E-Book Description
Hernia Surgery 1st Edition PDF Free Download
All the latest trends and technical innovations for both routine and complex hernia repair
Surgical procedures to repair hernias are among the most common procedures of all, with a history going back over 200 years. While most procedures are routine, they can be a challenge, particularly when previous surgery in the area has caused scarring that distorts the anatomy.
All currently established operative techniques are described and explained in detail in the book and illustrated, step by step, with a wealth of brilliant figures and diagrams. A detailed description of laparoscopic anatomy and preperitoneal procedures is given. Important information regarding indications and postoperative care is provided.
New surgical treatment concepts for hernia arising in the early 21st century and expounded in this book include tension-free principles, inguinal hernia repair under local anesthesia, use of the preperitoneal space, and laparoscopic hernia repair.
Key Features
3D mesh and patch-and-plug procedures
Laparoscopic methods such as the single-port technique and mini-technique
New developments in open and laparoscopic surgery of incisional hernias
Special disorders such as sports hernia
Richly illustrated with hundreds of exquisite artist renderings
Ideal for all surgeons in training, and of benefit to experienced surgeons as well, Schumpelick’s Hernia Surgery is a complete introduction to evidence-based techniques in this field.
Table of Contents
1.1 Anatomy of the Anterior
Abdominal Wall 2
Andreas Prescher and Werner Lierse (†)
1.1.1 Muscles of the Abdominal Wall . 2
The Rectus Abdominis Muscle . 2
The External Oblique Muscle 4
The Internal Oblique Muscle . 6
The Transversus Abdominis Muscle . 7
1.1.2 Fasciae and Fascial Structures8
Subcutaneous (Camper) Fascia or Fatty Layer
of the Abdomen 8
Superficial Abdominal Fascia (Scarpa fascia) or
Membranous Layer of the Abdomen 8
The Rectus Sheath9
The Linea Alba . 9
The Transversalis Fascia. 10
Peritoneum . 13
Inguinal Ligament14
Inguinal Falx (Conjoint Tendon)15
Interfoveolar Ligament (of Hesselbach)15
1.1.3 Anatomical Regions and Hernial
Orifices. 15
Inguinal Canal with Superficial and Deep
Inguinal Rings . 15
Muscular Lacuna. 18
Vascular Lacuna and Femoral Ring 18
The Inguinofemoral Region 18
1.1.4 Laparoscopic Anatomy 23
1.2 Definition and Terminology 24
Volker Schumpelick
1.2.1 Hernia 24
1.2.2 Structure of a Hernia 24
1.2.3 Hernia Disease 24
1.2.4 Incarceration 26
1.2.5 Hernia Location. 26
1.3 Diagnosis . 30
Son Truong Ngoc and Marcel Binnebösel
1.3.1 History. 30
1.3.2 Examination 30
1.3.3 Differential Diagnosis . 31
1.3.4 Investigations. 31
Plain X-Ray of the Abdomen . 31
Gastrointestinal or Colon Imaging with
Water-Soluble Contrast Agent 31
Herniography (Peritoneography) . 31
Computed Tomography, Magnetic
Resonance Imaging . 31
1.3.5 Ultrasonography 32
Equipment and Examination Technique . 32
Ultrasonographic Hernia Criteria . 32
Ultrasonographic Differential Diagnosis of
Pathological Findings in the Abdominal Wall
and Groin. 35
1.3.6 Doppler Ultrasonography, Duplex
Ultrasonography 36
1.4 The History of Hernia Surgery 37
Volker Schumpelick
1.4.1 Definition, Anatomy, and
Pathogenesis 37
1.4.2 Conservative Treatment. 39
1.4.3 Surgery. 39
1.5 Repair Principles and Materials. 46
Uwe Klinge and Matthias Pross
1.5.1 Choice of Procedure. 46
The Patient46
Hernia Type. 46
Operation Techniques . 47
1.5.2 Principles for Choice of Procedure 47
1.5.3 Basic Hernia Repair Procedures 48
Inguinal Hernias . 48
Abdominal Wall 48
1.5.4 Materials . 52
Uwe Klinge and Bernd Klosterhalfen
1.6 Hernia Biomechanics . 54
Christian Hollinsky
1.6.1 Introduction 54
Muscle Forces in the Abdominal Wall. 54
Linea Alba. 55
1.6.2 Mechanics of Hernia Surgery with Mesh
Reinforcement 55
Material Properties of Hernia Meshes. 55
Prosthesis Overlapping 55
Bulging . 57
Fixation of Plastics . 58
1.7 Biological Meshes 58
Dirk Weyhe
1.7.1 Introduction and Basic Principles 58
1.7.2 Biomechanical Principle of Mesh
Augmentation 58
1.7.3 Biological Materials. 58
Biological Cross-Linked and Non-Cross-Linked
Membranes (Collagenase Resistance) . 58
1.7.4 Indications and Complications of Biological
Membranes. 59
1.8 Anesthesia 60
Ekkehard Schippers
1.8.1 General Anesthesia 60
1.8.2 Epidural and Spinal Anesthesia 60
1.8.3 Local Anesthesia 60
Local Anesthesia Technique 61
1.9 Pediatric Hernia 65
Gerhard Steinau
1.9.1 Indication. 65
1.9.2 Preparation for Operation . 65
1.9.3 Special Risks and Informed Consent 65
1.9.4 Anesthesia 65
1.9.5 Position. 65
1.9.6 Access 65
1.9.7 Relevant Anatomy, Dangers, and Tricks. 65
1.9.8 Management of Special Complications. 65
1.9.9 Postoperative Care 65
1.9.10 Operation Techniques. 65
Inguinal Hernia Operation in Boys . 65
Hydrocele. 70
Inguinal Hernia Surgery in Girls70
Inguinal Testis . 73
1.9.11 Laparoscopy 77
2 Adult Inguinal Hernia 86
2.1 Indications and Choice of Procedure . 86
Volker Schumpelick
2.1.1 Indications . 86
Choice of Procedure86
2.2 Open Suture Techniques 87
2.2.1 Approach and Dissection 87
Volker Schumpelick
Indication. 87
Operation Preparation 87
Special Risks, Informed Consent87
Anesthesia 87
Position . 87
Access87
Relevant Anatomy, Dangers, and Tricks87
Management of Special Complications87
Postoperative Management 87
Operation Techniques . 87
2.2.2 Hernia Repair. 96
Bassini Repair 96
Volker Schumpelick
The Zimmerman Repair. 101
Karsten Junge
Minimal Repair Technique . 104
Ulrike Muschaweck and Christoph Peter
Schuhmacher
Shouldice Repair. 107
Volker Schumpelick and Andreas Tittel
Lotheissen/McVay Repair114
Karsten Junge
2.3 Open Mesh Techniques 117
2.3.1 Lichtenstein Repair 117
Georg Arlt
Repair Principle 117
Indication. 118
Operation Techniques . 118
2.3.2 Transinguinal Preperitoneal Patch 121
Volker Schumpelick, Ralph Lorenz, and
Andreas Koch
Repair Principle 121
Indication. 121
Operation Techniques . 121
2.3.3 Nyhus Repair with Mesh 127
Georg Arlt
Repair Principle 127
Indications127
Operation Techniques . 127
2.3.4 The Stoppa/Wantz Procedure 132
Volker Schumpelick
Indications133
Contraindications133
Material . 133
Preparation133
Anesthesia 133
Position . 133
Postoperative Care . 133
Operation Techniques . 133
2.3.5 Three-dimensional Mesh Procedures. 144
Tim Tollens and Ralph Lorenz
Introduction and History: The Gilbert
Technique with the Prolene Hernia System/
Ultrapro Hernia System. 144
Operation Techniques . 144
Summary . 146
2.3.6 Plug and Patch 147
Friedrich-Eckart Isemer
Indications147
Equipment148
Operative Principle . 148
Operation Techniques . 148
2.4 Laparoscopic Techniques150
2.4.1 Transabdominal Preperitoneal Mesh. 150
Reinhard Bittner and Jochen Schwarz
Historical Development. 150
Indications151
Informed Consent, Preoperative Preparation,
Perioperative Management 151
Anesthesia 152
Patient and Operator Position 152
Trocar Choice and Position 152
Pneumoperitoneum Creation 152
Operation Techniques . 153
Learning Curve Results with Simple and
Difficult Hernias . 156
Comparison of TAPP with TEP 157
2.4.2 Totally Extraperitoneal Mesh
Repair (TEP) 157
Andreas Kuthe
Introduction . 157
Operation Techniques . 157
Special Aspects 161
Results 163
TEP: Indications and Contraindications164
2.4.3 Minitechnique 165
Henning Niebuhr
Introduction . 165
Instruments . 165
Operation techniques . 165
3 Special Hernias 172
3.1 Female Hernias . 172
Georg Arlt
3.1.1 Operation Tactics172
3.1.2 Operation Techniques . 172
3.2 Sportsman’s Groin174
Ulrike Muschaweck and Christoph Peter
Schuhmacher
3.2.1 History. 174
3.2.2 Diagnosis. 175
Clinical Examination 175
Ultrasonography. 175
Magnetic Resonance Imaging and Computed
Tomography . 175
Herniography 176
3.2.3 Treatment 176
3.2.4 Summary. 176
3.3 Sliding Hernia 177
Volker Schumpelick
3.4 Recurrent Hernia. 180
Karsten Junge
3.4.1 General Remarks/Epidemiology . 180
3.4.2 Risk Factors. 180
3.4.3 Forms and Location. 181
3.4.4 Choice of Procedure. 184
3.4.5 Preparation. 185
3.4.6 Dissection and Repair. 186
3.4.7 Complications 186
3.5 Umbilical Hernia . 187
Ulla Volmer and Georg Arlt
3.5.1 Epidemiology and Pathogenesis . 187
3.5.2 Diagnosis and Classification . 187
3.5.3 Indications 187
3.5.4 Complications 187
3.5.5 Operation Technique 187
Spitzy Repair189
Preperitoneal Umbilical Mesh
Plasty . 189
3.6 Femoral Hernia 192
Volker Schumpelick
3.6.1 Basic Principles. 192
General Remarks. 192
The Hernial Orifice . 192
Pathogenesis192
Diagnosis. 193
3.6.2 Indications 193
3.6.3 Preparation, Anesthesia, and Positioning 193
3.6.4 Operation Tactics 193
3.6.5 Forms of Repair. 194
Crural Access 194
Inguinal Access 194
Preperitoneal Access 197
3.6.6 Operation Techniques. 197
Crural Access 197
Inguinal Access 201
Alloplastic Repair 208
3.7 Rare Hernias . 208
Christian Peiper and Ralph Lorenz
3.7.1 Lumbar Hernia 208
Location 208
Symptoms. 208
Operation Techniques . 208
3.7.2 Supravesical Hernia. 209
Location 209
Symptoms. 210
Operation Techniques . 210
3.7.3 Obturator Hernia 210
Location 210
Symptoms. 210
Operation Techniques . 212
3.7.4 Sciatic Hernia. 212
Location 212
Symptoms. 212
Operation Techniques . 213
3.7.5 Perineal Hernia . 213
Location 213
Symptoms 213
Operation Techniques. 215
3.7.6 Interparietal Hernias 215
Location 215
Symptoms215
Operation Techniques . 215
3.8 Spigelian Hernia 217
Marc Miserez
3.8.1 Definition, Anatomy, and Incidence 217
3.8.2 Diagnosis and Choice of Procedure. 217
3.8.3 Results and Complications. 217
3.8.4 Operation Techniques. 217
3.9 Internal Hernias 223
Volker Schumpelick and Uwe Klinge
3.9.1 Anatomy 223
3.9.2 Incidence. 223
3.9.3 Diagnosis. 223
3.9.4 Indications 229
3.9.5 Anesthesia 229
3.9.6 Position. 229
3.9.7 Access 229
3.9.8 Complications 229
3.9.9 Results . 229
3.9.10 Operation Techniques. 229
4 Incisional Hernias234
4.1 General Principles. 234
Joachim Conze
4.1.1 Definition 234
4.1.2 Diagnosis. 234
4.1.3 Classification . 234
4.1.4 Indications . 234
4.1.5 Preoperative Preparation and Informed
Consent 234
4.1.6 Anesthesia234
4.1.7 Position 234
4.1.8 Operation Tactics234
4.1.9 Perioperative Management 235
4.2 Open Technique 235
4.2.1 Open Sublay (Retromuscular
Augmentation). 235
Joachim Conze
Operation Techniques . 236
Relevant Anatomy, Dangers, and Tricks243
Management of Special Complications243
Postoperative Care . 243
4.2.2 Open Onlay (Epifascial Mesh
Augmentation) 243
Joachim Conze
Operation Techniques . 243
Relevant Anatomy, Dangers, and Tricks 246
Management of Special Complications 246
Postoperative Care246
4.2.3 Open Intraperitoneal Onlay Mesh
Technique 246
Frank P. Müller
Introduction 246
Operation Techniques . 247
Advantages and Disadvantages . 251
Summary. 251
4.3 Laparoscopic Repair of Incisional
Hernias . 252
4.3.1 General Principles . 252
Dieter Berger
Indications253
Contraindications253
Operation Techniques . 253
Postoperative Care . 258
Unanswered Questions 258
Summary . 258
4.3.2 Endoscopic Totally Extraperitoneal
Transhernial Sublay Ventral Hernia Repair
using the Single-Port Technique 258
Wolfgang Reinpold
Indications259
Operation Preparation 259
Special Risks, Informed Consent259
Anesthesia 259
Position . 259
Access259
Relevant Anatomy, Dangers, and Tricks259
Management of Special Complications259
Postoperative Care . 259
Operation Techniques . 259
4.3.3 Laparoscopic Repair of Parastomal Hernias. 261
Dieter Berger
Keyhole Technique. 261
Sugarbaker Technique . 262
Sandwich Technique 262
Postoperative Care . 264
Limits of the Laparoscopic Technique. 264
Summary . 264
4.3.4 Open Repair of Parastomal Hernias 264
Ulrich Andreas Dietz
Indications265
Operation Preparation 265
Special Risks, Informed Consent265
Anesthesia 265
Positioning265
Operation Technique 1: Retromuscular
Mesh Position . 265
The Sugarbaker Intraperitoneal Mesh
Operation Technique 269
Postoperative Care . 272
4.3.5 Preoperative Progressive
Pneumoperitoneum 272
Stefan Willis
Physiological Basis. 272
Indications272
Contraindications272
Technique. 273
Complications . 275
Results 275
Conclusion275
4.3.6 Giant Incisional Hernia. 275
Joachim Conze and Volker Schumpelick
Diagnosis. 275
Indications275
Preoperative Preparation and Informed
Consent . 276
Anesthesia 276
Position . 276
Operation Tactics. 276
Perioperative Management 277
Repair Techniques277
Postoperative Care . 281
4.3.7 Posterior Component Separation
According to Rosen. 281
Wolfgang Reinpold
Indications282
Diagnosis and Operation Preparation . 282
Special Risks, Informed Consent282
Anesthesia 282
Position . 282
Access282
Operation Steps 282
Relevant Anatomy, Dangers, and Tricks283
Management of Special Complications283
Postoperative Care . 284
Summary . 284
4.3.8 Anterior Component Separation
According to Ramirez 285
Michael Stumpf
Basis285
Indications285
Operation Techniques . 285
4.3.9 Endoscopic Component Separation 287
Wolfgang Reinpold
Indications287
Diagnosis and Operation Preparation . 287
Special Risks, Informed Consent287
Anesthesia 288
Position . 288
Access288
Operation Steps 288
Relevant Anatomy, Dangers, Tricks 290
Management of Special Complications290
Postoperative Care . 290
4.3.10 Laparostomy Hernias 290
Joachim Conze
Treatment. 290
Summary . 292
4.4 Abdominal Wall Tumors. 292
Filip Muysoms and Joachim Conze
4.4.1 Epidemiology . 292
4.4.2 Clinical Symptoms . 292
4.4.3 Diagnosis. 293
Diagnostic Imaging 293
Differential Diagnosis . 293
Pathological Diagnosis 293
4.4.4 Treatment 294
Conservative 294
Surgical . 295
Adjuvant Therapy295
4.4.5 Prognosis. 295
4.5 Prevention of Incisional Hernias295
René H. Fortelny
4.5.1 Abdominal Wall Closure
Techniques 296
Dissection of the Linea Alba . 296
Closure . 296
4.5.2 Indications for Prophylactic Mesh
Reinforcement 298
4.5.3 Prophylactic Mesh Reinforcement
Operation Procedure 299
Initial Dissection of the Linea Alba 299
Operation Procedure: Onlay Mesh 299
Operation Procedure: Sublay Mesh . 299
4.5.4 Postoperative Management 299
5 Complications . 306
5.1 Infection . 306
Bernhard J. Lammers
5.1.1 Introduction 306
5.1.2 Definition 307
5.1.3 Infections in Inguinal Hernia Surgery . 307
5.1.4 Infections in Incisional Hernia Surgery 307
5.1.5 Prevention of Wound Infections 308
5.1.6 Treatment of Wound and Mesh
Infections in Hernia Surgery . 308
5.2 Incarceration310
Bernd Stechemesser
5.2.1 Etiology 310
5.2.2 Clinical Features310
5.2.3 Diagnosis. 310
5.2.4 Treatment310
5.2.5 Incarceration Rates and Risk . 311
5.3 Postoperative Pain. 311
Georg Arlt
5.3.1 Acute Postoperative Pain . 311
5.3.2 Chronic Postoperative Pain after Inguinal
and Femoral Hernia Operation. 312
5.4 Triple Neurectomy314
Georg Arlt
5.4.1 Diagnosis. 314
5.4.2 Indications 316
5.4.3 Operation Techniques. 316
5.4.4 Results . 316
6 Miscellaneous . 320
6.1 Training in Hernia Surgery: Hernia
Compact—Young Surgery as a
3-Day Further Education Course. 320
Ralph Lorenz, Bernd Stechemesser, and
Wolfgang Reinpold
6.2 Hernia Register: Outcome Research in
Hernia Surgery . 320
Ferdinand Köckerling, Dietmar Jacob,
Christine Schug-Paß
6.2.1 Patient Data and Methodology . 321
Project 321
Informed Consent321
Recording of Clinical Data . 321
Data Protection 322
Data Retrieval 323
Follow-up. 323
Hernia Surgery 1st Edition PDF Ebook
Abdominal Wall 2
Andreas Prescher and Werner Lierse (†)
1.1.1 Muscles of the Abdominal Wall . 2
The Rectus Abdominis Muscle . 2
The External Oblique Muscle 4
The Internal Oblique Muscle . 6
The Transversus Abdominis Muscle . 7
1.1.2 Fasciae and Fascial Structures8
Subcutaneous (Camper) Fascia or Fatty Layer
of the Abdomen 8
Superficial Abdominal Fascia (Scarpa fascia) or
Membranous Layer of the Abdomen 8
The Rectus Sheath9
The Linea Alba . 9
The Transversalis Fascia. 10
Peritoneum . 13
Inguinal Ligament14
Inguinal Falx (Conjoint Tendon)15
Interfoveolar Ligament (of Hesselbach)15
1.1.3 Anatomical Regions and Hernial
Orifices. 15
Inguinal Canal with Superficial and Deep
Inguinal Rings . 15
Muscular Lacuna. 18
Vascular Lacuna and Femoral Ring 18
The Inguinofemoral Region 18
1.1.4 Laparoscopic Anatomy 23
1.2 Definition and Terminology 24
Volker Schumpelick
1.2.1 Hernia 24
1.2.2 Structure of a Hernia 24
1.2.3 Hernia Disease 24
1.2.4 Incarceration 26
1.2.5 Hernia Location. 26
1.3 Diagnosis . 30
Son Truong Ngoc and Marcel Binnebösel
1.3.1 History. 30
1.3.2 Examination 30
1.3.3 Differential Diagnosis . 31
1.3.4 Investigations. 31
Plain X-Ray of the Abdomen . 31
Gastrointestinal or Colon Imaging with
Water-Soluble Contrast Agent 31
Herniography (Peritoneography) . 31
Computed Tomography, Magnetic
Resonance Imaging . 31
1.3.5 Ultrasonography 32
Equipment and Examination Technique . 32
Ultrasonographic Hernia Criteria . 32
Ultrasonographic Differential Diagnosis of
Pathological Findings in the Abdominal Wall
and Groin. 35
1.3.6 Doppler Ultrasonography, Duplex
Ultrasonography 36
1.4 The History of Hernia Surgery 37
Volker Schumpelick
1.4.1 Definition, Anatomy, and
Pathogenesis 37
1.4.2 Conservative Treatment. 39
1.4.3 Surgery. 39
1.5 Repair Principles and Materials. 46
Uwe Klinge and Matthias Pross
1.5.1 Choice of Procedure. 46
The Patient46
Hernia Type. 46
Operation Techniques . 47
1.5.2 Principles for Choice of Procedure 47
1.5.3 Basic Hernia Repair Procedures 48
Inguinal Hernias . 48
Abdominal Wall 48
1.5.4 Materials . 52
Uwe Klinge and Bernd Klosterhalfen
1.6 Hernia Biomechanics . 54
Christian Hollinsky
1.6.1 Introduction 54
Muscle Forces in the Abdominal Wall. 54
Linea Alba. 55
1.6.2 Mechanics of Hernia Surgery with Mesh
Reinforcement 55
Material Properties of Hernia Meshes. 55
Prosthesis Overlapping 55
Bulging . 57
Fixation of Plastics . 58
1.7 Biological Meshes 58
Dirk Weyhe
1.7.1 Introduction and Basic Principles 58
1.7.2 Biomechanical Principle of Mesh
Augmentation 58
1.7.3 Biological Materials. 58
Biological Cross-Linked and Non-Cross-Linked
Membranes (Collagenase Resistance) . 58
1.7.4 Indications and Complications of Biological
Membranes. 59
1.8 Anesthesia 60
Ekkehard Schippers
1.8.1 General Anesthesia 60
1.8.2 Epidural and Spinal Anesthesia 60
1.8.3 Local Anesthesia 60
Local Anesthesia Technique 61
1.9 Pediatric Hernia 65
Gerhard Steinau
1.9.1 Indication. 65
1.9.2 Preparation for Operation . 65
1.9.3 Special Risks and Informed Consent 65
1.9.4 Anesthesia 65
1.9.5 Position. 65
1.9.6 Access 65
1.9.7 Relevant Anatomy, Dangers, and Tricks. 65
1.9.8 Management of Special Complications. 65
1.9.9 Postoperative Care 65
1.9.10 Operation Techniques. 65
Inguinal Hernia Operation in Boys . 65
Hydrocele. 70
Inguinal Hernia Surgery in Girls70
Inguinal Testis . 73
1.9.11 Laparoscopy 77
2 Adult Inguinal Hernia 86
2.1 Indications and Choice of Procedure . 86
Volker Schumpelick
2.1.1 Indications . 86
Choice of Procedure86
2.2 Open Suture Techniques 87
2.2.1 Approach and Dissection 87
Volker Schumpelick
Indication. 87
Operation Preparation 87
Special Risks, Informed Consent87
Anesthesia 87
Position . 87
Access87
Relevant Anatomy, Dangers, and Tricks87
Management of Special Complications87
Postoperative Management 87
Operation Techniques . 87
2.2.2 Hernia Repair. 96
Bassini Repair 96
Volker Schumpelick
The Zimmerman Repair. 101
Karsten Junge
Minimal Repair Technique . 104
Ulrike Muschaweck and Christoph Peter
Schuhmacher
Shouldice Repair. 107
Volker Schumpelick and Andreas Tittel
Lotheissen/McVay Repair114
Karsten Junge
2.3 Open Mesh Techniques 117
2.3.1 Lichtenstein Repair 117
Georg Arlt
Repair Principle 117
Indication. 118
Operation Techniques . 118
2.3.2 Transinguinal Preperitoneal Patch 121
Volker Schumpelick, Ralph Lorenz, and
Andreas Koch
Repair Principle 121
Indication. 121
Operation Techniques . 121
2.3.3 Nyhus Repair with Mesh 127
Georg Arlt
Repair Principle 127
Indications127
Operation Techniques . 127
2.3.4 The Stoppa/Wantz Procedure 132
Volker Schumpelick
Indications133
Contraindications133
Material . 133
Preparation133
Anesthesia 133
Position . 133
Postoperative Care . 133
Operation Techniques . 133
2.3.5 Three-dimensional Mesh Procedures. 144
Tim Tollens and Ralph Lorenz
Introduction and History: The Gilbert
Technique with the Prolene Hernia System/
Ultrapro Hernia System. 144
Operation Techniques . 144
Summary . 146
2.3.6 Plug and Patch 147
Friedrich-Eckart Isemer
Indications147
Equipment148
Operative Principle . 148
Operation Techniques . 148
2.4 Laparoscopic Techniques150
2.4.1 Transabdominal Preperitoneal Mesh. 150
Reinhard Bittner and Jochen Schwarz
Historical Development. 150
Indications151
Informed Consent, Preoperative Preparation,
Perioperative Management 151
Anesthesia 152
Patient and Operator Position 152
Trocar Choice and Position 152
Pneumoperitoneum Creation 152
Operation Techniques . 153
Learning Curve Results with Simple and
Difficult Hernias . 156
Comparison of TAPP with TEP 157
2.4.2 Totally Extraperitoneal Mesh
Repair (TEP) 157
Andreas Kuthe
Introduction . 157
Operation Techniques . 157
Special Aspects 161
Results 163
TEP: Indications and Contraindications164
2.4.3 Minitechnique 165
Henning Niebuhr
Introduction . 165
Instruments . 165
Operation techniques . 165
3 Special Hernias 172
3.1 Female Hernias . 172
Georg Arlt
3.1.1 Operation Tactics172
3.1.2 Operation Techniques . 172
3.2 Sportsman’s Groin174
Ulrike Muschaweck and Christoph Peter
Schuhmacher
3.2.1 History. 174
3.2.2 Diagnosis. 175
Clinical Examination 175
Ultrasonography. 175
Magnetic Resonance Imaging and Computed
Tomography . 175
Herniography 176
3.2.3 Treatment 176
3.2.4 Summary. 176
3.3 Sliding Hernia 177
Volker Schumpelick
3.4 Recurrent Hernia. 180
Karsten Junge
3.4.1 General Remarks/Epidemiology . 180
3.4.2 Risk Factors. 180
3.4.3 Forms and Location. 181
3.4.4 Choice of Procedure. 184
3.4.5 Preparation. 185
3.4.6 Dissection and Repair. 186
3.4.7 Complications 186
3.5 Umbilical Hernia . 187
Ulla Volmer and Georg Arlt
3.5.1 Epidemiology and Pathogenesis . 187
3.5.2 Diagnosis and Classification . 187
3.5.3 Indications 187
3.5.4 Complications 187
3.5.5 Operation Technique 187
Spitzy Repair189
Preperitoneal Umbilical Mesh
Plasty . 189
3.6 Femoral Hernia 192
Volker Schumpelick
3.6.1 Basic Principles. 192
General Remarks. 192
The Hernial Orifice . 192
Pathogenesis192
Diagnosis. 193
3.6.2 Indications 193
3.6.3 Preparation, Anesthesia, and Positioning 193
3.6.4 Operation Tactics 193
3.6.5 Forms of Repair. 194
Crural Access 194
Inguinal Access 194
Preperitoneal Access 197
3.6.6 Operation Techniques. 197
Crural Access 197
Inguinal Access 201
Alloplastic Repair 208
3.7 Rare Hernias . 208
Christian Peiper and Ralph Lorenz
3.7.1 Lumbar Hernia 208
Location 208
Symptoms. 208
Operation Techniques . 208
3.7.2 Supravesical Hernia. 209
Location 209
Symptoms. 210
Operation Techniques . 210
3.7.3 Obturator Hernia 210
Location 210
Symptoms. 210
Operation Techniques . 212
3.7.4 Sciatic Hernia. 212
Location 212
Symptoms. 212
Operation Techniques . 213
3.7.5 Perineal Hernia . 213
Location 213
Symptoms 213
Operation Techniques. 215
3.7.6 Interparietal Hernias 215
Location 215
Symptoms215
Operation Techniques . 215
3.8 Spigelian Hernia 217
Marc Miserez
3.8.1 Definition, Anatomy, and Incidence 217
3.8.2 Diagnosis and Choice of Procedure. 217
3.8.3 Results and Complications. 217
3.8.4 Operation Techniques. 217
3.9 Internal Hernias 223
Volker Schumpelick and Uwe Klinge
3.9.1 Anatomy 223
3.9.2 Incidence. 223
3.9.3 Diagnosis. 223
3.9.4 Indications 229
3.9.5 Anesthesia 229
3.9.6 Position. 229
3.9.7 Access 229
3.9.8 Complications 229
3.9.9 Results . 229
3.9.10 Operation Techniques. 229
4 Incisional Hernias234
4.1 General Principles. 234
Joachim Conze
4.1.1 Definition 234
4.1.2 Diagnosis. 234
4.1.3 Classification . 234
4.1.4 Indications . 234
4.1.5 Preoperative Preparation and Informed
Consent 234
4.1.6 Anesthesia234
4.1.7 Position 234
4.1.8 Operation Tactics234
4.1.9 Perioperative Management 235
4.2 Open Technique 235
4.2.1 Open Sublay (Retromuscular
Augmentation). 235
Joachim Conze
Operation Techniques . 236
Relevant Anatomy, Dangers, and Tricks243
Management of Special Complications243
Postoperative Care . 243
4.2.2 Open Onlay (Epifascial Mesh
Augmentation) 243
Joachim Conze
Operation Techniques . 243
Relevant Anatomy, Dangers, and Tricks 246
Management of Special Complications 246
Postoperative Care246
4.2.3 Open Intraperitoneal Onlay Mesh
Technique 246
Frank P. Müller
Introduction 246
Operation Techniques . 247
Advantages and Disadvantages . 251
Summary. 251
4.3 Laparoscopic Repair of Incisional
Hernias . 252
4.3.1 General Principles . 252
Dieter Berger
Indications253
Contraindications253
Operation Techniques . 253
Postoperative Care . 258
Unanswered Questions 258
Summary . 258
4.3.2 Endoscopic Totally Extraperitoneal
Transhernial Sublay Ventral Hernia Repair
using the Single-Port Technique 258
Wolfgang Reinpold
Indications259
Operation Preparation 259
Special Risks, Informed Consent259
Anesthesia 259
Position . 259
Access259
Relevant Anatomy, Dangers, and Tricks259
Management of Special Complications259
Postoperative Care . 259
Operation Techniques . 259
4.3.3 Laparoscopic Repair of Parastomal Hernias. 261
Dieter Berger
Keyhole Technique. 261
Sugarbaker Technique . 262
Sandwich Technique 262
Postoperative Care . 264
Limits of the Laparoscopic Technique. 264
Summary . 264
4.3.4 Open Repair of Parastomal Hernias 264
Ulrich Andreas Dietz
Indications265
Operation Preparation 265
Special Risks, Informed Consent265
Anesthesia 265
Positioning265
Operation Technique 1: Retromuscular
Mesh Position . 265
The Sugarbaker Intraperitoneal Mesh
Operation Technique 269
Postoperative Care . 272
4.3.5 Preoperative Progressive
Pneumoperitoneum 272
Stefan Willis
Physiological Basis. 272
Indications272
Contraindications272
Technique. 273
Complications . 275
Results 275
Conclusion275
4.3.6 Giant Incisional Hernia. 275
Joachim Conze and Volker Schumpelick
Diagnosis. 275
Indications275
Preoperative Preparation and Informed
Consent . 276
Anesthesia 276
Position . 276
Operation Tactics. 276
Perioperative Management 277
Repair Techniques277
Postoperative Care . 281
4.3.7 Posterior Component Separation
According to Rosen. 281
Wolfgang Reinpold
Indications282
Diagnosis and Operation Preparation . 282
Special Risks, Informed Consent282
Anesthesia 282
Position . 282
Access282
Operation Steps 282
Relevant Anatomy, Dangers, and Tricks283
Management of Special Complications283
Postoperative Care . 284
Summary . 284
4.3.8 Anterior Component Separation
According to Ramirez 285
Michael Stumpf
Basis285
Indications285
Operation Techniques . 285
4.3.9 Endoscopic Component Separation 287
Wolfgang Reinpold
Indications287
Diagnosis and Operation Preparation . 287
Special Risks, Informed Consent287
Anesthesia 288
Position . 288
Access288
Operation Steps 288
Relevant Anatomy, Dangers, Tricks 290
Management of Special Complications290
Postoperative Care . 290
4.3.10 Laparostomy Hernias 290
Joachim Conze
Treatment. 290
Summary . 292
4.4 Abdominal Wall Tumors. 292
Filip Muysoms and Joachim Conze
4.4.1 Epidemiology . 292
4.4.2 Clinical Symptoms . 292
4.4.3 Diagnosis. 293
Diagnostic Imaging 293
Differential Diagnosis . 293
Pathological Diagnosis 293
4.4.4 Treatment 294
Conservative 294
Surgical . 295
Adjuvant Therapy295
4.4.5 Prognosis. 295
4.5 Prevention of Incisional Hernias295
René H. Fortelny
4.5.1 Abdominal Wall Closure
Techniques 296
Dissection of the Linea Alba . 296
Closure . 296
4.5.2 Indications for Prophylactic Mesh
Reinforcement 298
4.5.3 Prophylactic Mesh Reinforcement
Operation Procedure 299
Initial Dissection of the Linea Alba 299
Operation Procedure: Onlay Mesh 299
Operation Procedure: Sublay Mesh . 299
4.5.4 Postoperative Management 299
5 Complications . 306
5.1 Infection . 306
Bernhard J. Lammers
5.1.1 Introduction 306
5.1.2 Definition 307
5.1.3 Infections in Inguinal Hernia Surgery . 307
5.1.4 Infections in Incisional Hernia Surgery 307
5.1.5 Prevention of Wound Infections 308
5.1.6 Treatment of Wound and Mesh
Infections in Hernia Surgery . 308
5.2 Incarceration310
Bernd Stechemesser
5.2.1 Etiology 310
5.2.2 Clinical Features310
5.2.3 Diagnosis. 310
5.2.4 Treatment310
5.2.5 Incarceration Rates and Risk . 311
5.3 Postoperative Pain. 311
Georg Arlt
5.3.1 Acute Postoperative Pain . 311
5.3.2 Chronic Postoperative Pain after Inguinal
and Femoral Hernia Operation. 312
5.4 Triple Neurectomy314
Georg Arlt
5.4.1 Diagnosis. 314
5.4.2 Indications 316
5.4.3 Operation Techniques. 316
5.4.4 Results . 316
6 Miscellaneous . 320
6.1 Training in Hernia Surgery: Hernia
Compact—Young Surgery as a
3-Day Further Education Course. 320
Ralph Lorenz, Bernd Stechemesser, and
Wolfgang Reinpold
6.2 Hernia Register: Outcome Research in
Hernia Surgery . 320
Ferdinand Köckerling, Dietmar Jacob,
Christine Schug-Paß
6.2.1 Patient Data and Methodology . 321
Project 321
Informed Consent321
Recording of Clinical Data . 321
Data Protection 322
Data Retrieval 323
Follow-up. 323
Hernia Surgery 1st Edition PDF Ebook
About the Authors
Volker Schumpelick, MD
Professor Emeritus
Former President European Hernia Society (EHS)
Hamburg, Germany
Georg Arlt, MD
Associate Professor
Department of General, Visceral, and Minimally Invasive Surgery
Park-Klinik Weissensee
Berlin, Germany
Joachim Conze, MD
Associate Professor
UM Hernia Center Dr. Conze
Munich, Germany
Karsten Junge, MD
Professor
Department of General, Visceral, and Minimally Invasive Surgery
Rhein-Maas Klinikum
Würselen, Germany
Professor Emeritus
Former President European Hernia Society (EHS)
Hamburg, Germany
Georg Arlt, MD
Associate Professor
Department of General, Visceral, and Minimally Invasive Surgery
Park-Klinik Weissensee
Berlin, Germany
Joachim Conze, MD
Associate Professor
UM Hernia Center Dr. Conze
Munich, Germany
Karsten Junge, MD
Professor
Department of General, Visceral, and Minimally Invasive Surgery
Rhein-Maas Klinikum
Würselen, Germany
Download Links
