Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1433_Библиотеки_им_академика_М_И_Перельмана.pdf
70
J. Rosenberg and K. Andresen
8.2 The ONSTEP Technique
Because of space limitations the reader is kindly referred to a detailed description
of the operative technique published previously [1].
8.2.1 Why a Technique that Involves two Different Planes?
planes. The medial part of the mesh is placed in the preperitoneal space, the space
Lichtenstein repair. The mesh is not sutured to tissue and this special mesh
8.2.2 The Onflex Mesh
to keep it deployed in the preperitoneal space. The ring is made of absorbable
has a non-absorbable ring, so that skinny patients could sometimes feel it and had
in the correct position, then even though he or she may feel the lateral part of the
the preperitoneal space. When the mesh is positioned the pocket is meant for the
71
8 Open New Simplified Totally Extraperitoneal (ONSTEP) Technique for Inguinal Hernia Repair
8.2.3 Pain from the Recoil Ring
about 1 cm is performed on top of the palpable part of the ring corresponding to
8.2.4 Recurrence Repair after Previous ONSTEP
Fig. 8.1
permission from Bard-Davol
Inc.
72
J. Rosenberg and K. Andresen
transabdominal preperitoneal (
8.3 Clinical Data
patients. Third, a very short duration of surgery – mean (SD): 17 (6) minutes –
-
-
The non-controlled series outside the departments of the inventors supported
the WHO trial search portal [12]. Both studies are from Denmark. One is the
recruiting patients [13]. Both studies are being conducted as multicenter studies
The early results from the ONLi trial demonstrated a safe implementation
73
8 Open New Simplified Totally Extraperitoneal (ONSTEP) Technique for Inguinal Hernia Repair
these disabling symptoms.
laparoscopy and therefore if non-inferiority can be demonstrated regarding pain
learning curve.
8.4 Learning, Training, and Implementation
easier to learn than the Lichtenstein repair, but solid data are missing to support
preperitoneal space [16].
Table 8.1 Case series
Country No Study type Persistent Recurrence Minutes
Pain
74
J. Rosenberg and K. Andresen
8.5 Health Economics
laparoscopic and Lichtenstein repair has not been conducted yet, but it is planned
compared to the laparoscopic techniques and comparable or maybe even cost-
saving compared to the Lichtenstein technique.
Compared to the laparoscopic technique, the Lichtenstein technique has
of serious complications that can result in increased costs.
Lichtenstein technique carries a risk of serious disabling chronic pain, that
results in tremendous cost for society because of resulting unemployment, for the
employer because of long sick leave and for the insurance, be it public or private,
Furthermore, if the assumptions regarding a shorter learning curve are true,
hands in the surgical department and thereby be cost-saving, compared to training
surgeons for the Lichtenstein or laparoscopic repairs.
8.6 Perspectives
and comparable levels of acute pain and recurrences, then there may be a place for
75
8 Open New Simplified Totally Extraperitoneal (ONSTEP) Technique for Inguinal Hernia Repair
easiest technically to perform. The main goal of changing strategy for choice of
approach.
8.7 Conclusions
in routine inguinal hernia repair in the near future.
Table 8.2 Suggested treatment strategies of inguinal hernias. This could become effective if other
Onstep technique
Current hernia Previous operation Recommended procedure
Male primary hernia – Onstep
Male, recurrent hernia Lichtenstein Laparoscopic repair
Laparoscopic repair Onstep
Onstep Laparoscopic repair or Onstep
Female, primary hernia – Laparoscopic repair
Female, recurrent hernia Open procedure Laparoscopic repair
Laparoscopic repair Lichtenstein
Male, special cases (prostate cancer, – Onstep or Lichtenstein
76
J. Rosenberg and K. Andresen
References
2. Sevonius D, Montgomery A, Smedberg S, Sandblom G (2016) Chronic groin pain,
discomfort and physical disability after recurrent groin hernia repair: impact of anterior and
posterior mesh repair. Hernia 20:43–53
5. Andresen K, Burcharth J, Rosenberg J (2013) Lichtenstein versus Onstep for inguinal hernia
repair: protocol for a double-blinded randomised trial. Dan Med J 60:A4729
6. Andresen K, Burcharth J, Rosenberg J (2015) Onstep versus laparoscopy for inguinal hernia
7. Öberg S, Andresen K, Hauge D, Rosenberg J (2016) Recurrence mechanisms after inguinal
hernia repair by the Onstep technique – a case series. Hernia, in press
repair. Case Reports in Surgery, article ID 5209095
Onstep technique for inguinal hernia repair in a general surgical department. Scand J Surg
104:61–65
-
int/trialsearch. 21 December, 2015
13. Andresen K, Burcharth J, Fonnes S et al (2015) Short-term outcome after Onstep versus
Hernia 19:871–877
-
17. Medical Research Council Laparoscopic Groin Hernia Trial Group (2001) Cost-utility anal-
clinical trial. Br J Surg 88:653–661
18. Rosenberg J, Bisgaard T, Kehlet H et al (2011) Danish Hernia Database recommendations
for the management of inguinal and femoral hernia in adults. Dan Med Bull 58:C4243
-
pean Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia
18:151–163
77
G. Campanelli (Ed), Inguinal Hernia Surgery,
Updates in Surgery
DOI: 10.1007/978-88-470-3947-6_9, © Springer-Verlag Italia 2017
)
9
Polysoft Patch for Inguinal Hernia Repair
Edouard P. Pélissier, Giel G. Koning, and Philippe Ngo
9.1. Introduction
-
ping on visceral and vascular structures
(1998).
78
E.P. Pélissier et al.
9.2 The TIPP (Transinguinal Preperitoneal Patch) Technique
9.2.1 Operative Technique
iliohypogastric nerve and genital branch is not necessary since they are not affected
local anesthesia can make it easier for the patient to strain and to cough.
In indirect hernias the cremaster is cut at its insertion around the deep inguinal
procedure. The sac is dissected and reduced into the preperitoneal space. Blunt
bone. Then lateral dissection is carried out in the space of Bogros, up to the iliac
according to anatomy.
the pubic bone. To do so, one angled retractor lifts the epigastric vessels, another
79
9 Polysoft Patch for Inguinal Hernia Repair
one (blade retractor) reclines the peritoneum medially, so that the Cooper’s ligament
introduced in the direction of the pubis. Then, the clamp and retractors are removed.
the other, the surgeon manages to gently introduce the lateral half of the patch
in the lateral compartment of the preperitoneal space. Then, the retractors are
facilitate deployment. Asking the patient to strain helps check that the prosthetic
or spinal anesthesia are good choices. Thanks to the abdominal pressure, the
In direct hernias a circular incision of the transversalis fascia is performed
at the base of the sac and the sac is reduced. Then, preperitoneal dissection and
the cord and correctly cover the lateral compartment. The procedure is very easy
9.2.2 Tips and Tricks
peritoneum. As small blood vessels are contained in the fat, they are not damaged
they are easily palpated and protected by the vascular sheath.
changing hands can facilitate the gesture.
the patch to the surgeon after
it is important that: 1) the clamp does not hold the memory-ring, 2) the clamp
is positioned under the patch, so that the patch is bent over the clamp and its