Keterangan
Hernia management involves the treatment of a condition in which an organ or tissue protrudes through a weakened area of the surrounding muscle or connective tissue. The most common types of hernias include inguinal hernias, which occur in the groin, and umbilical hernias. Surgical hernia repair is typically recommended for larger, more symptomatic hernias, or those that have the potential to become incarcerated or strangulated. Open hernia repair involves making an incision at the site of the hernia, while laparoscopic repair involves using a small camera and specialized instruments to repair the hernia through several small incisions. Recovery from hernia surgery typically involves a period of rest and limited physical activity, as well as pain management and follow-up care with the surgeon.
Ringkasan
- Dr. Vasim, a general and laparoscopic surgeon, discussed hybrid techniques in laparoscopic ventral hernia mesh repair. He highlighted that hernia is a protrusion of viscus through a weakness in the abdominal wall, a common surgical condition documented since ancient times, with the landmark being the introduction of surgical meshes.
- Hernias are categorized based on cause (congenital or acquired), clinical presentation (reducible, irreducible, obstructed, strangulated), and site (groin, ventral, hiatus). Laparoscopic hernia mesh repair is the treatment of choice for ventral and incisional hernias, superior to open repair except in complicated cases.
- While laparoscopic hernia repair is standardized, the ideal mesh type, defect management, and fixation techniques are debated. Primary closure of the defect and interperitoneal mesh placement are standard. Closure reduces seroma formation and reinforces the wall.
- Open and laparoscopic surgeries are often considered mutually exclusive, but hybrid techniques combine both for difficult cases. Hybrid techniques avoid large subcutaneous flaps, benefiting patients. Open repair requires larger incisions and more dissection, while laparoscopic uses small incisions with edicolysis under vision.
- Hybrid techniques include laparoscopic edicolysis followed by open sack excision with defect closure and laparoscopic mesh placement. Other techniques are laparoscopic edicolysis/umbilectomy with defect closure and laparoscopic mesh, and open edicolysis/sack excision with defect closure and laparoscopic mesh.
- Ventral hernias are increasingly managed laparoscopically, with hybrid techniques combining open and laparoscopic steps for good repair and minimal access. Closure of defects, sack removal, and necrotic skin removal can be done openly, with mesh placed laparoscopically. Studies suggest hybrid techniques are safe in recurrent, difficult incisional hernias and obese patients.
- Patients undergoing hybrid mesh repair experience fewer complications, shorter stays, lower hospital charges, routine discharge, and decreased morbidity compared to open repair. Laparoscopic ventral hernia hybrid mesh repair is a safe and feasible approach for complicated hernias, decreasing morbidity associated with open repair, and tackles large sacks and skin necrosis.
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