CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28/29 OTTOBRE Dott. P. Riccio

CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28/29 OTTOBREDott. P. RiccioOspedale S.Maria della Scaletta Imola (BO)U.O. Chirurgia Generale Dir. S. Artuso

CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBREUS: 2 Millions of laparotomies per yearIncisional hernia rate: 3-20 %90000 ventral hernia annuallyFactors associated with formation of incisional hernia:WOUND INFECTIONIMMUNOSUPPRESSIONMORBID OBESITYPREVIOUS OPERATIONPROSTATISMSURGERY FOR ANEURYSMAL DISEASEAbdominal wall defects are typically observed within the first 5 years

CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE

HERNIA REPAIR METHODRECURRENCEPRIMARY REPAIR WITH SUTURE41-52 %HERNIORRHAPHIES WITH PROSTHETIC MESH. 12-24%Required dissection of wide areas of soft tissue with increased incidence of wound infections and wound-related complications15 %

CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE MINIMALLY INVASIVE SURGERY:

SHORTER HOSPITAL STAYIMPROVED PATIENTS OUTCOMEFEWER COMPLICATION


OUTCOMESComplications 112 (13.2%)Recurrence 35 (4.7%)Conversion to open technique 31 (4.6%)

CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRECOMPLICATIONS

CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRERECURRENCE


OUTCOMES 39 ptComplications 10 (25.6%)Recurrence 3 (7.7%)Conversion to open technique 1 (2.5%)Operating time 161.8Hospital stay 5.1

Recent experience of laparoscopic incisional and ventral hernia repair (LVIHR): good results give value to the procedureP. Riccio, G. Vetrone, S. Artuso

Imola, 2005 apr 2010CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE


Patient Characteristics (147)Male/Female51/96Age (y)61.7 (15-88)Body mass index 28.8 (18-45)ASA classification2.1 (1-3)Previous open hernia repair18 (12.2%)Max diameter size (cm)8.4 (2-28)Operating time (min)97.5 (25-240)Postoperative hospital stay (d)4.8 (1-27)Associated procedures6 (5 laparoscopic cholecistectomy, 1 inguinal hernia)


Type of defect (1)Laparoscopic Incisional Hernia Repair - LIHR (111) Median laparotomies: 94 Lateral: 14Left side 3Mc Burney 2Subcostal 8Right Pararectal 1 Parastomal 3 Laparoscopic Ventral Hernia Repair - LVHR (36) Umbilical hernia 20 Epigastric hernia 16


Type of defect (3)Chevrel classificationSmall ( 10 cm)53 (36.1)

Type of defect (2)ABDOMINAL BORDER (25) Subxiphoidal 4Suprapubic 13Subcostal 8

Type of defect (4)Swess-Cheese26 (17.6%)


Type of ProsthesisSEPRAMESH7 (4.8%)DYNA-MESH5 (3.4)PARIETEX2 (1.4)COMPOSIX33 (22.4%)PROCEED97 (66%)PROLENE3 (2%)


Type of fixationABSORBABLE TACK38 (25.9%)NON ABSORBABLE TACK109 (74.1%)

Ann Surg 2003CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE

OUTCOMES (147)Complications 25 (17%)Recurrence 10 (6.8%)Conversion to open technique 4 (2.7%)

OUTCOMES (805 pt)Complications 112 (13.2%)Recurrence 35 (4.7%)Conversion to open technique 31 (4.6%)


COMPLICATIONS (19)Prolonged seroma (> 8 wk)6 (4%)Prolonged ileus6 (4%)Prolonged pain (> 6 months)4 (2.7%)Pulmunary Embolism 1 (0.6%)Myocardial Infarction1 (0.6%)Pneumonia + wound infection1 (0.6%)Wound infection1 (0.6%)RE-OPERATION (5)Intestinal injury (2 ileus, 1 colon)3 (2%)Postoperative bleeding1 (0.6%)Trocar site erniation1 (0.6%)TOTAL25 (17%)


RECURRENCE 10 (6.8%)Time to recurrence (days): 537 (31-1517)Treatment of recurrence:Laparoscopic repair 2 Open repair 3No repair 5 (small, asypmtomatic)


CONVERSION TO OPEN TECHNIQUE 4 (2.7%)Severity of adhesions 3 (2%)Complete prosthesis detachment 1 (0.6%)

%CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28-29 OTTOBRE

YEARNBMI > 30ASA 3AgeChevrel >=10Duration of surgeryPost-operative hospital stayComplicationsRe-operationConversion to open techniqueRecurrence20053015 (50%)11 (36,7%)63,813 (43,3%)1105,23 (10%)1 (3.3%)1(3.5%)4 (14%)2006326 (18,8%)8 (25%)60,15 (15,5%)875,17 (21%)2 (6%)1(3.1%)3 (9%)2007191(5,9%)2 (10,5%)63,16 (31,5%)984,34 (21%)1 (5%)0020082414 (58,3%)11 (45,8%)6513 (54,2%)994,93 (12.5%)01 (4%)3(12.5%)2009-20104215 (35,5%)8 (19%)5816 (38%)944,48 (19%)1 (2.3%)1 (3.1%)0


Complications (25)PRecurrence (10)PConversione (4)PIncisional (111)21 (19.1)0.279 (8.1%)0.273 (2.7)0.981Ventral (36)4 (11.1)1 (2.8%)1 (2.8)Year >= 2009 (42)8 (19.5)0.63200.0381 (2.4)0.87Year < 2009 (105)17 (16.2)10 (9.5%)3 (2.9)BMI > =30 (51)7 (14)0.793 (5.9%)0.762 (3.9)0618BMI < 30 (83)13 (15.7)6 (7.2%)2 (2.4)ASA 3 (40)8 (20)0.55 (12.5%)0.100.211ASA 1-2 (112)16 (15.4)5 (4.8%)4 (3.8)SWISS-CHEESE (26)6 (24)0.3162 (7.7%)0.841 (3.8)0.7No SWISS-CHEESE (121)19 (15.7)6 (6.6%)3 (2.5)Previous repair (18)1 (5.9)0.193 (16.7)0.071 (5.6)0.4No previous repair (129)24 (18.6)7 (5.4)3 (2.3)Chevrel large (53)10 (19.2)0.596 (11.3)0.072 (3.8)0.64Chevrel small-medium (94)13 (15.7)3 (3.6)2 (2.4)Abdominal border (25)6 (24)0.312 (8)0.791 (4)0.66NO abdominal border (122)19 (15.7)8 (6.6)3 (2.5)Fixation with absorbable tack (38)6 (15.8)0.81 (2.6)0.23600.231Fixation with NON absorbable tack (109)19 (17.6)9 (8.3)4 (3.7)


Timing (min)PDegenza post-op (day)PMax diameter defect size (cm)PComplications (25)1140.0570.008.40.9NO Complications (121)944.38.3No recurrence (137)950.074.80.98.20.09Recurrence (10)1204.810.2NO Conversion (143)950.034.60.008.30.3Conversion (4)15710.510.5Year >= 2009 (42)940.64.90.48.50.8Year < 2009 (105)984.48.3BMI > =30 (51)1070.075.20.48.70.7BMI < 30 (83)934.78.3ASA 3 (40)1120.015.80.028.90.9ASA 1-2 (112)924.48.3No SWISS-CHEESE (121)920.004.70.37.60.00SWISS-CHEESE (26)1235.411.6Previous repair (18)1060.34.70.98.30.8No Previous repair (129)964.88.4Chevrel large (53)1150.005.10.412.30.00Chevrel small-medium (94)884.65.9Abdominal border (25)1090.095.50.27110.00NO abdominal border (122)954.67.8

CHIRURGIA LAPAROSCOPICA DEI LAPAROCELI - IMOLA 28/29 OTTOBRE Dott. P. Riccio

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