The Surgical clinics of North America
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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.
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Surg. Clin. North Am. · Oct 2013
ReviewPrevention of incisional hernias: how to close a midline incision.
The development of wound complications is closely related to the surgical technique at wound closure. The risk of the suture technique affecting the development of wound dehiscence and incisional hernia can be monitored through the suture length to wound length ratio. ⋯ Excessive tension should not be placed on the suture. Closure must always be with a suture length to wound length ratio higher than 4.
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Laparoscopic ventral hernia repair (LVHR) has established itself as a well-accepted option in the treatment of hernias. Clear benefits have been established regarding the superiority of LVHR in terms of fewer wound infections compared with open repairs. Meticulous technique and appropriate patient selection are critical to obtain the reported results.