repair . . . . . . . . . . . . . . 131
Juan Manuel Suárez Grau, Carolina Rubio Chaves,
Fernando Docobo Durantez, and Manuel Bustos Jiménez
ix
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