Emerging Concepts in the Minimal Access Repair of Abdominal Wall Hernia—a Narrative Review
Indian Journal of Surgery - Trang 1-9 - 2021
Tóm tắt
Hernia is a ubiquitous patho-anatomical surgical entity that a surgeon encounters and treats employing various methods and following certain principles to affect a durable repair. In recent years, the increasing understanding of the bio-physiology and mechanics of the abdominal wall coupled with innovations in surgical technique and evolution of novel procedures has created a sphere of reconstructive surgery wherein large complex hernias can be treated. There are various technical factors pertaining to a hernia repair including the surgical approach, extent and plane of dissection, the use of component separation, and placement of the mesh which needs to be addressed to bring about an optimum result. Complex hernias with loss of domain pose a challenge wherein an abdominal wall repair surgeon is tasked to bring about a tissue-based reconstruction with prosthetic reinforcement utilizing the now available various pre-operative tissue expansion techniques followed by a myofascial advancement procedure. With the advent and adoption of minimal invasive surgery, such procedures can be effectively undertaken in centers with available expertise. Similarly, groin hernias are now treated using a laparo-endoscopic approach. The modern abdominal wall repair surgeon should have in his armamentarium the knowledge and skill to effectively carry out a hernia repair with minimum morbidity but without affecting the durability or compromising the basic underlying principles. In this review, we endeavor to address these relevant issues so that an informed decision making for the accomplishment of a safe hernia surgery can be taken.
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