How to prevent hernia recurrence
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This document provides tips to prevent recurrence in laparoscopic hernia repair. It discusses choosing the appropriate mesh based on patient factors like smoking or obesity. Lightweight meshes have benefits like less inflammation and pain but higher risk of recurrence. The document outlines proper surgical techniques like fully dissecting the hernia sac and surrounding tissues, using an appropriately sized mesh that is securely fixed in place and covers the defect. Adhering to best practices for anatomy display, limitations awareness, advanced skills and standardized dissection principles can help minimize recurrence risk.
How to prevent hernia recurrence
- 1. How to prevent Recurrences in Laparoscopy for Hernia Dr John Thanakumar MBBS (Vellore), MS (Vel), MNAMS (Vel), FRCS, FRCS, Dip MIS, FALS Chairman, ANURGAG HOSPITAL Coimbatore. President IAGES 2012-14. Dr Pravin Hector John MS
- 2. Light Weight Mesh Heavy Weight Mesh
- 6. Choice of patient Collagen disease Smoking Obesity Malnutrition Diabetes Type II Chronic lung disease Coagulopathy Steroids Radiotherapy Chemotherapy Jaundice Male gender Anemia
- 7. Choice of hernia • Surgeon’s inexperience in laparoscopy • Surgeon’s inexperience in technique • Giant hernias • Recurrences after laparoscopy
- 8. Dissection • Do not miss out hernial sacs • Do not miss out lipomas of cord • Dissect medially across midline • Dissect medial, posterior and lateral margins well • Good hemostasis • Difficulty- convert
- 9. Dissect Across Midline and Down to Bladder
- 10. Dissect Sac and Ligate
- 11. Center fix mesh,fix, unroll
- 12. Dissection of Borders Medial Across midline Lateral Upto ASIS Nerves Posterior Upto Psoas Peritonealize the Cord
- 13. Choice of Mesh • Large hernia- use standard prolene mesh • Large hernia do not use LWM • Not too small mesh for large hernias • Do not slit meshes • No infolding of the mesh at corners • While desufflating, hold the mesh (TEP)
- 14. Mesh • Size 15X 12 cm • No slitting of mesh • Blunten the corners • Center of mesh to be against center of defect • Mesh to cover 5 cm all around defect • Mesh to cover the Myopectineal orifice of Fruchaud • Apply wrinkle free
- 15. Fixation of Mesh • Use 1 stapler at Cooper for fixation; 2nd for prevention of rotation of mesh in hernias • Large hernia, use fixation near Cooper, medial and laterally above the ilio pubic tract • Sutures / fixation as good
- 16. Tips to prevent recurrence • Best knowledge & display of anatomy • Always meshes for adult hernias • Awareness of one’s limitations • Advanced laparoscopic skills • Strict and standardized principles of dissection
- 17. • Anurag Hospital, • 8, Krishna Nagar,Sowripalayam • Coimbatore - 641028. • Tel: 0422- 6587871 • www.anuraghospital.com • Email: info@anuraghospital.com With the best compliments of Centre for Advanced Laparoscopy and Bariatric Surgery