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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1601_Библиотеки_им_академика_М_И_Перельмана
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XII
Concluding Recommendations
to Prevent the Recurrence
45 Questionnaire (39 Participants) 421
XII
45 Questionnaire (39 Participants)
1. Total Number of Hernias Performed/Year
▬ Inguinal 9075
▬ Incisional 2232
2. Percentage of Operations Performed
▬ Inguinal
Lichtenstein 35.4 %
Shouldice 24.2 %
TAPP 7.8 %
TEP 17.6 %
TIPP-Rives 1.4 %
Stoppa 1.0 %
Wantz 1.0 %
Ugahary 0.0 %
Plug 0.6 %
Others 11.1 %
▬ Incisional
Sublay 51.6 %
Onlay 6.8 %
Inlay 0.0 %
IPOM 27.4 %
Others 14.2 %
3. Type of Mesh Actually Used (Multiple
Answers Possible)
4. Do You Think That Operations Per-
formed Without Any Technical Failure Are
Able to Eliminate Recurrences in All Cases?
▬ Yes 10.3%
▬ No 89.7%
In-
guinal
Inci-
sional
Hiatal
Polypropylene
(Atrium, Marlex)
63.4% 56.1% –
Low weight
Polypropylene
(Vypro, UltraPro)
46.3% 46.3% 12.1%
Polyester
(Mersilene)
4.9% 9.8% –
ePTFE
(DualMesh)
2.4% 29.3% 9.8%
Others 9.8% 9.8% –
422 Concluding Recommendations to Prevent the Recurrence
45
5. Is There Any Prophylactic Use of Meshes
Imaginable?
▬ Yes 90.3%
▬ No 9.7%
6. Which Incision Is Preferable for an Elective
Laparotomy?
▬ Midline 58.5%
▬ Transverse 41.5%
▬ Paramedian 12.2%
▬ Oblique 0.0%
7. Which Incision Should Be Avoided?
▬ Midline 17.1%
▬ Transverse 2.4%
▬ Paramedian 34.2%
▬ Oblique 36.6%
8. Mesh Repair for Incisional Hernias
A.
How should the overlap at the rib cage be dealt with?
Sublay 58.5%
Onlay 12.2%
Periosteum suture fixation 9.8%
Suture around rib 22.0%
B.
How should the overlap at the xiphoid be dealt
with?
Sublay 78.0%
Onlay 12.2%
Periosteum suture fixation 9.8%
C. How should the overlap at the pubic bone be dealt
with?
Sublay 51.2%
Onlay 9.8%
Periosteum suture fixation 7.3%
Fixation to Coopers ligament 56.1%
D. How should the overlap lateral to the rectus sheath
be dealt with?
Preperitoneal 34.1%
Between muscles 51.2%
Onlay 19.5%
E. How should a mesh be fixed?
Non-absorbable suture 46.3%
Absorbable suture 39.0%
Glue 7.3%
No fixation at all 14.6%
F. Which overlap to all sides should be achieved in
incisional hernia repair?
< 2 cm 0.0%
2-5 cm 28.6%
> 5cm 71.4%
9. Mesh repair for inguinal hernias
A. Do you believe in one single standard procedure or
a tailored surgery?
Single standard 27.5%
Tailored approach 72.5%
B. Does every hernia (even in young patients with a
small lateral hernia) demand a mesh repair?
Yes 36.6%
No 63.4%
C. What do you think are the major reasons for the
constantly high recurrence rates reported by health
care analyses (multiple answers possible)?
Poor technical skill 92.7%
Insufficient teaching 85.4%
Patients´ biology 53.7%
D. Which patient related factors do you think are of im-
portance for the development of a recurrent hernia
(multiple answers possible)?
Gender 46.3%
Age 53.7%
Weight 70.7%
Affected relatives 31.7%
Medication 41.5%
Smoking 87.8%
E. Are there any limitations (hernia size, location, pre-
vious surgery) that restrict the use of the following
mesh technique?
Lichtenstein Yes 55.8% No 44.1%
TAPP Yes 93.3% No 6.7%
TEP Yes 90.3% No 9.7%
TIPP-Rives Yes 87.1% No 12.9%
Plug Yes 90.0% No 10.0%
423
XII
Questionnaire (39 Participants)
F. Which overlap to all sides should be achieved in the
inguinal area?
< 2 cm 7.5%
2–5 cm 80.0%
> 5cm 12.5%
8. Mesh Repair for Hiatal Hernias
A. Does every hiatal hernia demand a mesh repair?
Yes 9.4%
No 90.6%
B. The hiatoplasty should be performed?
anterior 0.0%
posterior 66.7%
both 33.3%
C. Is excision of the hernial sac mandatory?
Yes 80.0%
No 20.0%
D. Which factors are related to hiatal hernia recur-
rence?
Poor technical skill 63.4%
Insufficient teaching 46.3%
Patients´ biology 36.6%
Summary
Today surgical repair of abdominal wall offers a huge
variety of different techniques, mostly using meshes as
reinforcement. However, the problem of recurrence still
exist, either due to technical mistakes or to a patient re-
lated inadaequate wound healing. More than 50 interna-
tional experts joined the 4rd Suvretta meeting to discuss
their experience with creating, avoiding and repairing
recurrent hernia. This book summarizes the today risks
and opportunities of most current techniques to treat
hiatal hernia as well as incisional or inguinal hernia.
The lively discussions reflect controversies and reveal
open questions, that have to be examined in future.
XIII
Appendix
Subject Index 427
XIII
A
A-shape 109
abdominal
adhesiolysis 229
closure 117
compartment syndrome 199
entry 136
herniation 45
skin scar 59
wound dehiscence 135
abdominal wall
closure 115
hernia 35
connective tissue
attenuation 54
reconstruction 167
partitioning 10
pathology 129
physiological stretchability 193
temporary reinforcement 230
activating protein-2 (AP2) 64
activator of transcription factor 3
(Stat3) 64
acute postoperative wrap herniation
91
adhesiogenesis 244
adhesiolysis 228
adhesion 91
formation 213, 238
prevention 244
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adult umbilical hernia 359, 360
aging 47
allanto-enteric diverticulum 359
Alloderm 152, 153
allogenic (human) acellular dermal
matrix, see also Alloderm 154
allograft bioprostheses 152
anastomotic leakage 48
anatomical
limitation 179
recurrence 20
aneurysm 47
aneurysmal disease 161
angiogenesis 407
anterior
open repair 293
rectus abdominis sheath 54
anti-infection 312
measures 313
anti-NFκB 65
anti-recurrence 312
antiprotease defence mechanism 131
antireflux surgery 89
anuloplasty 385
aortic aneurysm 228
aponeurotic repair 234
appendicectomy 267
Arc de Triomphe-shape 109
arcuate line 180
of Douglas 180
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arterial wall 47
ascites 161
ascorbic acid 414
Atrium 322
atrophy 294
autogenic remodelling 230
autogenous suture repair 25
autograft 152
B
barium swallow 20
basic fibroblast growth factor (bFGF)
405
Bassini procedure 3, 9, 27, 29, 255,
301, 385
bFGF delivery 406
bilateral sliding rectus abdominis
myofascial advancement flap
159
biocompatibility 63, 324
biograft 153
biological glue 145
biomaterial 63, 244
biomechanical
data 183
therapy 401
bioprostheses 151, 160
bladder injury 299, 302, 305
Bochdalek hernia 94
Bogotá bag 199
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Subject Index
428 Appendix
Bogros’ space 302
bowel
fistula 249
obstruction 237
breaking strength 406
bridging 109, 139, 209, 243
burst abdomen 126, 135
buttonhole hernia 204
C
c-myc 59
candidate gene 398
carboxymethylcellulose (CMC) 244,
408
cardiac temponade 101
Cardiff technique 164
catenin 59
causative proteolytic factor 55
cell
cross-talk 63, 65
turnover 60
central mesh rupture 371
cerebral aneurysm 47
Chevrel
classification 216
procedure 11, 165
cholecystectomy 147
chronic
fistulization 244
inflammatory reaction 63
inguinodynia 264
lung disease 161
pain 242, 263, 317, 324
of the groin 4
postoperative 4
wound 404
cigarette smoking 46
cirrhosis 161
clean surgery 313
collagen 130, 131, 192
destruction 45
gene 398
immunostaining 406
malformation 45
metabolism 59, 391, 411
production 407
quality 61
test 391
tissue 259
type I 59
type I/III ratio 46
type II 59
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collagen-interacting protein 59
collagen/protein ratio 412
collagenolysis 131
Collis gastroplasty 76, 84, 93
color Doppler ultrasonography 335
colostomy 233
components separation method 10,
164, 201, 205
congenital hip dislocation (CDH) 47
conjoint tendon 263
connective tissue
attenuation 54
biology, disorders 59
biopsy, ultrastructure 54
disorder 227
metabolism 54
continuous closure 118
Cooper’s ligament 10, 271, 298, 354
COX-2 59
cribriformis fascia 260
Crohn’s disease 48
cross-polarization microscopy (CPM)
59, 412
crural repair 107
cruroplasty 100
crurorhaphy 107
CT scanning 160
cutaneous fistulization 391
cutis laxa 53
D
Danish Hernia Database 7
Danish Nationwide Questionnaire
Study 318
Darn repair 10
defect-overlap ratio 186
Deschamps ligature needle 218
Dexon 119
diabetes 161
diaphragmatic crura 17
direct hernia 270
discoidin domain receptor DDR-2 61
disseminated cystic medial
necrosis 45
diverticular disease 48
double crown technique 248
Douglasi 123
doxycycline 414
DualMesh 224
Plus prosthesis 235
Dynamesh IPOM 224
dysphagia 107, 109
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E
edge approximation 10
eesophageal-gastric resection 111
Ehlers-Danlos syndrome 47, 53
elastic property 324
elastine degrading activity 54
elastosis 47
EndoAncho 247
endopelvic fascia 260
endoscopic
extraperitoneal mesh 229
extraperitoneal radical prosta-
tectomies (EERPE) 305
hernia repair 27
enteric fistula 241
entero-cutaneous fistula 159, 208
enterostoma 365, 368
enterotomy 223, 233, 237
entrapment 262
epigastric vessel 302
ePTFE, see expanded polytetrafluoro-
ethylene
ESDN 59
esophageal
erosion 71, 94
length 93
lengthening procedure 93
sphincter 17
stenosis 109
esophagogastric junction 74, 84
esophagogram 72
Ets 65
European Society of Hernia
Surgery 11
exaggerated fibroblastic response
334
expanded polytetrafluoroethylene
(ePTFE) 55, 94, 145, 152, 167,
173, 224
expert hernia surgeon 35
external
mucle 123
oblique muscle 180
extracellular matrix (ECM) 130, 192,
322, 402, 411
network 61
F
factor XIII 59
far-near near-far suture 139
fascia lata autograft 152
fascia transversalis 54
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429
Subject Index
XIII
fast green stain 391
fatty triangle 181, 210
femoral
hernia 259, 353, 387
laws 353
sheath 354
triangle 260
FGFb 130
fibrillar collagen 153
fibrin
glue 146
sealant 185
fibro-collagenous tissue 167
fibroblast 63, 245, 397
fibroproliferative growth factor 403
fibrosis 322
fibrotic reaction 333
fistula 201, 237
fistulization 94
fixation 247
Flament technique 17, 173
flat mesh 327
floppy valve syndrome 45, 47
Foley catheter 303
foreign-body reaction 63, 244
full-thickness abdominal wall suture
fixation 247
fundoplication 83, 84
G
β-galactosidase 65
gastric
banding 76
incarceration 75
ulceration 90
volvulus 75
gastro-esophageal
junction (GEJ) 90
reflux disease (GERD) 17, 71, 83
gastro-intestinal quality-of-life index
value 20
gastrochisis 359
gastropexy 20, 71
gastrostomy 71, 76
general anaesthesia 282
gene regulation 63
genetic influence 47
genital nerve 263
genito-urinary prolapse 48
giant hernia 228
glucocorticoid 219
glycosaminoglycan 154
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Gore-Tex 23
GPRVS 280
granuloma 63
grasp gene function 64
groin hernia 35
repair 228
anaesthesia 282
preperitoneal 38
surgery 3
groin pain 327
growth factor 403
bFGF 55
GRPVS 9
H
haemostasis 298
Hassan technique 218
HEAD score 391
healing 47
Helicobacter pylori 25
hemangioma 407
hemorrhoids 397
hernia
content reduction 92
development, biology 25
disease 227
biological treatment 401
metabolic aspect 259
funiculi umbilicalis 359
mechanics 183
recurrence 89
non-modifiable risk factors 53
non-surgical risk factors 53
potentially modifiable risk
factors 54
repair failure 35
surgery, failures by experts 35
test stand 183
hernial sac 204
hernioplasty 143
herniorrhaphy 102, 170, 175
Hesselbach triangle 262, 275, 302
hiatal hernia 17, 35, 48
anatomical features 91
classification 90
effective laparoscopic redo 92
laparoscopic repair 20, 89
recurrence 72
promoting factors 90
sliding 18
technical pitfalls 71
hiatal insufficiency 84
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hiatal surface area (HSA) 19, 102
high-volume department 387
Hill 21
homocystinuria 47
horseshoe-shaped mesh 94
host-body reaction 244
Hurler-Hunter’s syndrome 53
hyaluronate sodium 244
hyaluronic acid 414
hydrocele 335
I
iliohypogastric nerve 124, 263
ilioinguinalis syndrome 328, 393
ilioinguinal nerve 124, 264
impaired
collagen biosynthesis 54
wound healing 55
implant site 109
inadequate fixation 38
incarceration 360
incision 123
closure 124
midline 124
Pfannenstiel 124
transverse 124
incisional hernia 10, 35
biological factors 129, 130
genesis 129
laparoscopic surgery
technical pitfalls 142
patient- and hernia-related risk
factors 164
pre-operative assessment 160
prevention
new techniques 139
repair 10
risk factor management 160
smokers 131
technical pitfalls 135
indirect hernia 270
infantile umbilical hernia 359
infection 38, 175, 311, 327, 371
resistance 110, 244
infertility 264, 333, 336
inflammatory
infiltrate 407
response 322
ingrowth 243
inguinal
abscess 328
anatomy 259
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430 Appendix
hernia
clinical studies 3
epidemiological database 3
ligament of Poupart 180
inguinodynia 264
inlay mesh repair 38
instable scar
biological reasons 59
Instron pneumatic tensiometer 406
insufficient scar formation 411
intercostal nerve 124
internal
muscle 123
oblique muscle 180, 197
interrupted closure 118
intra-operative vasography 333
intraperitoneal
onlay mesh 109, 269
polytetrafluoroethylene mesh 14
sublay 170
intrathoracic wrap
herniation 91
migration 90, 107
IPOM technique 240
ischemic
orchitis 328, 329
testis 335
J
jaundice 161
Johnsen scoring system 336
K
Kaplan-Meier plot 386
Keen technique 164
keyhole 109
Kugel 38
L
lacuna sceleti sternopubica 179
LacZ reporter gene 64
laparoscopic
fundoplication 71
intraperitoneal prosthetic patch
repair 143
parastomal hernia repair 233
redosurgery 102
repair 223, 294, 385
laparostomy 199
laparotomy 209
large hiatal defect 93
late mesh infection 391
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lateral
detachment 38
femoral cutaneous nerve 272
parietalization 298
lateralization 240
layered
closure 117
steel wire 164
learning curve 379
Leriche syndrome 47
Lichtenstein
repair 5, 8, 27, 29, 256, 291, 297,
328, 383
tension-free hernioplasty 262
ligament
of Cooper 259
of Gimbernat 354
of Poupart 260
light-weight polypropylene mesh
322
linea
alba 180
semicircularis 123
semilunaris 123, 195, 197
Lister 313
local
anaesthesia 282
patch 226
low-volume centre 387
lower oesophageal sphincter
(LOS) 83
lumbar hernia 198
lymph node 354
lysyl hydroxylase deficiency 47
M
malignancy 161
malignant transformation 371
Marfan’s syndrome 45, 47, 53
Marlex mesh repair 372, 383
mass closure 117
mass nylon 164
matrix-degrading enzyme 397
matrix metalloproteinase (MMP) 46,
63, 130, 131
degrading 411
I (MMP-1) 55, 61
II (MMP-2) 63, 397
gene regulation 65
IX (MMP-9) 55
matrix remodelling 60
Mayo repair 25, 164, 360
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McVay repair 258, 355, 385
mechanical wound failure 401
medial preperitoneal approach 280
mediastinal retention cyst 91
medical device 63
Mersilene mesh 208
mesh
border 376
complications 110
deformity 264
erosion 102, 237
exchange 213
explantation 327
extension 214
failure 212
fixation 174, 183
infection 212
in recurrent incisional hernia 242
material 321
migration 63, 102, 174, 305, 327
overlap 14, 173, 174, 210, 228
placement 271
plug 327
removal 312, 328
repair
basic mistakes 307
retro-oesophageal 81
rupture 375
shrinkage 63, 264, 322
size 321
slippage 174
slit 305
tensile strength 244
viscera 243
weakness 371
mesh-plug procedure 383
mesh-size-to-hernia-size ratio 227
meshoma 263
microporous mesh 109
midline
abdominal fascial closure 117
closure 124
incision 124
subxiphoidal hernia 204
mini-platzbauch 216
mini-residencies 90
minilaparotomy 223
minimally invasive incisional hernior-
rhaphy 170
missed
hernia 305
lipoma 305
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431
Subject Index
XIII
mixed hernia 90
monofilament suture material
non-absorbable 118
Morgagni hernia 94
multiple recurrences 339
myopectineal orifice of Fruchaud 276,
301
N
Nahas technique 209
National Research Council (NRC) 206
National Study of Quality Improve-
ment (NSQIP) 25
Nattal technique 164
needle sign 348
neoperitoneum 245
neuralgia 272
neurectomy 329
neutrophil collagenase level 54
Nissen 21
fundoplication 20, 108
non-metastasizing protein 23 (nm23)
64
non-tension-free herniorrhaphy 334
notch 59
O
off-work period 242
omphalocele 359
onlay 11, 38, 203
patch 266
polypropylene mesh 167
position 183
open
anterior re-operation after previous
mesh repair 294
mesh repair 292
onlay mesh reconstruction 165
repair 191, 385
pathophysiological concept
191
orchalgia 264
osteogenesis imperfecta 53
overlap 81, 145, 165, 183, 191, 225,
243, 262, 371
insufficient 272, 297
ovoid-shaped mesh 94
P
p53 59, 64
paediatric recurrent inguinal hernia
347
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PAI 59
pain 126, 317
pancreatitis 200
para-esophageal hernia (PEH) 18, 19,
22, 71, 83, 90, 107
para-umbilical hernia 360
paracolostomy hernia 237
parastomal hernia 139, 229, 233, 237,
365
pathogenesis 240
reasons for recurrence 240
parietal interface 243
parietalization 271, 277, 298
Parietene 322
Pasteur 313
patch 109, 340
patent processus vaginalis 269
patients at risk 397
PDGF
see platelet-derived growth
factor 63
perfix plug 383
peritoneal tear 304
Permacol 152, 153
persisting postoperative pain 212
pervasive co-morbidity 45, 48
pexy 76
Pfannenstiel incision 124
pharmacological treatment 411
phreno-esophageal membrane 19
PHS 38
repair 33
technique 265
platelet-derived growth factor (PDGF)
63, 403
plug 340
migration 39
repair 291
technique 265
pneumoperitoneum 223, 240, 303,
349
point fixation 247
polycystic disease 47
polydioxanone-S (PDS) 119, 125, 207
polyglactin (Vicryl) 125
polyglycolic acid (Dexon) 125
polyglyconate (Maxon) 119
polypropylene 55, 74, 102, 110, 152,
224
mesh 145, 166, 333
polytetrafluoroethylene (PTFE) 94
polyvinylidene fluoride 224
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porcine
acellular cross-linked dermal colla-
gen implant (Permacol) 153
intestinal submucosa 94
muscular tissue 183
submucosal acellular extracellular
matrix (Surgisis) 153
pore size 63
porosity 109, 244
port-site
hematoma 173
hernia 173, 216, 269
infection 175
post-appendectomy scar 228
post-herniorrhaphy
inguinodynia 264
pain 257
of the groin 333
wound infection 311
post-operative
bulging 231
pain 317, 350
POVATI trial 126
prefascial mesh prosthesis 192
preperitoneal
mesh implantation 297
repair 294
space 181
primary
abdominal wall hernia 35
esophageal motility disorder 84
lateral inguinal hernia 387
medial inguinal hernia 386
processus vaginalis 347
professional assistance 36
Prolene Hernia System 360
3 in 1 266
prolene mesh 23
promoter 64
prophylactic
antibiotic 29
mesh 241, 366
prosthesis
handling 281
preparation 281
prosthetic
debridement 312
hiatal closure 100
overlap 238
protease-anti-protease imbalance 54
protrusion 244
pseudorecurrence 17
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