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Laparoscopic repair of ventral hernia in complex locations
In this lecture, Dr. Morales Conde briefly outlines laparoscopic ventral hernia repair in complex locations (including lumbar, suprapubic, subcostal, subxiphoid, and parastomal hernias). He presents technical difficulties and complex anatomy in the lumbar area. The importance of appropriate identification of all nerves for mesh fixation is essential to prevent inguinodynia. The author also develops this identification issue based on the experience of surgeons, taking into account the indications and diagnostic imaging techniques and corresponding defect reconstructions based on anatomical landmarks in order to prevent recurrence and avoid complications.
S Morales-Conde
Lecture
2 years ago
2120 views
204 likes
0 comments
13:41
Laparoscopic repair of ventral hernia in complex locations
In this lecture, Dr. Morales Conde briefly outlines laparoscopic ventral hernia repair in complex locations (including lumbar, suprapubic, subcostal, subxiphoid, and parastomal hernias). He presents technical difficulties and complex anatomy in the lumbar area. The importance of appropriate identification of all nerves for mesh fixation is essential to prevent inguinodynia. The author also develops this identification issue based on the experience of surgeons, taking into account the indications and diagnostic imaging techniques and corresponding defect reconstructions based on anatomical landmarks in order to prevent recurrence and avoid complications.
Endoscopic subcutaneous approach to components separation for suture closure and underlay mesh reinforcement of central ventral hernias
This video describes the technique for repair of central ventral defects by endoscopic subcutaneous component separation, suture closure of the central ventral defects using V-Loc™ suture and reinforcement of the reconstruction with an underlay composite mesh. Advantages of this approach are the preservation of abdominal wall dynamics with a low recurrence rate and fewer complications usually observed in other complex abdominal reconstructions such as seromas, hematomas, infection, pain, delayed recovery, and undesirable cosmetic results. The video shows the endoscopic subcutaneous component separation technique in detail as well as the identification and closure of the central ventral defect and the underlay placement of a composite mesh. CT-scan images of abdominal wall reconstruction at three months postoperatively are presented. In our first 6 cases, early clinical and CT-scan results were encouraging.
J Daes
Surgical intervention
6 years ago
1669 views
25 likes
0 comments
09:01
Endoscopic subcutaneous approach to components separation for suture closure and underlay mesh reinforcement of central ventral hernias
This video describes the technique for repair of central ventral defects by endoscopic subcutaneous component separation, suture closure of the central ventral defects using V-Loc™ suture and reinforcement of the reconstruction with an underlay composite mesh. Advantages of this approach are the preservation of abdominal wall dynamics with a low recurrence rate and fewer complications usually observed in other complex abdominal reconstructions such as seromas, hematomas, infection, pain, delayed recovery, and undesirable cosmetic results. The video shows the endoscopic subcutaneous component separation technique in detail as well as the identification and closure of the central ventral defect and the underlay placement of a composite mesh. CT-scan images of abdominal wall reconstruction at three months postoperatively are presented. In our first 6 cases, early clinical and CT-scan results were encouraging.
Laparoscopic Spigelian hernia repair
Spigelian hernia is a rare condition and it is difficult to diagnose it clinically. It has been estimated to account for 0.12% of abdominal wall hernias. The hernia ring is a well-defined defect in the transversus abdominis aponeurosis. The hernia sac, surrounded with extraperitoneal adipose tissue, often lies interparietally passing through the transversus abdominis and the internal oblique muscle aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique muscle. The laparoscopic repair is well-established. Most authors use a transperitoneal approach either by placing the mesh in an intraperitoneal position or by raising the peritoneal flap and placing the mesh in the extraperitoneal space. In this video, we demonstrate the laparoscopic repair of a Spigelian hernia through the transabdominal preperitoneal (TAPP) placement of a composite mesh.
A D'Urso, D Mutter, J Marescaux
Surgical intervention
5 months ago
2153 views
10 likes
1 comment
08:23
Laparoscopic Spigelian hernia repair
Spigelian hernia is a rare condition and it is difficult to diagnose it clinically. It has been estimated to account for 0.12% of abdominal wall hernias. The hernia ring is a well-defined defect in the transversus abdominis aponeurosis. The hernia sac, surrounded with extraperitoneal adipose tissue, often lies interparietally passing through the transversus abdominis and the internal oblique muscle aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique muscle. The laparoscopic repair is well-established. Most authors use a transperitoneal approach either by placing the mesh in an intraperitoneal position or by raising the peritoneal flap and placing the mesh in the extraperitoneal space. In this video, we demonstrate the laparoscopic repair of a Spigelian hernia through the transabdominal preperitoneal (TAPP) placement of a composite mesh.
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.
S Holland-Cunz
Surgical intervention
2 years ago
2044 views
208 likes
0 comments
03:54
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.
Incisional hernia: laparoscopic hybrid repair
About 10% of laparotomies are complicated by the development of incisional hernia (1). The prosthetic repair is the rule in the treatment of incisional hernia and is reported to have a lower recurrence rate than primary suture repair (2). The laparoscopic approach proposed since the early nineties with intraperitoneal onlay mesh (IPOM) repair has gained popularity over years. The IPOM technique is easy in case of midline incisional hernia but is more complex in case of lateral suprailiac hernia. The laparoscopic repair is associated with fewer infections as compared to the open technique (3). There are only very few reports on laparoscopic-endoscopic sublay mesh repair of abdominal wall hernias (4, 5).
We present the case of a 66-year-old patient admitted for an incisional hernia subsequent to an open liver resection for gallbladder carcinoma in 2011. The patient developed a symptomatic lateral incisional hernia in the right side of his subcostal incision. The oncologic preoperative work-up was negative. The patient was scheduled for a laparoscopic approach with a hybrid onlay and sublay mesh repair.
Here, authors aim to propose an original technique with a combined onlay and sublay approach to this complicated lateral abdominal incisional hernia.
Bibliographic references:
1. Mudge M, Hughes LE. Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 1985;72:70-1.
2. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004;240:578-83.
3. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 2011;3:CD007781.
4. Schroeder AD, Debus ES, Schroeder M, Reinpold WM. Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc. 2013;27:648-54.
5. Miserez M, Penninckx F. Endoscopic totally preperitoneal ventral hernia repair. Surg Endosc 2002;16:1207-13.
A D'Urso, J Leroy, T Piardi, P Pessaux, J Marescaux
Surgical intervention
5 years ago
3778 views
56 likes
0 comments
07:27
Incisional hernia: laparoscopic hybrid repair
About 10% of laparotomies are complicated by the development of incisional hernia (1). The prosthetic repair is the rule in the treatment of incisional hernia and is reported to have a lower recurrence rate than primary suture repair (2). The laparoscopic approach proposed since the early nineties with intraperitoneal onlay mesh (IPOM) repair has gained popularity over years. The IPOM technique is easy in case of midline incisional hernia but is more complex in case of lateral suprailiac hernia. The laparoscopic repair is associated with fewer infections as compared to the open technique (3). There are only very few reports on laparoscopic-endoscopic sublay mesh repair of abdominal wall hernias (4, 5).
We present the case of a 66-year-old patient admitted for an incisional hernia subsequent to an open liver resection for gallbladder carcinoma in 2011. The patient developed a symptomatic lateral incisional hernia in the right side of his subcostal incision. The oncologic preoperative work-up was negative. The patient was scheduled for a laparoscopic approach with a hybrid onlay and sublay mesh repair.
Here, authors aim to propose an original technique with a combined onlay and sublay approach to this complicated lateral abdominal incisional hernia.
Bibliographic references:
1. Mudge M, Hughes LE. Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 1985;72:70-1.
2. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004;240:578-83.
3. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 2011;3:CD007781.
4. Schroeder AD, Debus ES, Schroeder M, Reinpold WM. Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc. 2013;27:648-54.
5. Miserez M, Penninckx F. Endoscopic totally preperitoneal ventral hernia repair. Surg Endosc 2002;16:1207-13.
Transumbilical single access laparoscopic Toupet fundoplication
Background: Different procedures have been reported to be feasible and safe through single access laparoscopy (SAL). A transumbilical SAL Toupet fundoplication is demonstrated here.

Video: A young lady sought care for gastroesophageal reflux disease associated with grade B esophagitis, hiatal hernia and esophageal dyskinesia. The SAL procedure was performed by the opening of the umbilicus through Hasson’s technique. An 11mm reusable trocar was inserted for a 10mm, 30-degree angled, non-flexible, and standard length scope. Curved reusable instruments according to Dapri (Karl Storz Endoskope) were introduced through the same scar without trocars. The gastroesophageal junction was exposed thanks to the insertion of a 2mm wire under the xiphoid access. Crura repair and fundoplication were performed using intracorporeal knots, with a curved needle-holder. The umbilicus was finally closed in layers.

Results: No extra-umbilical trocar was necessary, and no intraoperative complications were registered. Operative time was 172 minutes and the final umbilical scar was 15mm. Postoperative pain was kept minimal, and the patient was discharged on the third postoperative day after a satisfying gastrograffin swallow.

Conclusions: Transumbilical SAL Toupet fundoplication is feasible. Use of curved and reusable instruments permits to avoid the conflict between the instruments’ tips intracorporeally or between the surgeons’ hands externally. Thanks to this technique, the cost of SAL is similar to multi-trocar laparoscopy.
G Dapri, L Gerard, S Carandina, GB Cadière
Surgical intervention
6 years ago
2831 views
35 likes
0 comments
08:05
Transumbilical single access laparoscopic Toupet fundoplication
Background: Different procedures have been reported to be feasible and safe through single access laparoscopy (SAL). A transumbilical SAL Toupet fundoplication is demonstrated here.

Video: A young lady sought care for gastroesophageal reflux disease associated with grade B esophagitis, hiatal hernia and esophageal dyskinesia. The SAL procedure was performed by the opening of the umbilicus through Hasson’s technique. An 11mm reusable trocar was inserted for a 10mm, 30-degree angled, non-flexible, and standard length scope. Curved reusable instruments according to Dapri (Karl Storz Endoskope) were introduced through the same scar without trocars. The gastroesophageal junction was exposed thanks to the insertion of a 2mm wire under the xiphoid access. Crura repair and fundoplication were performed using intracorporeal knots, with a curved needle-holder. The umbilicus was finally closed in layers.

Results: No extra-umbilical trocar was necessary, and no intraoperative complications were registered. Operative time was 172 minutes and the final umbilical scar was 15mm. Postoperative pain was kept minimal, and the patient was discharged on the third postoperative day after a satisfying gastrograffin swallow.

Conclusions: Transumbilical SAL Toupet fundoplication is feasible. Use of curved and reusable instruments permits to avoid the conflict between the instruments’ tips intracorporeally or between the surgeons’ hands externally. Thanks to this technique, the cost of SAL is similar to multi-trocar laparoscopy.