Kristen E Elstner, MBBS, MS1, John W Read, FRANZCR2, Peter H Cosman, FRACS2, Anita Jacombs, MBBS, PhD1, Omar Rodriguez-Acevedo, MBBS1, Nabeel Ibrahim, FRACS, FACS1. 1Hernia Institute Australia, Edgecliff, Australia, 2Macquarie University Hospital, Sydney, Australia
INTRODUCTION: Despite recent advances in the operative management of complex ventral hernia, these remain a significant challenge for surgeons. Ten percent of hernias are ‘complex’, and although there is variation in what defines a complex hernia, they are invariably time consuming and technically challenging. Closure of large defects in the unprepared abdomen can have serious pathophysiological consequences due to chronic contraction and retraction of the lateral abdominal wall muscles. In certain clinical situations and patient populations, high rates of hernia recurrence remain problematic. Adequate preoperative preparation of patients is essential for an effective repair.
METHODS: An illustrative series of clinical cases will be used to provide an introduction to the preoperative preparation of patients prior to repair of complex ventral hernia. The Hernia Program consists of a comprehensive program which can take up to six months to adequately prepare a patient for surgery. It utilizes a multidisciplinary team setting, consisting of surgeons, radiologists, nursing staff, counsellors, and microbiologists. Weight loss, smoking cessation, preoperative imaging, optimization of co-morbidities, and psychological assessment are all cornerstones of the Hernia Program. Preoperative ultrasound-guided Botulinum Toxin A (BTA) injections to the lateral abdominal wall muscles is a unique feature of this Program, as is the use of Preoperative Progressive Pneumoperitoneum (PPP) in select patients.
RESULTS: Since 2013, 50 patients have progressed successfully through the Hernia Program. A thorough exploration of the preoperative preparation of patients will be presented, including a detailed examination of the BTA and PPP components of the Program. All 50 patients have undergone successful laparoscopic or laparoscopic-open-laparoscopic (hybrid) mesh hernia repair, including fascial closure. There have been no hernia recurrences to date.
CONCLUSION: The Hernia Institute Australia’s comprehensive Program is a unique, effective, and successful program to preoperatively prepare patients for ventral hernia surgery for laparoscopic repair of complex ventral hernia. The Program’s results thus far offer outstanding potential as a new standard of care for complex ventral hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80065
Program Number: P039
Presentation Session: Poster (Non CME)
Presentation Type: Poster