[Abdominal wall hernias part 2 : Operative treatment techniques]
F Köckerling1, W Reinpold2, Ch Schug-Pass3
1Viszeral- und Gefäßchirurgie,Referenzzentrum für Hernienchirurgie, Vivantes Klinikum Spandau, Neue Bergstraße 6, 13585, Berlin, Deutschland. ferdinand.koeckerling@vivantes.de.
Summary
New guidelines recommend specific mesh techniques for abdominal wall hernias based on defect size and patient factors. Minimally invasive options are increasingly favored over traditional laparoscopic intraperitoneal onlay mesh (IPOM) for incisional hernias.
Area of Science:
- Surgical repair of abdominal wall hernias
- Minimally invasive surgical techniques
- Hernia repair guidelines
Background:
- Abdominal wall hernias, including umbilical and epigastric hernias, require specific repair strategies.
- Incisional hernias are commonly treated with sublay operations or laparoscopic intraperitoneal onlay mesh (IPOM).
- Advancements in surgical techniques offer new options for hernia repair.
Purpose of the Study:
- To outline current guidelines for surgical repair of abdominal wall hernias.
- To detail the recommended techniques based on hernia type, defect size, and patient characteristics.
- To highlight the evolving role of minimally invasive approaches in hernia surgery.
Main Methods:
- Review of suture procedures and mesh techniques for abdominal wall hernia repair.
- Evaluation of laparoscopic intraperitoneal onlay mesh (IPOM) and minimally invasive techniques: endoscopic mini/less open sublay (E/MILOS), enhanced-view totally extraperitoneal (eTEP), and totally endoscopic sublay (TES).
- Consideration of posterior component separation with transversus abdominis muscle release for large defects (>10 cm).
Main Results:
- For primary abdominal wall hernias, preperitoneal mesh, IPOM, E/MILOS, eTEP, and TES are recommended based on defect size and patient factors.
- For incisional hernias, sublay and laparoscopic IPOM are common, with laparoscopic IPOM being replaced by open sublay and new techniques (E/MILOS, eTEP, TES).
- Posterior component separation is established for defects >10 cm; open IPOM or onlay techniques are used for recurrences and complex defects.
Conclusions:
- Surgical technique selection for abdominal wall hernias should be individualized based on hernia characteristics and patient factors.
- Minimally invasive techniques like E/MILOS, eTEP, and TES are gaining prominence, particularly for incisional hernias.
- Established and novel techniques provide a range of options for diverse abdominal wall hernia presentations, including complex cases.
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