Incisional Hernia

I Anatomy of the Abdominal Wall.- 1 Descriptive Anatomy.- 1.1 Skin.- 1.1.1 Surgical Applications.- 1.2 Subcutaneous Tissue.- 1.2.1 Vascular Supply of the Skin and Subcutaneous Fat.- 1.2.2 Surgical Applications.- 1.3 Surgical Anatomy of the Umbilical Region.- 1.4 Flat Muscles of the Anterior Abdominal Wall and the Rectus Abdominis and Pyramidalis Muscles.- 1.4.1 External Oblique Fascia (Innominate Fascia of Gallaudet).- 1.4.2 External Oblique Aponeurosis.- 1.4.3 Inguinal (Poupart’s) Ligament.- 1.4.4 Ligament of Gimbernat (Lacunar Ligament).- 1.4.5 Internal Oblique Muscle and Aponeurosis.- 1.4.6 Transversus Abdominis Muscle and Aponeurosis.- 1.4.7 Arch of the Internal Oblique and Transversus Abdominis Muscles.- 1.4.8 Conjoined Area.- 1.4.9 Rectus Abdominis Muscle and its Sheath.- 1.4.10 Linea Alba.- 1.5 Fascia Transversalis.- 1.5.1 Thickenings of the Fascia Transversalis.- 1.6 Spaces.- 1.6.1 Vascular Space.- 1.6.2 Space of Bogros.- 1.7 Vascularization of the Muscles.- 1.8 Innervation of the Abdominal Wall.- 1.8.1 Thoracoabdominal Nerves.- 1.8.2 Ilioinguinal Nerve.- 1.8.3 Iliohypogastric Nerve.- 1.8.4 Genitofemoral Nerve.- 1.8.5 Surgical Applications.- 1.9 Peritoneum.- 1.10 Fossae of the Anterior Abdominal Wall.- 1.11 Myopectineal Orifice of Fruchaud.- 1.12 Cooper’s Ligament.- 1.13 Femoral Canal and Femoral Sheath.- 1.14 “Good Stuff”.- 1.15 Discussion.- References.- 2 Functional Anatomy.- 2.1 Upper Abdominal Zone Herniation.- 2.2 Incidence.- 2.3 Pathological Anatomy.- 2.4 Repair Techniques.- 2.5 Condensation and Sling of the Fascia Transversalis.- 2.6 Discussion.- References.- 3 Surgical Anatomy.- 3.1 Introduction.- 3.2 Skin and Subcutis.- 3.3 Muscles of the Abdominal Wall.- 3.3.1 Rectus Abdominis Muscle.- 3.3.2 Oblique External Muscle of the Abdomen.- 3.3.3 Oblique Internal Muscle of the Abdomen.- 3.3.4 Transverse Muscle of the Abdomen.- 3.4 Fascial Structures.- 3.4.1 Sheath of Rectus Abdominis Muscle.- 3.4.2 Linea Alba.- 3.4.3 Fascia Transversalis.- 3.5 Preperitoneal Space.- 3.6 Inguinal Falx (or Conjoined Tendon or Henle’s Ligament).- 3.7 Interfoveolar (Hesselbach’s) Ligament.- 3.8 Discussion.- References.- II Wound Healing.- 4 Fascial Metabolic Defects.- 4.1 Introduction.- 4.2 Personal Observations.- 4.3 Hypothesis.- 4.4 Pulmonary Emphysema.- 4.5 Metastatic Emphysema.- 4.6 Supporting Data.- 4.7 Proteolysis in Patients with Aneurysm.- 4.8 Congenital and Genetic Influences.- 4.9 Conclusion.- 4.10 Summary.- 4.11 Discussion.- References.- 5 Growth Factors and Hernia.- 5.1 Function.- 5.2 Availability.- 5.3 Experimental Findings.- 5.4 Outlook.- 5.5 Discussion.- References.- III Abdominal Wall Defects.- 6 Primary Hernia.- 6.1 Epigastric Hernia.- 6.2 Anatomy.- 6.3 Umbilical Hernia.- 6.4 Infantile Umbilical Hernia.- 6.5 Acquired Umbilical Hernia.- 6.6 Para-umbilical Hernia.- 6.7 Umbilical Hernia in Adults.- 6.8 Spigelian Hernia.- 6.9 Obturator Hernia.- 6.10 Lumbar Hernia.- 6.11 Discussion.- 7 Nonhernial Defects.- 7.1 Tumor Resection.- 7.2 Trauma.- 7.3 Necrotizing Fasciitis.- 7.4 Laparostomy.- 7.5 Radiotherapy.- 7.6 Donor Defect After a Transverse Rectus Abdominis Musculocutaneous Flap.- 7.7 Prune Belly Syndrome.- 7.8 Congenital Abdominal Wall Necrosis.- 7.9 Discussion.- References.- 8 Acute Wound Failure.- 8.1 Incidence.- 8.2 Pertinent Aspects of Fascial Healing.- 8.3 Choice of Incision.- 8.4 Mechanisms.- 8.5 Choice of Closure.- 8.6 Risk Factors.- 8.7 Role of Infection.- 8.8 Postoperative Increases in Intra-abdominal Pressure.- 8.9 Summary.- 8.10 Discussion.- References.- 9 Natural History and Patient-Related Factors.- 9.1 Introduction.- 9.2 Natural History of Wound Healing.- 9.3 Wound Infection.- 9.4 Patient-Related Risk Factors.- 9.5 Increased Intra-abdominal Pressure.- 9.6 Drugs.- 9.7 Discussion.- References.- 10 Diagnosis of Abdominal Wall Defects.- 10.1Sonography.- 10.1.1 Sonographic Anatomy of the Abdominal Wall.- 10.1.2 Sonographic Differential Diagnosis of Pathological Findings.- 10.1.3 Preoperative Investigations.- 10.2 Sonographic Criteria for Hernias.- 10.2.1 Epigastric Hernia.- 10.2.2 Inguinal Hernia.- 10.2.3 Femoral Hernia.- 10.2.4 Spigelian Hernia.- 10.2.5 Lumbar Hernia.- 10.2.6 Incisional Hernia.- 10.2.7 Umbilical Hernia.- 10.3 Further Anomalies.- 10.3.1 Metastasis.- 10.3.2 Lipoma.- 10.3.3 Lyphoma.- 10.3.4 Endometriosis.- 10.3.5 Abdominal Wall Relaxation.- 10.3.6 Varicose Nodules.- 10.3.7 Postoperative Investigations.- 10.3.8 Hematoma.- 10.3.9 Seroma.- 10.3.10 Abscess.- 10.3.11 Hematoma of the Rectus Sheath.- 10.3.12 Wound Rupture (Burst Abdomen).- 10.4 Results.- 10.4.1 Sonography.- 10.4.2 Computed Tomography and Magnetic Resonance Imaging.- 10.5 Conclusion.- 7.6 Discussion.- References.- IV Principles of Repair.- 11 Preparation of Patients for Hernia Surgery.- 11.1 General Aspects.- 11.2 Progressive Pneumoperitoneum.- 11.3 Pathophysiology.- 11.4 Technique.- 11.5 Results.- 11.6 Conclusion.- 11.7 Discussion.- References.- 12 Augmentation with Autologous Material.- 12.1 Introduction.- 12.2 Technical Aspects.- 12.2.1Cutisplasty.- 12.2.2 Tensor Fasciae Latae Transposition Flap.- 12.2.3 Free Transplanted Myocutaneous Flap — Latissimus Dorsi Free Flap.- 12.3 Summary.- 12.4 Discussion.- References.- 13 Biomaterials — Classification,Technical and Experimental Aspects.- 13.1 Infection.- 13.2 Seroma.- 13.3 Intestinal Adhesions and Fistula Formations.- 13.4 Shrinkage of the Prosthesis.- 13.4.1 Collapse of the Prosthetic Plug (Mesh Plug).- 13.4.2 Shrinkage of the Mesh Patch.- 13.5 Conclusion.- 13.6 Discussion.- References.- 14 Biocompatibility of Biomaterials — Clinical and Mechanical Aspects.- 14.1 Introduction.- 14.2 Three-Dimensional Stereography.- 14.3 Intra-abdominal Pressure.- 14.4 Fascia and Suture Tearout Force.- 14.5 Tension Strength.- 14.6 Tensile Strength.- 14.7 Mechanical Aspects of Biomaterial.- 14.8 Textile Analysis Results.- 14.9 Discussion.- References.- 15 Biomaterials — Experimental Aspects.- 15.1 Textile Characteristics.- 15.2 Experimental Aspects.- 15.2.1 Mechanical Testing.- 15.2.2 Histology.- 15.2.3 Conclusion.- 15.3 Adhesions and Fistulas.- 15.3.1 Clinical Prevention.- 15.4 Infection.- 15.5 Mesh Shrinkage.- 15.6 Meshes and Tumorgenesis.- 15.7 Summary.- 15.8 Discussion.- References.- 16 Biocompatibility of Biomaterials — Histological Aspects.- 16.1 Current Status of Mesh Research.- 16.2 Concept of Low- and Heavy-Weight Surgical Meshes.- 16.3Tissue Response in Low- Versus Heavy-Weight Meshes.- 16.4 Cellular Response in Low- Versus Heavy-Weight Meshes.- 16.5 Short- and Long-Term Biocompatibility of Surgical Meshes.- 16.6 Risk of Foreign Body Carcinogenesis.- 16.7 General Histological Principles for the Future Development of Surgical Meshes.- 16.8 Discussion.- References.- 17 Biomaterials — Principles of Implantation.- 17.1 Choice of the Prosthesis.- 17.2 Site of Implantation.- 17.2.1 Intraperitoneal Positioning.- 17.2.2 Premuscular Positioning.- 17.2.3 Retromuscular Prefascial Prosthesis.- 17.3 Fixation of the Prosthesis.- 17.4 Postoperative Care.- 17.4.1 Early Postoperative Infection.- 17.4.2 Late Postoperative Infection.- 17.5 Results.- 17.6 Conclusion.- 17.7 Discussion.- References.- V Closure of Laparotomy.- 18 Long- Versus Short-Term Absorbable Sutures.- 18.1 Introduction.- 18.2 Wound Dehiscence.- 18.3 Wound Infection.- 18.4 Incisional Hernia.- 18.5 Conclusion.- 18.6 Discussion.- References.- 19 Absorbable Versus Nonabsorbable Suture for Laparotomy Closure.- 19.1 Requirements for the Ideal Suture.- 19.2 Current Sutures: A Sampling.- 19.3 Current Sutures: Randomized Trials.- 19.4 Summary.- 19.5 Discussion.- References.- 20 Experience with Continuous Absorbable Suture for Laparotomy Closure.- 20.1 Introduction.- 20.2 Patients and Methods.- 20.3 Results.- 20.3.1 Early Complications.- 20.3.2 Late Complications.- 20.4 Conclusion.- 20.5 Summary.- 20.6 Discussion.- References.- 21 Continuous Closure of Laparotomy Incisions: Aspects of Suture Technique.- 21.1 Introduction.- 21.2 Suture Length to Wound Length Ratio.- 21.3 Stitch Length.- 21.4 Tension.- 21.5 Modifying Surgical Technique.- 21.6 Knots.- 21.7 Recommendations.- 21.8 Discussion.- 21.2 References.- 22 Closure of the Abdomen in Acute Wound Failure.- 22.1 Reducing the Incidence of Burst Abdomen.- 22.2 Repairing Burst Abdomen to Reduce the Incisional Hernia Rate Postoperatively.- 23.3 Discussion.- References.- VI Repair of Primary Hernia.- 23 Surgery of Umbilical, Epigastric and Spigelian Hernia.- 23.1 Umbilical Hernias.- 23.1.1 Omphalocele.- 23.1.2 Infantile Umbilical Hernias.- 23.1.3 Paraumbilical Hernias.- 23.1.4 Umbilical Hernia in Adults and Acquired Umbilical Hernias.- 23.2 Epigastric Hernias.- 23.3 Spigelian Hernias.- 23.4 Discussion.- References.- VII Repair of Incisional Hernia.- Mesh-Free Techniques.- 24 Indication and Limitations of Suture Closure — Significance of Relaxing Incisions.- 24.1 Technical Factors.- 24.2 Biological Factors.- 24.2.1 Presurgical Aspects.- 24.2.2 Perisurgical Aspects.- 24.2.3 Incisional Hernia Classification.- 24.2.4 General Remarks.- 24.3 Auxiliary Methods.- 24.3.1 Pneumoperitoneum.- 24.3.2 Relaxing Incisions.- 24.4 Discussion.- References.- 25 Significance of Fascia Doubling in the Management of Incisional Hernia.- 25.1 Introduction.- 25.2 Technique of Fascia Doubling.- 25.3 Preference for Fascia Doubling in Incisional Hernia Repair.- 25.4 Long-Term Results of Fascia Doubling for Primary and Recurrent Incisional Hernia Repair.- 25.5 Conclusion.- 25.6 Discussion.- References.- Mesh Techniques.- 26 Polypropylene Mesh Repair of Incisional Hernia: Marlex and Prolene Mesh.- 26.1 Incision and Dissection.- 26.2 Preparation of Mesh.- 26.3 Insertion of Mesh.- 26.4 Closing the Defect.- 26.5 Extraperitoneal, Subaponeurotic, Sublay Mesh Placement.- 26.6 Deciding Which Technique to Use.- 26.7 Discussion.- References.- 27 Prosthetic Incisional Hernioplasty: Indications and Results.- 27.1 Materials.- 27.2 Prostheses.- 27.3 Indications for Mesh.- 27.4 Mortality and Complications.- 27.5 Recurrences.- 27.6 Conclusion.- 27.7 Discussion.- References.- 28 Intermediate Follow-Up Results of Sublay Polypropylene Repair in Primary and Recurrent Incisional Hernias.- 28.1 Indication for Meshes.- 28.2 Implantation Technique.- 28.3 Mesh Material.- 28.4 Conclusion.- 28.5 Discussion.- References.- 29 Polyester Mesh for Incisional Hernia Repair.- 29.1 History.- 29.2 Material and Methods.- 29.3 Conclusion.- 29.4 Discussion.- References.- 30 Polytetrafluoroethylene Repair of Incisional Hernia: Development and Results.- 30.1 Introduction.- 30.2 Physical Modification.- 30.3 Macroscopic Structural Modification.- 30.3 Microscopic Structural Modification.- 30.5 Chemical Modification.- 30.6 Double-Layer Principle.- 30.7 Future Developments.- 30.8 Conclusion.- 30.9 Discussion.- References.- 31 Plastic Reconstruction of Abdominal Wall Defects.- 31.1 Introduction.- 31.2 Material and Methods.- 31.3 Results.- 31.4 Conclusion.- 31.5 Discussion.- References.- VIII Recurrent Inguinal Hernia.- Suture Repair.- 32 Experience of the Shouldice Clinic in Recurrent Inguinal Hernia Repair.- 32.1 Introduction.- 32.2 Background (Past).- 32.3 Background (Present).- 32.4 Conclusion.- 32.5 Discussion.- References.- 33 Shouldice Repair for Recurrent Inguinal Hernia — A Ten-Year Follow-Up.- 33.1 Introduction.- 33.2 Patients and Methods.- 33.3 Results.- 33.4 Conclusion.- 33.5 Discussion.- References.- 34 Suture Repair of Recurrent Inguinal Hernia — A Review of the Literature.- 34.1 Introduction.- 34.2 Results of the Open Approach.- 34.2.1 Bassini Technique.- 34.2.2 McVay Procedure.- 34.2.3 Transversalis Repair.- 34.2.4 Shouldice Technique.- 34.2.5 Lichtenstein Technique.- 34.2.6 Mesh Plug.- 34.2.7 Preperitoneal Mesh Layer Using the Inguinal Approach (Transinguinal Preperitoneal Prosthesis/Rives Procedure).- 34.2.8 Preperitoneal Mesh Layer Using the Extrainguinal Approach (Wantz Technique).- 34.2.9 Stoppa Procedure.- 34.3 Conclusion.- 34.4 Discussion.- References.- 35 Causes and Treatment of Recurrent Inguinal Hernias.- 35.1 Treatment.- 35.2 Technique.- 35.3 Discussion.- References.- 36 European Experience with the Lichtenstein Repair for Recurrent Inguinal Hernia.- 36.1 Introduction.- 36.2 Lichtenstein Plug Operation.- 36.3 Lichtenstein Patch Repair.- 36.4 Conclusion.- 36.5 Discussion.- 36.4 References.- 37 Transinguinal Preperitoneal Prosthesis Placement Under Local Anesthesia — Management and Follow-Up of 100 Patients.- 37.1 Development and Technique.- 37.2 Local Anesthesia.- 37.3 Patients.- 37.4 Results.- 37.5 Comments.- 37.6 Discussion.- References.- 38 Experience with the Mesh Umbrella Repair of Recurrent Inguinal Hernia.- 38.1 Introduction.- 38.2 Personal Experience.- 38.2.1 Case Rate.- 38.2.2 Perioperative Patient Management.- 38.2.3 Indication.- 38.2.4 Methodology.- 38.2.5 Results.- 38.2.6 Comparison of Conventional Shouldice Versus the Flatt Netting and Mesh Umbrella Techniques.- 38.3 Conclusion.- 38.4 Discussion.- 39 Prosthetic Repair of Recurrent Groin Hernias.- 39.1 Introduction.- 39.2 Treatment.- 39.3 Results.- 39.4 Discussion.- References.- 40 Indications and Results of Open Preperitoneal Mesh Repair for Recurrent Groin Hernia.- 40.1 Introduction.- 40.2 Patients and Methods.- 40.3 Results.- 40.4 Techniques.- 40.5 Comments.- 40.6 Discussions.- References.- Laparoscopic and Endoscopic Techniques.- 41 Laparoscopic Treatment of Recurrent Hernias.- 41.1 Introduction.- 41.2 Evolution of the Preperitoneal Approach.- 41.3 Causes of Recurrence After Anterior Herniorrhaphy.- 41.3.1 Indirect Recurrence.- 41.3.2 Direct Recurrence.- 41.3.3 Femoral Recurrence.- 41.4 Causes of Recurrence After Open or Laparoscopic Preperitoneal Herniorrhaphy.- 41.4.1 Incomplete Dissection.- 41.4.2 Inadequate Mesh Size.- 41.4.3 Inadequate Overlap.- 41.4.4 Mesh Slitting.- 41.4.5 Missed Hernias.- 41.4.6 Mesh Displacement.- 41.5 Transabdominal Preperitoneal Repair (TAPP).- 41.6 Totally Extraperitoneal Repair (TEP.- 41.7 Comments.- 41.8 Conclusion.- 41.9 Discussion.- References.- 42 Endoscopic Repair: Totally Endoscopic Preperitoneal Prosthesis in Recurrent Inguinal Hernia.- 42.1 Aarberg’s Strategy for Inguinal Hernia Repair.- 42.2 Operative Technique.- 42.3 Aarberg’s Results.- 41.9 Conclusion.- 41.9 Discussion.- References.- IX Pitfalls,Complications and Quality Control.- 43 Complications of the Suture Repair of Incisional Hernia.- 43.1 Introduction.- 43.2 Scar.- 43.3 Buttonhole Herniation.- 43.4 Incisional Herniation After Resection of Abdominal Aortic Aneurysm.- 43.5 Personal Observations.- 43.6 Supporting Data.- 43.7 Congenital and Genetic Influences.- 43.8 Tissue Reinforcement.- 43.9 Plastic Reinforcement.- 43.10 Summary.- 43.11 Discussion.- References.- 44 Pitfalls and Complications in Open Recurrent Hernia Repair.- 44.1 Clinical Setting.- 44.2 Surgical Setting.- 44.3 Complications.- 44.3.1 Organ Involvement.- 44.3.2 Infections.- 44.3.3 Prostheses.- 44.3.4 Recurrences.- 44.4 Conclusion.- 44.5 Discussion.- References.- 45 Complications of the Laparoscopic-Endoscopic Approach in Recurrent Inguinal Hernia Repair.- 45.1 Methods of Repair.- 45.2 Results.- 45.3 Repair of Recurrences.- 45.4 Comments.- 45.5 Discussions.- References.- 46 Quality Control in Hernia Surgery: The Swedish Experience.- 46.1 Recurrence Rate: Obtaining Information.- 46.2 The Swedish Hernia Register.- 46.3 Register Data and Economics.- 46.4 Register Data and Randomised Controlled Trials.- 46.5 Conclusions.- 46.6 Discussions.- References.- X Conclusion.- 47 Pannel Discussion.- 47.1 Incision.- 47.2 Closure.- 47.3 Suture Bites.- 47.4 Postoperative Activities.- 47.5 Primary Closure of Incisional Hernia.- 47.6 Relaxing Incisions.- 47.7 Mesh Repair for Incisional Hernia.- 47.8 Mesh Fixation.- 47.9 Mesh Material.- 47.10 Bowel Protection.- 47.11 Mesh Migration.- 47.12 Classification.- 47.13 Recurrent Inguinal Hernias.- 47.14 Treatment.- Appendix: Questionnaire.