The Surgical clinics of North America
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Surg. Clin. North Am. · Oct 2013
Review Comparative StudyLaparoscopic versus open inguinal hernia repair.
The laparoscopic approach to inguinal hernia surgery is safe and reliable. It has a similar recurrence rate as open tension-free mesh repair. ⋯ These results can be achieved if a surgeon is proficient in the technique, has a clear understanding of the anatomy, and performs it on a regular basis. This article focuses on questions related to laparoscopic inguinal hernia surgery and provides answers based on published literature.
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In this article, the authors describe their current operative technique for open ventral hernia repair using component separation. Although methods of anterior component separation are described, in their current practice, the authors primarily use posterior component separation with transversus abdominis release to permit dissection beyond the retrorectus space. This method adheres to the literature-supported principles of a tension-free midline fascial closure with wide mesh overlap of mesh positioned in a sublay position. The authors' experience with this method supports a low recurrence rate and reduced wound morbidity.
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Occurrence of parastomal hernia is considered a near inevitable consequence of stoma formation, making their management a common clinical dilemma. This article reviews the outcomes of different surgical approaches for hernia repair and describes in detail the laparoscopic Sugarbaker technique, which has been shown to have lower recurrence rates than other methods. Also reviewed is the current literature on the impact of prophylactic mesh placement during ostomy formation.
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This article reviews the incidence, presentation, anatomy, and surgical management of abdominal wall defects found in the pediatric population. Defects such as inguinal hernia and umbilical hernia are common and are encountered frequently by the pediatric surgeon. ⋯ Less common conditions such as femoral hernia, Spigelian hernia, epigastric hernia, lumbar hernia, gastroschisis, and omphalocele are also discussed. The surgical treatment of gastroschisis and omphalocele has undergone some advancement with the use of various silos and meshes.
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Thorough knowledge of anatomy, appropriate preoperative planning, and reliance on the principles of hernia repair ensure successful outcomes. There are many options for repair, including technique and mesh choice. ⋯ Long-term outcomes related to suprapubic, subxiphoid, and lateral hernia repairs are limited; however, open and laparoscopic repairs using wide mesh overlap and adequate fixation have acceptable outcomes and recurrence rates. Future research will likely focus on comparative studies based on patient factors, techniques, mesh, and cost.